Document Information

This document is the functional design brief for Schneider Electric’s EcoStruxure offer for
Healthcare Projects

This Version

Authored by:

Name: Chris Roberts

Position: Healthcare - Applications and Solutions Architect

th
Date: 6 June 2011

Reviewed by:

Name: Graeme Robertson

Position: Business Development Director Healthcare

th
Date: 13 June 2011

Authorised for issue by:

Name: Chris Roberts

Position: Healthcare - Applications and Solutions Architect

th
Date: 27 July 2011

Version History

Version Date Status Changes Overview

2.0 27/07/2011 For issue Second draft

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Healthcare
Functional Design Brief
This document showcases the use of
Schneider Electric’s solutions for constructing
high performance healthcare buildings.

July 2011

SM Page 2
Make the most of your energy
Functional Design Brief Usage Guidelines

Purpose

This document describes the healthcare infrastructure solution recommended by

Schneider Electric, and describes a selection of capabilities and functionalities from
Schneider Electric, which optimise CapEx and OpEx benefits to healthcare decision
makers, and improves the environment of care for patients.

It is NOT:
o A comprehensive description of all the possible functionalities that Schneider Electric can
deliver in a healthcare facility.
o A detailed technical specification of each technical system Schneider Electric
can deliver.
o A library schematics of the various technical systems Schneider Electric can deliver.
Target readers and users

The target audience includes decision makers at private and public hospitals, as well as
construction companies and engineering consultants. It intends to describe how the
healthcare facility will operate with an EcoStruxure for Healthcare solution from Schneider
Electric and the following long-term benefits:
o improved financial performance
o a welcoming, safe, and secure environment for patients, staff, visitors, and assets
o improved productivity
o improved patient satisfaction
o improved project delivery and reduced project risks
Business use

This document should be used during the initial design phase of a new healthcare
construction project or refurbishment of existing healthcare facilities. It should be used to
facilitate contractual relationships in the design-phase partnership by providing the
client’s functional design brief.

This is a global document. It needs to be adapted locally in each country according to:
o local energy regulations
o local Green building certification
o local standards
o local construction codes
o Schneider Electric products and services available in the country
o alliance and partnership situation in the country

It is a generic document. It needs to be adapted for each project. Adapt the content to
the customer’s business needs, the owner’s design requirements. For example, you might
need to remove and add functions, adapt to the actual equipment of the building, or adapt
to the third-party technical systems.

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Contents
1 INTRODUCTION......................................................................................................... 8
1.1 PRINCIPLES ............................................................................................................. 8
1.1.1 ENERGY EFFICIENCY ............................................................................................ 8
1.1.2 PATIENT SAFETY .................................................................................................. 8
1.1.3 PATIENT ENVIRONMENT ........................................................................................ 8
1.1.4 STAFF PRODUCTIVITY AND RETENTION .................................................................. 8
1.2 OVERVIEW ............................................................................................................... 8
2 INFORMATION AND COMMUNICATION TECHNOLOGY ................................................. 11
2.1 BENEFITS .............................................................................................................. 11
2.1.1 CAPEX COST BENEFITS .................................................................................... 11
2.1.1.1 Cabling, Construction and Network Devices ...................................... 11
2.1.2 OPEX COST BENEFITS ...................................................................................... 11
2.1.2.1 Network Operating Resilience ............................................................ 11
2.1.2.2 Staff Productivity ................................................................................. 12
2.1.2.3 Patient Satisfaction and Safety ........................................................... 12
2.2 DESIGNING THE ICT NETWORK ............................................................................... 12
3 MECHANICAL AND ELECTRICAL SERVICES .............................................................. 15
3.1 PRINCIPLES ........................................................................................................... 15
3.2 ELECTRICAL POWER DISTRIBUTION......................................................................... 15
3.2.1 HOSPITAL CONSTRAINTS AND PAIN POINTS ......................................................... 15
3.2.2 CRITICAL LOADS ................................................................................................ 16
3.2.3 RULES AND STANDARDS SUMMARY ..................................................................... 16
3.2.3.1 Shock Sensitivity ................................................................................. 16
3.2.3.1.1 Group 0 ........................................................................................................................16
3.2.3.1.2 Group 1 ........................................................................................................................16
3.2.3.1.3 Group 2 ........................................................................................................................16
3.2.3.1.4 Criticality Level .............................................................................................................17
3.2.3.1.5 Application of Criticality Levels to Building Care Departments and Utilities ................... 17
3.2.4 ELECTRICAL POWER DISTRIBUTION ..................................................................... 17
3.2.4.1 Electrical Distribution and Power Monitoring Architecture .................. 17
3.2.4.2 Equipment and Software .................................................................... 18
3.2.4.3 Operating and Maintenance Services ................................................. 18
3.2.5 TYPICAL ARCHITECTURE ..................................................................................... 18
3.2.6 KEY ELEMENTS .................................................................................................. 20
3.2.6.1 Utility Incomer and Utility Backup Source ........................................... 20
3.2.6.2 MV Substation and MV Loop Distribution ........................................... 20
3.2.6.3 Backup Power ..................................................................................... 20
3.2.6.4 High-Quality LV Switchboard .............................................................. 20
3.2.6.5 Security Switchboard .......................................................................... 20
3.2.6.6 UPS ..................................................................................................... 21
3.2.6.7 Operating Theatres ............................................................................. 21
3.2.6.8 Operation and Maintenance ............................................................... 21
3.2.6.9 Power Monitoring and Control System ............................................... 21
3.2.7 REQUIREMENTS ................................................................................................. 21
3.2.7.1 The MV Level ...................................................................................... 21
3.2.7.2 The LV Level ....................................................................................... 21
3.3 HEATING, VENTILATION AND AIR CONDITIONING AND W ATER DISTRIBUTION SYSTEM. 22
3.3.1 ENVIRONMENTAL CONTROL ................................................................................ 22
3.3.1.1 Air Conditioning ................................................................................... 22
3.3.1.2 Air Quality ........................................................................................... 24
3.3.1.3 Noise Control ...................................................................................... 24
3.3.1.4 Water Distribution ............................................................................... 24
3.3.1.5 Infection Control, Airborne Contamination .......................................... 25
3.3.1.5.1 Filtration .......................................................................................................................25
3.3.1.5.2 Ultraviolet Lamp System............................................................................................... 25
3.3.1.5.3 Control of Air Movement ............................................................................................... 26
3.3.1.6 Infection Control, Legionella ............................................................... 26

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 3.3.2 HVAC CONTROL AND MONITORING ARCHITECTURE ............................................ 27
3.3.2.1 Distributed Intelligence........................................................................ 27
3.3.2.2 Peer-to-Peer Communications ........................................................... 28
3.3.3 EQUIPMENT AND SOFTWARE ............................................................................... 28
3.3.4 OPERATING AND MAINTENANCE SERVICES .......................................................... 28
4 LIFE SAFETY.......................................................................................................... 29
4.1 FIRE DETECTION .................................................................................................... 29
4.1.1 FIRE SYSTEM ARCHITECTURE ............................................................................. 29
4.1.2 OPEN PROTOCOL ............................................................................................... 29
4.1.3 ANNUNCIATION OF FIRE ...................................................................................... 29
4.1.4 INTEGRATION ..................................................................................................... 29
4.1.4.1 CCTV .................................................................................................. 29
4.1.4.2 Access Control .................................................................................... 30
4.1.4.3 Lighting ............................................................................................... 30
4.1.4.4 Digital Signage .................................................................................... 30
4.1.4.5 Nurses’ Station Display ....................................................................... 30
4.1.5 LIFE CYCLE ........................................................................................................ 30
4.2 PUBLIC ADDRESS / VOICE ANNUNCIATION ............................................................... 30
4.3 DIGITAL SIGNAGE ................................................................................................... 30
4.4 FIRE SUPPRESSION ................................................................................................ 30
4.5 SMOKE CONTROL SYSTEMS ................................................................................... 31
4.6 EMERGENCY LIGHTING ........................................................................................... 31
4.7 DISABLED TOILET AND REFUGE .............................................................................. 31
4.8 ELEVATOR MONITORING AND ALARMS ..................................................................... 31
4.9 W ATER AND GASSES LEAK DETECTION ................................................................... 32
5 SECURITY .............................................................................................................. 33
5.1 INTRODUCTION....................................................................................................... 33
5.2 ACCESS CONTROL ................................................................................................. 34
5.2.1 STAFF................................................................................................................ 34
5.2.2 PATIENTS, VISITORS AND UNAUTHORISED STAFF ................................................. 35
5.2.3 HIGH SECURITY.................................................................................................. 35
5.2.4 ELEVATOR CONTROL .......................................................................................... 35
5.2.5 STAFF PERSONNEL DATABASE INTEGRATION ....................................................... 35
5.2.6 VISITOR MANAGEMENT ....................................................................................... 36
5.2.7 REPORTING ....................................................................................................... 36
5.2.8 SMART CARD TECHNOLOGY................................................................................ 36
5.2.9 ENERGY MONITORING ........................................................................................ 36
5.2.10 PNEUMATIC TUBE DELIVERY SYSTEM ............................................................. 36
5.2.11 SYSTEM INTEGRATION.................................................................................... 36
5.3 DIGITAL VIDEO SURVEILLANCE (CCTV) .................................................................. 37
5.3.1 DIGITAL VIDEO TECHNOLOGY.............................................................................. 37
5.3.2 SYSTEM INTEGRATION ........................................................................................ 37
5.4 INTRUSION DETECTION ........................................................................................... 37
5.4.1 SYSTEM INTEGRATION ........................................................................................ 37
5.5 STAFF ASSAULT ..................................................................................................... 37
5.6 INFANT TAGGING AND PATIENT ELOPEMENT ............................................................ 38
5.7 RFID ASSET PROTECTION ..................................................................................... 38
6 OPERATING SUITES ............................................................................................... 39
6.1 ELECTRICAL POWER .............................................................................................. 40
6.1.1 SYSTEM DESCRIPTION ........................................................................................ 41
6.1.1.1 Environmental Conditions (Operating or Electrical Room) ................. 42
6.1.1.2 Electrical Data ..................................................................................... 42
6.1.2 STANDARDS ....................................................................................................... 42
6.2 VENTILATION SYSTEM ............................................................................................ 42
6.2.1 AIRBORNE CONTAMINATION ................................................................................ 43
6.2.1.1 Filtration .............................................................................................. 43
6.2.1.2 Ultraviolet Lamp System ..................................................................... 43

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 6.2.2 AIR MOVEMENT CONTROL .................................................................................. 44
6.2.3 CONTROL OF TEMPERATURE AND HUMIDITY ......................................................... 44
6.2.4 REDUNDANCY OF SYSTEMS ................................................................................ 45
6.3 BOOKING SYSTEMS ................................................................................................ 45
6.3.1 SCHEDULING WITH INTELLIGENT BUILDING INFRASTRUCTURE ............................... 45
6.4 MONITORING AND DISPLAY ..................................................................................... 45
6.4.1 INTERACTIVE TOUCH SCREEN ............................................................................. 45
6.4.2 MONITORING EXTERNAL TO THE THEATRE ROOM................................................. 46
6.5 REMOTE ACCESS FOR MAINTENANCE PURPOSES .................................................... 47
6.6 MEDICAL GAS MONITORING .................................................................................... 47
7 MEDICAL WARDS ................................................................................................... 48
7.1 PRINCIPLES ........................................................................................................... 48
7.1.1 ENERGY EFFICIENCY .......................................................................................... 48
7.1.2 PATIENT SAFETY ................................................................................................ 48
7.1.3 PATIENT ENVIRONMENT ...................................................................................... 48
7.1.4 STAFF PRODUCTIVITY AND RETENTION ................................................................ 48
7.2 DEVICES AND FUNCTIONALITY................................................................................. 50
7.3 PATIENT ENVIRONMENT.......................................................................................... 50
7.4 PATIENT SAFETY .................................................................................................... 51
7.4.1 INTEGRATED SECURITY SYSTEM ......................................................................... 51
7.4.1.1 CCTV .................................................................................................. 51
7.4.1.2 Access Control .................................................................................... 52
7.4.2 INFECTION CONTROL .......................................................................................... 52
7.4.3 LIFE SAFETY ...................................................................................................... 52
7.4.4 NURSE CALL ...................................................................................................... 52
7.4.5 REAL-TIME LOCATION SYSTEM ........................................................................... 52
7.5 ENERGY EFFICIENCY .............................................................................................. 53
7.5.1 HEATING, VENTILATION AND AIR CONDITIONING (HVAC) ..................................... 53
7.5.2 LIGHTING ........................................................................................................... 53
7.5.3 POWER CIRCUITS ............................................................................................... 53
7.5.4 PATIENT AND STAFF INTERFACES ........................................................................ 53
7.6 STAFF PRODUCTIVITY AND RETENTION ................................................................... 54
7.7 INTEGRATION ......................................................................................................... 55
7.8 OPERATIONAL AND MANAGEMENT VIEWS ................................................................ 56
8 ENERGY EFFICIENCY .............................................................................................. 57
8.1 INTRODUCTION....................................................................................................... 57
8.2 REGULATORY OVERVIEW........................................................................................ 61
8.2.1 EN 15232 ......................................................................................................... 61
8.2.2 EN 16001 ......................................................................................................... 64
8.3 MEASUREMENT NORMALISATION AND ANALYSIS OF CONSUMPTION W.A.G.E.S. (W ATER,
AIR, GAS, ELECTRICITY, STEAM)............................................................................. 65
8.3.1 ELECTRICITY ...................................................................................................... 65
8.3.2 HEAT ................................................................................................................. 65
8.3.3 GAS................................................................................................................... 65
8.3.4 STEAM ............................................................................................................... 65
8.3.5 WATER .............................................................................................................. 66
8.3.6 SOFTWARE ANALYSIS MEASURES ....................................................................... 66
8.4 REMOTE ENERGY SERVICES................................................................................... 68
8.5 SPECIFIC ENERGY SAVING TECHNIQUES ................................................................. 68
8.5.1 DATA CENTRES .................................................................................................. 68
8.5.2 EXTERNAL LIGHTING........................................................................................... 68
8.6 SPECIFIC ENERGY COST SAVING TECHNIQUES ........................................................ 69
8.6.1 BILL VALIDATION ................................................................................................ 69
8.6.2 DEMAND RESPONSE ........................................................................................... 69
8.6.3 SMART GRID ...................................................................................................... 69
8.7 CORPORATE AND SOCIAL RESPONSIBILITY .............................................................. 69
8.8 PATIENT AND STAFF SATISFACTION......................................................................... 69
9 PERATING AND M AINTENANCE ................................................................................ 70

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 9.1 INTRODUCTION....................................................................................................... 70
9.2 INTELLIGENT TECHNOLOGY INFRASTRUCTURE ......................................................... 71
24/7 REMOTE SUPPORT WITH SPECIALIST ENERGY SERVICES ................................. 71
9.4 INTEGRATED MOBILE COMMUNICATIONS TECHNOLOGY ............................................ 72
9.5 AUTOMATED ANALYSIS AND REPORTING ................................................................. 72
10 ARCHITECTURE AND INTEGRATION.......................................................................... 74
10.1 OVERVIEW ............................................................................................................. 74
10.2 ARCHITECTURE ...................................................................................................... 78
10.3 BUSINESS ENTERPRISE VIEW ................................................................................. 79
10.4 OPERATIONAL VIEW ............................................................................................... 79
10.5 SUPERVISORY AND CONTROL ................................................................................. 80
10.6 INTEGRATED SYSTEMS ........................................................................................... 81

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1 Introduction

1.1 Principles

An intelligent technology infrastructure in hospitals incorporates the principles of evidence-based

design to provide a significantly improved healthcare and recovery environment. The intelligent
infrastructure will be the foundation for improving energy efficiency, increasing patient and staff
safety, increasing patient satisfaction, assisting in patient recovery, increasing staff productivity
and helping staff retention. The intelligent technology infrastructure will be utilised throughout the
healthcare facility, from the energy centre to the patient room, ensuring the highest level of system
performance and providing the optimum patient comfort levels.

This infrastructure also provides a platform to accommodate new technologies as they

emerge without the need for major reconfiguration.

To achieve a significantly improved healthcare environment, integrated technologies will be

deployed which interoperate with each other and interact with the patient and staff in the
following key areas:

1.1.1 Energy Efficiency

o Occupancy-based functionality of services
o Intelligent, interactive patient and staff interfaces
o Intelligent metering and monitoring of consumption
o Enterprise-level energy management and benchmarking

1.1.2 Patient Safety

o Security systems
o Infection control measures
o Life safety systems
o Nurse call systems
o Real-time location systems

1.1.3 Patient Environment

o Patient control of micro climate (temperature, light level, humidity and security)
o Air filtration and quality
o Acoustic monitoring
o Entertainment and communications
o Facilities for visitors

1.1.4 Staff Productivity and Retention

o Integrated, skills-sensitive nurse call and workflow management
o Intelligent, integrated staff-based systems
o Radio frequency identification (RFID) locating systems
o Predictive maintenance technology
o Increased levels of automation to reduce workload

1.2 Overview

The architecture of the intelligent technology infrastructure is configured to allow hospital

services to operate in the most efficient possible manner to best serve the needs of the
patients, staff, the healthcare organization and the environment, now and in the future.

The integration of the various systems and services connected via the intelligent technology
infrastructure provides an additional layer of intelligence and automation which provides
improvements in energy efficiency, patient safety, staff productivity and patient satisfaction.

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This lays solid foundations for the cost-effective introduction of new and emerging
technologies throughout the life cycle of the healthcare facility.

The illustration below details the services within the healthcare facility which are connected to
the intelligent infrastructure.

Integrated Security Integrated Building Data Centre Physical

Lighting Control System
Systems Automation Infrastructure

Dimmer units IP CCTV HVAC controls Power distribution

Lighting controllers Access control Utilities metering UPS
Room switch units Staff attack Predictive maintenance In-row cooling units
Multi sensors Infant tagging SCADA Integrated security
Scene setting Video intercom Monitoring & targeting Room cooling
External lighting Intruder detection Energy reclaim

Hospital Intelligent Technology Infrastructure

24/ 7 remote services Servers

Fire alarm HV/ MV / LV switchgear
Energy modeling Digital video recording
Emergency lighting Transformers
Bill validation POE switches
Public address Generator integration
Dynamic energy pricing Firewalls
Voice evacuation Busbar trunking
Load shedding Quality of service
Fire// smoke dampers Plug & play distribution
Maximum demand Digital signage

Life Safety Systems Electrical Distribution Energy Management ICT

Figure 1-1. Services Connected to Hospital Intelligent Technology Infrastructure

The design of the infrastructure is based on providing maximum “uptime” of systems through
an architecture that incorporates both high levels of resilience and intelligence distribution.
This leads to a greater overall availability of systems and services than found in a
conventional, separate discrete systems model.

The architecture allows all the systems to interoperate and provide an intelligent healthcare facility.

The design of the infrastructure facilitates a distributed intelligence, allowing the systems to
interoperate in different ways within different departments of the facility. This includes
improving energy efficiency in an energy centre with the control and monitoring of energy
sources, improving patient and staff safety in a mental health facility with staff protection and
access control systems and improving the environment in a patient room with nurse call
services, patient lighting and environmental control. The infrastructure is designed to allow
interoperability of all services in all areas of the healthcare facility, as detailed below in Figure
1-2. This provides the optimum healthcare environment for patients, visitors, facility and
healthcare staff and healthcare organisations.

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 Mental Health Midwifery
Operating Theatre General Wards Energy Centre Energy Department Nurse Stations
Units Lead Units

Electrical distribution Generator testing 24/7 remote services Nurse call

Electrical distribution Access control Environmental control
Environmental control Power factor Energy modelling Intelligent display units
Isolating transformers Video surveillance Visitor management
Nurse call Correction Bill validation Asset management
UPS Staff duress Access control
Bedhead services Smart grid Dynamic energy pricing Environmental
Surgeons panel Shatter resistant Infant protection conditions
Lighting control Boiler control Load shedding
Environmental control Outlets Video surveillance Medical service status
Hand hygiene Chiller control Maximum demand

HOSPITAL INTELLIGENT TECHNOLOGY INFRASTRUCTURE

Video wall Power distribution

Fire alarm Pressure regimes HVAC control Lighting/shade control
Intercom system UPS Utility monitoring
Emergency lighting Filtration monitoring Alarm handling Acoustic monitoring
Digital recording In row cooling units Medical gas monitoring
Public address Gas monitoring Remote access Entertainment systems
Access management Integrated security Water services
Voice evacuation Fume cupboard control Energy monitoring Environmental control
Alarm management Room cooling HVAC control
Fire/smoke dampers Environmental control Predictive maintenance Nurse call
RTLS management Energy reclaim

Facilities Private
Fire Officer Isolation Rooms Security Centre Data Centre Plantrooms
Management Ward Rooms

Figure 1-2. Services Connected to the Hospital Intelligent Technology Infrastructure by Department

A full description of the architecture and system integration and interoperation is provided in Section 10 of this document.

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2 Information and Communication Technology

2.1 Benefits

An integrated system that provides added value to its users requires different technical
systems to communicate at different levels. Providing a common information and
communication technology (ICT) network allows the different systems within a hospital to
communicate with each other and allows targeted information to be provided to different
users. For instance, building systems can be integrated into a single network, which provides
both capital expense (CAPEX) and operational expense (OPEX) benefits.

2.1.1 CAPEX Cost Benefits

2.1.1.1 Cabling, Construction and Network Devices

o The use of a single infrastructure base reduces wiring dedicated to individual
subsystems and therefore the costs related to them. Both the number of cables
and the average length of cables are reduced. Using standardised cabling
(CAT6 or 7 twisted pair) and universal network sockets (RJ-45) gives quantity
benefits compared to using special cabling and sockets for different
applications. With the reduction of cabling and the use of standardised
repeatable methods, the labour required to install the cabling is also reduced.
o An integrated ICT network reduces time spent on commissioning the systems,
which leads to cost reductions in construction labour.
o The number of active network devices is also reduced in an ICT network. Each
separate system doesn’t require its own switches or network equipment. The
switch capacity can be better optimized, which leads to reduction in cost.

2.1.2 OPEX Cost Benefits

2.1.2.1 Network Operating Resilience

o Resiliency and high availability can be better managed in a single network than
in many separate networks. High availability allows better network uptime and
better resilience to the whole system.
o Network management and diagnostics of a single network can be integrated into
the systems to indicate whether the point of failure is in the network or in the
equipment, which leads to better failure detection and faster reaction. For
example, an inactive network switch port can lead to a camera being silent. The
first reaction would be to investigate the camera, but with network diagnostics,
the point of failure can be detected in the network switch and the problem can
easily be fixed.
o Network safety with firewalls prevents unauthorized access to network
resources.
o Remote access can be built with secure solutions (such as VPN tunnels and
one-time passwords), allowing remote access to certain parts of the network
only. For example, building maintenance can use building management systems
(BMS) remotely, but will not be allowed to access to video security or access
control.
o Openness and flexibility allows future technological developments (such as
wireless ZigBee and RFID tagging) to be easily adapted to standard Ethernet/IP
communications. Relocating and reconfiguring equipment using standard IP
communication and wireless technologies is easier and more cost effective than
discrete technologies.
o Facilities management wireless connectivity allows mobile working whilst in
continuous connection to the integrated system. For example, facilities maintenance
can test system operations by connecting to a WLAN and using the management
system while standing next to the field equipment to realize correct system
behaviour.

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 o Power over Ethernet (PoE) techniques reduce maintenance and reconfiguration
costs. PoE-powered devices can be relocated to any network socket without
having to install new electrical cabling.
o Remote access to the systems reduces duty calls and results in faster problem
resolution. For example, the system can check to see if an alarm requires
immediate action remotely from a BMS or from video surveillance feeds.
o Targeted monitoring and control offers views to different management tasks. For
example, HVAC, camera, access control, electrical, energy efficiency, data
centre and network.
o A collective integrated dashboard offers views for total facility management.

2.1.2.2 Staff Productivity

o Intelligent staff information systems allow staff to react to events faster. For
example, procedures on how to react to security and life threatening events can
be delivered to the intelligent touch screen at a nurses’ station in case of an
emergency.
o Improved information transfer reduces time that the medical staff needs to spend
on requesting facilities intervention.

2.1.2.3 Patient Satisfaction and Safety

o Communication and response time with the staff is improved. Patients can use
information displays to communicate different needs directly with nurses instead
of just calling a nurse via a nurse call button.
o Access to the Internet allows communication with friends and family via web,
email, or other social services.
o Information can be delivered to a patient interface in case of a fire or other
threats. For example, exit routes can be shown in three-dimensional patient
displays and information screens along the way.

2.2 Designing the ICT Network

The ICT network is the backbone of the integrated building system. Many things need to be
taken into account when designing the network. There are functional, logical and physical
requirements that all need to be filled. Functional requirements are the most important because
the ICT network must meet the needs of the end users, as well as the needs of the technical
systems and the applications running on top of them. Once the requirements of end users,
applications, and systems are clear, the functional design must be incorporated into the logical
and physical requirements of the network. The logical and physical requirements come from
network safety requirements, availability requirements, building(s) layouts and cabling
requirements. This design approach is usually referenced as top-down network design.

Functional requirements of a network in a hospital can be derived from the functional

requirements of the system integration design. Figure 2-1 below demonstrates how the ICT
network is essential in all the levels of functional requirements, from top management to field
devices. The integrated design is described in detail in Section 10.

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 Integrated systems
Communication
Executive

CEO view CFO view Energy view

Operational views

TCP/ IP backbone
Patient Nurse Operating Security Remote CCTV Fire Energy
station theatre access efficiency
Expert monitoring
& control views

Building management, Video surveillance Datacenter, TCP/IP

power, security & fire, monitoring
access

Power ICT/IP BMS Security + Fire Access Other

Field Devices

• MV • Data center • Main HVAC • Camera & Data • Car park • Baby tag
• LV • UPS • Heat • EM & Light • Labs • Staff attack
• Genset • Energy • Gas • Fire system • Wards • RFID
• Meter • Rack • Ward • PA / VA • Tech rooms • Intercom
• UPS • Switches • Light • Intruder • Cashless • Bedhead
• O.T. • Patient IF vending • Nurse call
• Digital signage

Figure 2-1. Hospital Integrated System Functional Design

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The integrated ICT network usually covers only technical systems such as BMS, security, safety
and power monitoring. Medical systems should have a separate ICT network because of patient
confidentiality issues, although both of the networks can be built on the same core fibre-optic
cabling utilizing different fibres.

The logical design derives its requirements from the functional requirements. The logical
design covers protocols, topology and the safety of the network. Although the physical design
is the last step of the design process, the physical realities must be taken into account in the
logical design. The physical design covers network equipment, cabling and building layouts. A
simplified logical design is demonstrated in the Figure 2-2.

Figure 2-2. Simplified Logical Network Design

The design in Figure 2-2 shows the network devices, topology and safety elements. Ethernet
switches are used to route the network traffic from wiring cabinets to a centralized hospital data
centre. PoE switches are used to power TCP/IP cameras and other PoE devices. Resilience of
the network is raised by adding failover backup switches in the data centre and doubling the
network connections to servers and wiring cabinets. Resilience is also increased by using extra
fibre between wiring cabinets to create alternate routes for the traffic in case of cable failure.
There are also many other techniques such as virtual LANs, load balancing and Quality of
Service (QoS) that will be used to build as resilient and highly available network as possible.

Page 14
3 Mechanical and Electrical Services

3.1 Principles

The physical deployment and design of the intelligent building infrastructure and the
connected mechanical and electrical plant and equipment play a key part in the design,
construction and maintenance of the healthcare facility. The design of the mechanical and
electrical services are essential for the safe and efficient operation of the facility and form one
of the main pillars in the ideal balance of system architecture, services and the respective
equipment and software to provide maximum resilience as illustrated in Figure 3-1:

Architecture

Ideal
system
balance

Services Equipment &

Software

Figure 3-1. The Three Pillars of System Resilience

The main services where it is most important to achieve this balance are:
o Electrical power distribution system
o Heating, ventilation and air conditioning (HVAC) and water distribution system

3.2 Electrical Power Distribution

3.2.1 Hospital Constraints and Pain Points
Healthcare facilities are often complex and integrate several different processes.

Among them are:

o Critical medical processes: Operating theatres, intensive care and labs
o Critical non-medical processes: Patient data systems (server rooms and data
centres)
o Important medical processes: Hospitalization (patient rooms), normal care and
radiology rooms
o Non-critical medical: Ambulatory
o Non-critical and not medical: Parking, cafeteria and sterilization
As a result, healthcare facilities not only rely upon commercial loads (such as computers,
servers and lighting systems) and industrial loads (such as food preparation, laundry
equipments and medical gas systems), but they also rely on electronic medical loads (that is,
medical equipment) to operate the facility and provide patient care services.

We define healthcare facilities according to the following levels:

Enterprise level:
o This includes all the sites and buildings managed by the same health
organization. For example, one major hospital, x clinics and retirement homes).
For the electrical systems, this includes the supervision and monitoring terminals.

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Campus level:
o Cross over building infrastructure, common to all the buildings on the site
(including non-medical buildings). For the electrical distribution (ED), this covers
the medium voltage (MV) system when present.
Building level:
o Building infrastructure is specific to one building. For the ED, this covers the
medium voltage/low voltage (MV/LV) transformers and its protective devices,
the low voltage (LV) main panels, the UPS and the LV generator sets.
o Ward level:
o The different applications: Surgical care, Hospitalization, etc..
3.2.2 Critical Loads
For critical activity to go on uninterrupted in critical sectors of a hospital such as in operating
theatres, intensive care units and data centres, electrical power is essential and even vital.

Problems stemming from power availability and quality are often underestimated and can
have serious consequences on human life, finances, technical operations and the
environment, not to mention the impact on the hospital’s image.

There is no such thing as zero risk, but failures can be prevented by adopting an “efficiency by
integration” approach. This strategy, on the whole, consists of correlating site managers’ needs
with qualified, proven technical solutions developed specifically for critical activities and that are
carried out, throughout the different steps in the construction of buildings and infrastructures.

The primary objective is to guarantee the reliability and availability of power to allow
processes and systems to keep on working in all circumstances.

3.2.3 Rules and Standards Summary

3.2.3.1 Shock Sensitivity

Applied part: the part of the medical electrical equipment, which in normal use would need to
come into physical contact with the patient to perform its function, or can be brought into
contact with the patient, or needs to be touched by the patient.

3.2.3.1.1 Group 0

Medical location where no applied parts are intended to be used.

3.2.3.1.2 Group 1

Medical location where applied parts are intended to be used as follows: Externally, invasively
to any part of the body, except where the standard IEC 710.3.7 applies.

3.2.3.1.3 Group 2

Medical location where applied parts are intended to be used in applications such as
intracardiac procedures, operating theatres and vital treatment where discontinuity (failure) of
the supply can cause danger to life.

Page 16
 3.2.3.1.4 Criticality Level

Maximum duration
Continuity of for power cut and
Criticality Minimum endurance of the
service switching to a
level backup source
requirements backup power
source
Permanent power
1 < 0,5 Second 3 hours
supply
2 Brief interruption < 15 seconds 24 hours

3 Long interruption < 3 mn 24 hours

Figure 3-2. IEC Criticality Level

3.2.3.1.5 Application of Criticality Levels to Building Care Departments and Utilities

Application of criticality
Area 1 2 3
level
Technical installations Operating theatre
Obstetrics
Intensive care units
Emergency ward
Hospitalization Attentive care
Intensive care
Standard care
Medical imaging A
Administration B
Laboratories C
Pharmacy
Equipment room Elevators
Medical air conditioning
HVAC
Cold room
Automation systems
Fire safety Detection
Smoke extraction
o A = Computer and monitoring equipment
o B = IT equipment
o C = Automated analysis equipment
o HVAC = heating, ventilation, air conditioning
Figure 3-3. Application of IEC criticality Levels

3.2.4 Electrical Power Distribution

Vital to almost every aspect of a hospital’s day-to-day functioning is a safe, secure and
reliable electrical power infrastructure. The main pillars in the design of this infrastructure are
described as follows:

3.2.4.1 Electrical Distribution and Power Monitoring Architecture

The architecture shall be designed to ensure electrical distribution system availability

according to the facility’s different levels of criticality in terms of:

Page 17
 o Design and sizing of installations with redundancy
o Analysis of electrical risks
o Studies of dependability, coordination, lightning and harmonics
o Monitoring and control

3.2.4.2 Equipment and Software

To enable communication with the hospital intelligent systems infrastructure, the following key
components shall be chosen and installed according to standards, in compliance with the
architecture and with the goal of resilient operation:
o MV network, MV loop reconfiguration
o Generator set
o Automated load shedding system
o LV switchboards
o Operating theatre switchboard
o Power monitoring system
o UPSs for uninterrupted power and static transfer switch (STS)

3.2.4.3 Operating and Maintenance Services

Services must fit the required level of performance throughout the installation life cycle and be
backed by communicating products to support:
o Monitoring and control
o Scheduled maintenance
o Maintenance operations
o Repair
o Routine testing such as generator set or emergency power supply system testing
o Emergency assistance (particularly for crisis management)
o Training
3.2.5 Typical Architecture
The typical architecture is of a medical city is comprised of multiple buildings, with more than
500 beds and more than 10 operating theatres and with an overall power requirements of
more than 2,000 kVA.

Typical electrical power distribution architecture for a large medical city that embodies the
above principles is illustrated in Figure 3-2.

Page 18
Figure 3-2. Typical Medical City Electrical Power Distribution Architecture

Page 19
3.2.6 Key Elements
The key elements of the electrical distribution system are as follows.

3.2.6.1 Utility Incomer and Utility Backup Source

The utility service entrance includes two MV incomers from two different public grid
substations. Both feed an MV loop distribution network either within a single building, or more
generally, within a campus of multiple buildings. The advantage of this MV loop distribution
path is that, in case of a fault on the cable, it is possible to re-energize by another path. This
redirection can be made manually or automatically.

In case of a power outage from the utility source or fault from the transformer or MV
switchboard bus bar, the generator set shall start and re-energize the hospital’s MV loop.

The two substation incomers shall be located in different rooms and equipped with fire protection.

3.2.6.2 MV Substation and MV Loop Distribution

The MV substation architecture is characterized as a single loop electrical distribution

network, with an automatic loop reconfiguration, fed by three incomers – two from utility
substations, as described above and one from the back-up generator set.

This configuration is suited for large campuses and ensures a good level of secure power
availability. In case of a fault on a specific substation, the loop shall be re-energized within
three seconds. As an option, a high priority substation shall be equipped with a redundant
transformer to feed a high priority LV switchboard as shown on the single line diagram.

3.2.6.3 Backup Power

The backup is provided by one or two redundant generator sets that re-energize the critical
loads of the hospital. Generator sets shall be sized to feed the entire installation except loads
that are shed.

Generator sets shall adopt an N+1 configuration, which means that N generator sets are
sufficient to feed the total loads, with one spare in case of a generator set failure.

A generator set is connected at the main LV switchboard and it will start in a delay of no more
than 15 seconds.

One centralized UPS will feed the class 1 loads in case of shutdown of the utility, until the
generator set has re-energized the loads.

3.2.6.4 High-Quality LV Switchboard

The main LV switchboard shall be constructed from two coupled switchboards that supply the
same loads, with a transfer switch connecting them. This system design improves availability
and allows for maintenance or crisis management without shutdown of the whole switchboard.

A mobile generator set can be connected in case of a shutdown of the MV switchboard.

The other LV switchboards are divided by priority requirements and shall also be backed up
by a mobile generator set.

3.2.6.5 Security Switchboard

The security switchboard is fed by two incomers coming from each of the two parts of the
high-quality LV switchboard.

Page 20
It feeds critical loads (Criticality Level 1) such as smoke extractors, fire detection and suppression,
security elevators and so on. A mobile generator set shall be connected for redundancy.

3.2.6.6 UPS

A centralised UPS will feed highly critical loads such as operating theatres, data centres and
life support equipment.

The configuration of this UPS is online. It shall be equipped with a static switch in case of fault
and a bypass for maintenance.

3.2.6.7 Operating Theatres

An operating theatre is fed with two incomers – the main feeder that comes from the utility
source through the UPS and a secondary feeder that comes directly from the utility source
which can be used in case of UPS maintenance or failure. The transfer between sources will
occur within 0.5 seconds.

3.2.6.8 Operation and Maintenance

Maintenance on the LV switchboard can be conducted live, if the system design allows it (that
is, if it includes two coupled switchboards, as described in Point 4 above), or un-powered.

3.2.6.9 Power Monitoring and Control System

A consistent and coherent power monitoring system is mandatory to provide the facilities staff
the tools they need to manage and control the electrical network, especially to transfer source
at the MV level and at the LV switchboard level. The power monitoring and control system
shall also provide:
o MV loop monitoring and reconfiguration
o Status of devices and equipment
o Status of the reconfiguration electrical distribution process
o Alarms monitoring, including alarms sent to maintenance staff through short
message service (SMS)
o Generator set test information, including run-times and follow-up
o Crisis management tools and assistance to recover
o Energy consumption data
o Maintenance information
o Traceability of events and alarms
3.2.7 Requirements
The infrastructure shall provide high availability for which the following fundamental
requirements shall be met.

3.2.7.1 The MV Level

The MV level requires triple incomers, two from two separate utility sources and one from the
backup generator set. A double path is used to feed the high priority LV switchboard.

3.2.7.2 The LV Level

The high priority LV switchboard is fed by dual incomers from two different transformers. The
scheme shall allow for a possible reconfiguration of the electrical distribution network to feed
critical loads such as operating theatres or loads of the same class and any on-site data
centres. Other priority LV switchboards shall be also be backed up by a mobile generator set.

Page 21
3.3 Heating, Ventilation and Air Conditioning and Water Distribution System

The healthcare facilities heating, ventilation and air conditioning (HVAC) systems are required
to meet a variety of demands and applications at a high standard of performance. The HVAC
systems are an integral component of the buildings process, but also play an important role in
effecting human safety and health. Evidence-based design has shown that, in many cases, a
fully functioning HVAC system is a key factor in a patient’s recovery. In some cases, the
control of the environment can play a significant part in a patient’s treatment.

Studies have shown that patients in well-controlled environments generally show a greater
rate of recovery than those who are treated in uncontrolled conditions.

In addition to proving well-controlled environments to aid in the recovery of patients, the

HVAC systems play a vital role in infection control. Healthcare facilities are places where
relatively high levels of pathogenic microorganisms are generated and stringent practices and
controls to safeguard the patients and staff are required.

The HVAC systems in hospital, like in all other types of buildings, are required to provide
comfortable environmental conditions through the control of temperature, humidity, air
movement, noise reduction, objectionable odors and energy efficiency. The HVAC systems in
healthcare also play an additional role in supporting medical functions critical to health and
safety, such as:
o Environmental control
o Infection control
o Hazard control
o Life safety
o Energy efficiency
3.3.1 Environmental Control

3.3.1.1 Air Conditioning

The HVAC systems provide an environment which is both therapeutic and comfortable for the
patient and also comfortable for the medical staff as they carry out their work. Uncontrolled
environments lead to unsatisfied staff and cause stress for the patients. The stress caused to
the patients is more than discomfort but may cause problems with the healing process, with
the patient being unable to regulate heat properly. Stress can also cause psychologically
harm due to interference with sleep patterns.

Cardiac patients may be unable to maintain the circulation necessary to ensure normal heat
loss. Therefore, air conditioning in cardiac wards and rooms of cardiac patients, particularly
1
those with congestive heart failure, is necessary and considered therapeutic . Individuals with
head injuries, those subjected to brain operations and those with barbiturate poisoning may
have hyperthermia, especially in a hot environment, due to a disturbance in the heat
regulatory center of the brain. An important factor in recovery is an environment in which the
patient can lose heat by radiation and evaporation, such as a cool room with dehumidified air.

The ventilation system needs to be designed to ensure that the comfort levels of the medical
staff and the well-being of the patients are satisfied. The temperature and humidity should be
closely monitored and controlled by the control system to meet the design conditions as
detailed in Figure 3-3.

1
Burch, G.E., and De Pasquale. Hot Climates, Man and His Heart. Thomas, Springfield, III.
1962.

Page 22
 Min.
Min. total All room air Air Design
outdoor Design
Pressure air exhausted recirculation by relative
Function of space air temp
regime changes directly to means of room humidity
changes (°C)
per hour outdoors units (%)
per hour

Class B and C
Positive 4 20 N/R No 20-60 20-23
operating room

Operating / surgical
Positive 4 20 N/R No 20-60 20-23
cystoscopic rooms

Class A operating /
Positive 3 15 N/R No 20-60 21-23
procedure room

Delivery room Positive 4 20 N/R No 30-60 20-23

Treatment room Positive 5 12 N/R No 30-60 22-26

24,
Recovery room - 2 6 N/R No 20-60
+/-1

Triage areas Negative 2 12 Yes - - 21-24

30 (W)
Patient room - 2 6 - - 21-24
50 (S)

Airborne infection
Negative - 12 Yes No 30-60 21-24
isolation room

2
Figure 3-3. Recommended Environmental Conditions

The intelligent building management system can provide accurate control of the central air
conditioning systems to ensure that the design criteria are achieved for the different
departments. Tempering outside air with the aid of heat recovery devices, such as Low
Temperature Hot Water coils (LTHW), Chilled Water (CHW) coils and humidification devices
provide the departments with conditioned air. Local condition may be applied downstream of
the main ventilation system, in the form of Variable Air Volume (VAV) boxes or local heating
elements, to add additional conditioning all of which signals are transmitted back to the main
plant to ensure optimum performance.

The performances of all the elements are recorded and viewable on the intelligent building
management system for monitoring and performance evaluating. Trend logs are used to
monitor the performance of the system and reports can be produced to show the performance
along with predictive maintenance identifying any issues before they have a detrimental effect
on the system and the quality of the environmental conditions for the patients.

The medical staff should be provided with the ability to view and adjust certain environmental
conditions for temperature and humidity to improve the comfort levels of the staff and patients
as well as when any specialised procedures are to be carried out. Indications and adjustment
should be available via the intelligent staff base display units. Additional heating and cooling

2
American Society of Heating, Refrigeration and Air Conditioning (ASHRAE) Standard 62.1-
2010 – addendum ‘d

Page 23
systems downstream of the main ventilation will be needed for operating suites which carry
out specialised procedures.

Temperature and humidity sensors, which are installed in actively ventilated areas of the ward
and other departments and, which can be easily accessible for maintenance, continually
monitor the environment and provide active controls for the main ventilation system.

3.3.1.2 Air Quality

The quality of the air supplied to the departments is an important factor which needs to be
continuality monitored by the intelligent building management system to ensure optimal
patient environments. Sensors must be installed to centrally monitor air quality for smoke
2
detection, CO, CO and airborne contaminants such as volatile organic compounds (VOC).

In office areas the ventilation system can operate via demand control, fan speeds and
2
volumes can be varied according to the quantity of staff in the department. The CO sensor
2
will monitor the air to ensure that the ventilation system reacts to high levels of CO and
allows air change rates to be achieved.

3.3.1.3 Noise Control

The system must also be capable of monitoring acoustic levels to ensure good acoustical
conditions are maintained, which have been recognized for improving patient recovery rates
3
as well as staff health and efficiency. The U.S Green Guide for Healthcare and LEED
4
Healthcare both include acoustical design credits.

3.3.1.4 Water Distribution

The distribution of water is critical in allowing the ventilation systems to provide accurate
environmental conditions. Heated and chilled water produced from the central heating and
chiller systems are distributed to the heating and cooling devices of radiant panels and
ventilation system coils via water pumps. The water pumps are fitted with intelligent, variable
speed drives and connected to the intelligent building infrastructure.

The heating systems are split into two systems. The first system will provide the interior
heating; heated water will be supplied to the ventilation system and local heating devices.
These systems will require constant heating temperatures as the coils will be designed for a
constant supply air temperature throughout the year. The second system will provide the
heating for the perimeter heating devices. The demand for heating will be proportional to the
outside air conditions, allowing a reduced supply water temperature and reduced energy
expenditure.

The chilled water is also distributed to the ventilation system cooling coils and local cooling
devices in data rooms and medical refrigerated rooms. The chilled water is supplied at a constant
temperature. The control of the temperature is critical in these areas and an increase in
temperature or failure of the chilled water system can have major impacts on the medical research
and data information systems. Temperature sensors will be positioned in the index legs of the
chilled water systems to monitor the distributed water temperature. Alarms are issued to the
facilities team via SMS and email when the conditions deviate from the design conditions.

The water pumps are intelligently controlled to ensure that when demand is low, energy
conservation measures are taken. Using differential pressure sensors in the pipework, the
variable speed drives can modulate the speed of the pumps so that on low demands, the
energy consumption is reduced.

3
http://www.gghc.org/
4
http://www.usgbc.org/DisplayPage.aspx?CMSPageID=1765

Page 24
3.3.1.5 Infection Control, Airborne Contamination

The ventilation systems need to be carefully designed to restrict the amount of airborne
containments entering the internal spaces. Generally airborne containments can enter the
area by the following paths:
o Through the supply air
o Transferred from adjacent spaces
o Shed by operating staff
o Shed by patient
o Through medical activities
The intelligent building infrastructure systems can be implemented to help aid in the reduction
of routes for which airborne containments can travel.

3.3.1.5.1 Filtration

To maintain the strict regulations for outdoor air changes, the main ventilation systems shall
provide fresh air into the various departments at a fixed volume, as defined in Figure 3-3, to
achieve the ideal air change rates. The fresh air will pass through a series of filters installed in
the main section of the ventilation system which will reduce the level of airborne
contamination in the air stream.

The filtration will be provided in stages, as described below.

o The first stage of filtration shall be via a general panel pre-filter, with a grade no
5
lower than G4 . The pre-filter shall be provided to remove the heavier particles
found in the outdoor air. The particles which are removed by the pre-filter will
reduce the chance of particles blocking heater battery coils or settling in the air
distribution system.
o The second stage of filtration will be via a bag filter, with a grade no lower than
F7. The bag filter shall be provided to remove the very fine particles before the
air is supplied into operating theatres.
o Additional filters may be provided at grilles, dependent on the nature of the
operating theatre.
o The extract duct shall also be fitted with a panel filter, with a grade no lower than
G4, to remove the particles before been discharged into the outside air.
o HEPA filters may also be installed to provide additional filtration for the areas
requiring more filtration.
All filters will be monitored so that once they become dirty, maintenance teams can be notified
and clean filters can be installed.

To ensure the correct air volumes are maintained to satisfy the air change requirements when
filters become dirty, the intelligent frequency inverters, fitted to the fan motors, will
automatically be ramped up to a higher speed.

The “dirty: status of filters and frequency inverter speeds will be logged so reports can be
generated to show increased energy usage due to dirty filters.

3.3.1.5.2 Ultraviolet Lamp System

High-output UV-C (UVC) emitters shall be installed in the supply ductwork to provide
ultraviolet germicidal irradiation (UVGI) to interrupt the transmission of pathogenic organisms,
such as mycobacterium tuberculosis (TB), influenza viruses, mold and possible bioterrorism
agents.

The UVC emitters are to be mounted inside the ventilation duct, confining the UV energy to
the inside of the duct. A safety interlock will be needed, so if the fixture is removed from the

5
Standard EN 779

Page 25
duct or an access door is opened, the lamps turn off to avoid accidental human exposure to
UV energy.

The UVGI systems will be utilised to irradiate cooling coils, drain pans and other HVAC
components and to disinfect the moving air.

3.3.1.5.3 Control of Air Movement

The ventilation systems should be designed to minimise the movement of contaminated air
into clean air supplies. From the central ventilation system, the volume of air supplied and
extracted from the areas should be maintained at the design volume set points to achieve the
required air changes as defined in Figure 3-3. Any deviation away from the designed volumes
could lead to changes in air movement within the departments.

In areas such as airborne infection isolation rooms and laboratories, the pressure regimes
need to be designed to eliminate the movement of contaminated air from the rooms into the
adjoining areas. The supply and extraction of air to the rooms will be designed to ensure the
pressure regime is achievable but the air tightness of the rooms construction also needs to be
maintained.

In addition to transfer grills and pressure stabilisers, differential pressure sensors will be
installed across the pressure zones to ensure that the pressure regimes are maintained.
Local displays of live pressure readings will be visible on the intelligent staff base displays
and audible alarms will be configured to notify staff of any potential harmful situation.

Monitoring of the doors will alert staff when doors have been left ajar, causing changes in the
pressure regime. Door contacts will be installed on the doors to allow staff to act upon doors
left open.

The same monitoring will be needed for isolation rooms where patients are highly susceptible
to infection. Positive pressure regimes will need to be maintained.

3.3.1.6 Infection Control, Legionella

Legionnaires’ disease is a serious, life-threatening pneumonia caused by the environmental bacterium

Legionella pneumophila and related species. The disease is transmitted via aerosols from
environmental water sources and can be seen as both a community-acquired pneumonia, as well as
hospital-acquired (nosocomial) pneumonia. While single isolated cases (transmitted from domestic hot
water) are more common in the hospital setting, large multiple-case outbreaks have been reported.

To prevent Legionella, the hot water must be heated and stored at 60°C. Temperature
sensors installed in the storage tanks can continually monitor the temperature and control
valves can be modulated to maintain the required set points. Temperature sensors can be
installed in the flow of the hot water to ensure there are no low temperatures in the system.
Wireless sensors in the index legs and at department leg entrances continually monitor the
temperature, and any reading below 50°C will issued to the intelligent building management
system as alarms and the facilities staff notified.

Pasteurising of the system will be another way to prevent Legionella. At pre-defined times
(such as when the areas are unoccupied, during the night, or during times of limited use), the
storage temperature in the system can be increased to 70°C, for instance, and circulated
around the system, which would kill any trace of Legionella in approximately one minute.

Automatic flushing of cold water systems can be utilised to ensure there is no stagnant water
in the system. The system based on temperature and flow volume over time can prevent the
growth of bacteria and save the work of periodic manual flushing.

Page 26
3.3.2 HVAC Control and Monitoring Architecture
The architecture shall be designed to ensure maximum availability and eliminate single points
of failure. The key elements are:
o Distributed power architecture serving major plants and equipment
o Distributed intelligence
o Native interoperability utilizing peer-to-peer communications
o Highly resilient communications infrastructure

3.3.2.1 Distributed Intelligence

The diagram in Figure 3-4 illustrates the principle of distributed intelligence and power as
applied to the hospital ventilation systems. The same principle applies equally to other
systems, such as fluid power distribution systems. The application of this principle will reduce
the capital cost of the installation as it allows complete HVAC systems to be pre-fabricated
and tested at the factory, negating the requirement for custom manufactured motor control
centres (MCCs). The commissioning phase of the project is significantly improved due to
commissioning been taken away from the site face. Once in operation, each unit is fully
decentralised whereby failure of one direct digital control (DDC) unit would not cause the
failure of multiple plant items, thereby increasing system resilience.

This type of distributed design also allows for the standardisation of control panel designs,
software and graphics to increase familiarisation of the facilities staff.

Figure 3-4. Distributed Intelligence and Power in Ventilation Systems

Page 27
3.3.2.2 Peer-to-Peer Communications
Peer to peer communications between microprocessor based controllers

Different equipment
Controller Controller Different locations
Different functions

B Common language
Shared information
Interoperability

Improved performance
Increased efficiency
Increased reliability

PEER TO PEER
COMMUNICATIONS

Fig 3-5. Peer-to-Peer Communications

In Figure 3-5, the diagram illustrates the principle of native peer–to-peer communications
between two microprocessor devices connected to the intelligent infrastructure carrying out
different functions within the hospital. The devices are able to share information and thus
operate more intelligently to adapt and respond to changing conditions.

3.3.3 Equipment and Software

To enable communication with the hospital intelligent systems infrastructure, the following key
components shall be chosen and installed with the goal of resilient operation:
o Graphical user interface expert views
o Portable user interfaces (for laptops, PDAs and portable keypads)
o Network controllers
o DDC controllers housed in distributed control enclosures
o Frequency inverters
o Motorised control valves and damper actuators
o Sensors, switches and other field-mounted control and monitoring devices
3.3.4 Operating and Maintenance Services
Services must fit the required level of performance throughout the installation life cycle,
backed by communicating products to support the analysis of:
o 24-hour alarms
o Repeated alarms
o duration from alarm acknowledgement to clearance
o unacknowledged alarm duration
o Hardware point alarms
o alarm failure pattern
o alarms regarding Mean time to repair (MTTR) and Mean time between failures
(MTBF) control-loop performance and usage
o optimiser performance at occupancy time
o access to system
o modified points and manual overrides on a per-user basis

Page 28
4 Life Safety

4.1 Fire Detection

An addressable fire detection system will use automatic smoke or heat detectors appropriate
for the location being protected and manual call points to locate and report fire alarm
conditions within the hospital.

The fire alarm system will be programmed to automatically control life-safety systems such as
public address voice evacuation systems, smoke control dampers and smoke extract
systems. The fire alarm system will disable hospital environmental control services, as
required to ensure life safety via dedicated output devices hard-wired to the equipment. The
fire alarm system will meet the requirements of EN 54-2 European standard and will be
installed according to appropriate local hospital standards and directives such as UNI 9795:
2010 and specific rules for the public and private health facilities referred to in DM 20-09-2002
and later additions.

4.1.1 Fire System Architecture

The fire system will be comprised of a series of networked fire alarm panels, each panel being
flexibly configured to support the appropriate number of detectors, inputs and control outputs
associated with the panel. The detectors will be selected according to the environment being
protected and the level of sensitivity required and will be supported by manual fire alarm call
points located according to fire regulations. The system will support fire service reports and
control points for override of the smoke control systems managed by the fire alarm system.

The fire system will be zoned in accordance with local regulations for indication, evacuation
and reporting purposes.

4.1.2 Open Protocol

The fire system will support an open protocol for the fire detectors. This will give full flexibility
to the client for the future management of the fire alarm system.

4.1.3 Annunciation of Fire

A master control panel will be located at the designated control room of the hospital. This
panel will communicate with one or more additional fire panels as required by the design via a
bi-directional communications network. This will ensure that a fire alarm is reported at all
panels. Primary indication of a fire alarm will be from the master fire alarm panel, with a
secondary indication being provided by a locally connected computer running a dedicated
graphical display software package.

4.1.4 Integration
Integration of the fire alarm system into an intelligent network infrastructure will provide
additional benefits for the safety of the hospital occupants during a fire emergency. The
infrastructure will be configured with cause-and-effect regimes that will operate in conjunction
with the hard-coded fire panel program to provide enhanced management of an emergency
incident.

The intelligent infrastructure will facilitate the following forms of interoperation between systems.

4.1.4.1 CCTV

Integration with closed-circuit televisions (CCTV) cameras will speed the response of staff in
locating the incident and assist the fire department in identifying the scale of the incident and
controlling the response.

Page 29
4.1.4.2 Access Control

Integration with access control will ensure critical doors are unlocked during an incident and
allow automatic muster reports to be generated.

4.1.4.3 Lighting

Integration with lighting and emergency lighting will ensure maximum illumination is enabled
during an incident, thereby assisting investigation and/or evacuation.

4.1.4.4 Digital Signage

Integration with digital signage will enable the signage displays to present incident-specific
information relating to escape routes.

4.1.4.5 Nurses’ Station Display

Integration with an intelligent touch panel located at a nurses’ station will enable effective
incident management at the closest point of contact with patients ensuring the avoidance of
patient anxiety.

4.1.5 Life Cycle

The fire alarm system will function and interact with the intelligent infrastructure to minimise the
risk of false fire alarms, which often result in loss of productivity and potential compromise in
patient safety with unnecessary evacuation. Advanced automatic monitoring of the fire system
detectors will ensure early identification of high levels of contamination before false alarm
conditions occur. This will allow the maintenance personnel and other hospital staff to maintain
a high level of confidence with the system. Advanced life-cycle monitoring of this type will help
reduce maintenance costs by ensuring targeted and efficient management of the system. The
system will also incorporate Internet-based reporting to present system condition information to
remote users, further enhancing the efficiency of the maintenance regime.

4.2 Public Address / Voice Annunciation

The public address / voice annunciation (PA/VA) system will be installed under European
guidelines in accordance with its use for alerting the hospital occupants in the event of a fire
alarm evacuation or other emergency.

The fire alarm system will interface to the PA/VA system via dedicated control output units for the
activation of the appropriate alert message and zone amplifiers.

The central system equipment, including amplifiers, battery supplies and digital message
units, will be monitored in the event of a fault condition by the fire alarm system.

4.3 Digital Signage

Digital messaging systems are often deployed in public buildings for displaying information
helpful to the building users. These will be integrated into emergency systems by means of
the intelligent infrastructure. When the system receives a fire condition, it indicates the
appropriate emergency location on the displays and forces the message displays to present
information helpful to the occupants during the specific emergency situation.

4.4 Fire Suppression

Fire suppression systems, such as sprinklers or inert gas discharge systems, will be installed
by specialist contractors as required by the different needs of equipment rooms, wards,

Page 30
offices, operating theatres and data rooms. The equipment will be specified and installed in
accordance with local regulations.

The intelligent infrastructure will provide remote monitoring of these systems by means of
status switches on physical equipment, such as valves and flow-switches and by connection
to dedicated system control panels.

This integration will provide warning in the event of a manual override of suppression systems
or fault conditions, ensuring maximum visibility of system readiness and also rapid warning in
the event of the activation of such systems.

4.5 Smoke Control Systems

Smoke control and smoke extract systems are installed to help provide the maximum amount
of time for the safe evacuation of a building in the event of a fire emergency. These systems
are activated directly from the fire alarm system by output units located at the fire detection
and control panel or on the fire detection loop.

Systems such as smoke fans, smoke curtains and smoke dampers are active devices that are
powered from secure electrical supplies or fail-safe devices in the event of being activated by the
fire detection system. Certain systems will be controlled and monitored from dedicated controls
panels. The smoke control systems and devices shall be monitored in conjunction with their
respective secure electrical supplies for operation and fault condition by the intelligent
infrastructure to ensure they are ready to operate or have operated correctly when required.

Fire dampers located in air-conditioning ductwork systems that are fail-safe when activated by
a heat-sensitive linkage shall be monitored for status. This will ensure that during normal
operation, conditioned air is being supplied to all areas and will allow facilities managers to be
alerted if a damper is closed when not required as loss of airflow to critical areas could
compromise patient safety.

4.6 Emergency Lighting

Emergency lighting installed to ensure the safe evacuation of staff and patients will be
powered from a central battery system. Lighting units will be networked together and
monitored from a central management station that will report the failure of any control ballast
or light fitting. The central management system will also provide manual or automatic test
procedures as required by local legislation.

Integration of the intelligent infrastructure with the central management station will enable fault
conditions with the lighting or power supply system to be rapidly reported to the facilities management
team to facilitate a quick response and resolution.

4.7 Disabled Toilet and Refuge

Disabled toilets and disabled refuges will be fitted with alerting systems that will enable a
disabled person who is in difficulties to warn staff of a problem. Local alarm indication will be
installed and integration with the intelligent infrastructure will enable alarms to be distributed
more widely to nurses’ stations and mobile devices as required, thus ensuring maximum
response. This integration will also allow the CCTV system to automatically display the
location of the alarm.

4.8 Elevator Monitoring and Alarms

Vertical transport systems are very important in modern hospitals for providing easy transfer
of patients and equipment throughout the building. Integration of these systems with the
intelligent infrastructure will provide both alarm reporting and life-cycle information.

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Elevator alarms can be integrated with other systems such as CCTV, which may be located in
elevators, to enable the level of response to be managed according to the severity of the fault
and the possible effect on patients, staff, or visitors.

4.9 Water and Gasses Leak Detection

Water leakage is a major safety hazard, as it can lead to flooding, electrical faults, or fires, as
well as increasing the spread of harmful bacteria. A system of liquid leak detection is
therefore required throughout the hospital to identify at an early stage any possibility of
flooding resulting from loss of water by the various components of the water consuming
equipment and distribution systems. Leak detection sensors will be located in specific
locations including hidden spaces, particularly in floor ducts, tunnels and equipment rooms
containing equipment and cabling which may be affected by these events.

The system will alert medical and the facilities staff as appropriate and link to the intelligent
infrastructure to utilize the various means of alarm direction and annunciation to ensure a
rapid response to any situation.

Gas losses are detected through gas sensors that identify sources of danger to persons and
things related to gas leaks (medical and not). Gas sensors also detect the presence of
harmful and/or flammable gases in service environments such as car parks (CO and petrol
vapour), boiler rooms (CO and CNG/LPG) and other locations. The purpose of the monitoring
system is to alert the facilities staff and activate any physical subsystems for counter
measures and to proceed with the orderly evacuation of the premises concerned. In this case,
the equipment, with reference to flammable gases, shall satisfy the requirements of the rules
of the series TO IEC 60079-29, while the capabilities of the system as a whole are regulated
under the general and particular requirements in EN50402 (limited to the garages) referred to
DM 01-02-1986.

The system will alert the medical and facilities staff as appropriate and link to the intelligent
infrastructure to utilise the various means of alarm direction and annunciation to ensure a
rapid response to any situation.

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5 Security

5.1 Introduction

Hospital security provides a unique challenge by the nature of its design and use. Within a
typical healthcare facility, the environment is made up of a wide variety of people: staff,
patients, visitors and physicians. The facility also includes many different departments used
for different activities, as well as high-value equipment, drug storage areas and multiple
entrances. There is also a need to provide, where possible, ease-of-movement around the
building and premises. All these different variables have major impacts on the design of the
security management system.

The intelligent technology infrastructure incorporating the key elements of an integrated

security management system shall provide significantly improved patient, staff and visitor
safety, which will contribute to increased staff productivity and retention and patient
satisfaction. Another key element is the protection of hospital equipment and assets through
the use of RFID technology.

The intelligent infrastructure also provides a platform to accommodate new security

technologies as they emerge without the need for major reconfiguration.

Integrated security technologies which interoperate with each other and interact with the
patient and staff must be deployed in the following key areas:
o Access control
o Digital video surveillance (CCTV)
o Intercom systems
o Intrusion detection
o Staff assault
o Infant tagging
o Patient elopement
o RFID asset protection
o Visitor management
Elements of the integrated security systems are connected to the hospital intelligent
infrastructure, as shown in the Figure 5-1.

Page 33
 BAS security graphical
user interface -
alarms & events
reports CCTV Control
Integrated digital video
station surveillance system
HD IP CCTV cameras

System management &

video recording

BAS VLAN on
hospital FM
network

Hospital Intelligent Infrastructure

DAS BAS
controller controller

Alarm

Alarm
SMS
alarms
Integrated Access
Control

Integrated Baby/Patient
Tagging System Integrated RFID asset
tracking
Integrated intrusion
detection systems

Figure 5-1. Integrated Security Management Systems

5.2 Access Control

Healthcare facilities are complex buildings that by their design contain many different physical
areas or departments. The control and means of access into these different areas vary
depending on the activity within the department. Some areas need to be accessible for large
periods of time by visitors and patients with less control while other areas require high levels
of security with strict control over who gains access.

The integrated access control system will provide the healthcare facility with a controlled
means of access and egress for staff, patients and visitors thorough-out the healthcare
facility, including car parks. The access control and security installations must conform to CEI
EN50133 series standards.

Access control into buildings and departments shall be primarily controlled as follows:-
o Nursing and facilities management staff: Access card readers
o Patients, visitors and unauthorised staff: Video entry, audio entry and remote
release push buttons

5.2.1 Staff

Nursing and facilities management staff members will be provided with their own individually
personalised access cards. The access cards will be programmed to incorporate the
individual’s and/or departmental work group’s access rights.

Individuals or work groups will only be able to access buildings, departments and areas in
which they need to frequent as part of their work routine. Staff requiring entry into a specific
area will present their access card to proximity card readers located adjacent to the access-
controlled door.

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Access will either be granted or denied depending upon whether they are permitted into the
area. If granted, a tone will be emitted and a green LED will be displayed on the proximity
card reader alerting the staff member access has been granted. If access is denied, a
different tone will sound and a red LED will be displayed to notify staff that access through the
door is not permitted. Egress through access controlled doors by staff will generally be via
door release push buttons located adjacent to the doors, although in certain high risk areas,
egress will be via proximity card readers to record the activities on in the areas.

5.2.2 Patients, Visitors and Unauthorised Staff

Patients, visitors and staff will be prevented from certain buildings, departments and areas in
which they require authorisation to enter by access controlled doors. In order to gain entry
into these areas, authorisation is required by the relevant departmental or building staff
responsible for access through the door.

Individuals requiring entry into such areas shall utilise the video and audio entry systems located by
the door to request authorisation. At the door, the individual will press the appropriate button on the
entry unit for the area in which they require access. The entry unit will be linked to a base station or
to a local intelligent staff base unit within the area, generally at a staff base or reception area.

On depressing the entry button, a two-way audio link will be created between the entry
system and base station unit. The base station of the video entry system or the intelligent
staff-base unit will also show an image of the individual requesting entry for identification
purposes. Generally, where audio entry points are installed, identification will be via a CCTV
camera monitoring the door with the output viewed on a monitor located in the vicinity of the
audio base station unit.

Once staff has identified the individual, access will either be granted or denied. If access is
granted, staff will allow entry through the door by depressing the door release push button
located on the audio or video entry base station, or by releasing the door via the intelligent
staff base unit.

Egress through patient, visitor and unauthorised staff doors will generally be via door release
push buttons located adjacent to the doors, although in certain high risk areas, egress will be
controlled by staff via proximity card readers.

5.2.3 High Security

A range of reader technologies can be combined to provide high security. For example, a
proximity smart card reader may be combined with either a PIN keypad or a biometric reader
for access to a laboratory. During a security incident, it is possible to rapidly adjust the
security level throughout the system in accordance with a threat level and, in such
circumstances, staff may be denied access into certain areas, depending on their security
clearance level.

5.2.4 Elevator Control

An elevator control facility shall be provided as part of the intelligent security management
system. The system will be used to restrict access to the elevators, allowing access only to
staff that require the use of the lifts as part of their work routine. The system utilises proximity
card readers and access cards and is programmed as part of the security management
system software.

5.2.5 Staff Personnel Database Integration

In order to reduce the time required to keep the access control system advised of changes in
personnel, it will be possible to automatically populate the access control database from a
central personnel database.

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5.2.6 Visitor Management

Temporary access control for visitors or contractors will be provided from an integrated visitor
management system. Alarms may be generated in case of a range of conditions such as ‘visit
time elapsed’ to ensure unauthorised access is controlled.

5.2.7 Reporting

The intelligent infrastructure is able to report information from the access control system that
can assist in locating personnel during an emergency and provide muster reports in the event
of an evacuation of an access controlled area or building. The reporting system will have
sufficient flexibility to incorporate data from any part of the hospital connected via the
intelligent infrastructure.

5.2.8 Smart Card Technology

Smart cards used for access control will also be used for other purposes. Multiple data
storage sectors on the card will allow them to be used for such tasks as cashless vending,
thereby reducing the number of cards an individual is required to carry. This will result in
greater convenience for staff and reduce the requirement to carry large amounts of cash on
their person.

5.2.9 Energy Monitoring

The access control system will be utilised to for energy monitoring. Certain areas in
departments will have been designated for certain working hours. Using the card access
control system, reports can be generated to establish if the area has been used out of the
designated operating periods. Departments may be used out of hours contributing to
increased energy usage of lighting and electrical power. The access control system can
determine if the operating hours are being upheld.

5.2.10 Pneumatic Tube Delivery System

The pneumatic tube delivery systems, which deliver quick, safe and reliable patient-critical
materials between labs, pharmacies, operating suites, emergency rooms and nurses’
stations, will have additional layers of security added to them. In order to restrict access to the
delivered material, the access control system will be configured to provide a layered level of
access to the system. Depending on the nature of material, access to the pneumatic tube
system will be based on three levels of access, as follows:
o General open – patient records
o Level 2 – medical supplies
o Level 3 – critical drugs

5.2.11 System Integration

The intelligent infrastructure will be capable of managing cause-and-effect interaction

between the access control system and other hospital security systems. If, for example, an
infant tagging system is integrated into the infrastructure, it will be possible in an emergency
to initiate the automatic door locking of critical exit doors. Such integration will help ensure
staff and patient satisfaction within the security of the hospital.

Access control integration can also provide other benefits. Integration between access control
and heating and ventilation controls can be used to provide energy savings based upon
occupation of access controlled areas.

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5.3 Digital Video Surveillance (CCTV)

A video surveillance system is intended to provide visual security and control to important
locations within the hospital such as pharmacies, neonatal wards and car parks. In the event
of an alarm from an intrusion system or other emergency monitoring system, it will be
possible to secure a video recording before and after the event to assist with investigation.

The video surveillance system will be installed and operated to comply with privacy legislation
and according to CEI EN50132 standards.

5.3.1 Digital Video Technology

The digital video system will utilize the intelligent infrastructure to transmit video data from the
camera via the TCP/IP protocol. Data is managed by digital matrices for distribution to video
monitors and digital storage devices. Storage devices are distributed and configured for
maximum security of video data in the event of an interruption of the network or failure of
hardware. Failure of a recording device will automatically result in video data from a camera
being stored on an alternative digital video recorder.

Video analytics software allows the video surveillance system to monitor physical locations for
unusual activity, such as the movement or abandonment of objects or movement through a pre-
configured video zone. In such an event, an alarm can be activated to alert security personnel.

5.3.2 System Integration

Integration of the digital video system into the intelligent infrastructure will enable a more
comprehensive use of the technology. Alarms received from the various integrated systems
connected via the infrastructure, such as fire, nurse call and infant-tagging, can be integrated
with the video display commands to present images onto pre-defined monitors. At the same
time, the recorded video can be secured for review after the alarm has been cleared.

5.4 Intrusion Detection

An intrusion detection system will alarm when specialist detectors are triggered at the perimeter of the
hospital or at locations within the building that need to be secure. The alarms will be monitored from the
hospital control room and may be transmitted to a remote monitoring service. Intrusion systems and
their installation are covered by standards CEI 79-2, 79-3, IEC EN50131 series and EN50136.

5.4.1 System Integration

Integration of the intrusion system into the intelligent infrastructure will allow alarms to interact with
other systems, such as CCTV, and assist security personnel with their investigation of an alarm.
Video recording from cameras in the area of the alarm can be automatically directed through pan,
tilt and zoom settings and can be set to high resolution/high frame rate recording.

5.5 Staff Assault

As staff in modern hospitals face increasing threats from patients and visiting members of the
public, it is necessary to deploy appropriate systems to provide a degree of protection from
such threats. Staff attack systems are wireless-based devices, allocated to vulnerable staff for
them to carry on their person. When activated, they shall be capable of initiating an alarm that
has an immediate, local response using sounders as well as other integrated responses.

Integration via the intelligent infrastructure can allow wider system responses from video
surveillance and other systems. Such integration can create a higher level of staff confidence
in their security.

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5.6 Infant Tagging and Patient Elopement

Vulnerable patients, such as babies and elderly patients, can be protected from abduction or
wandering by tagging and location systems. Tamper-proof tags are secured to the patient and
monitored from wireless transceivers located at exits from secure areas.

Movement of a tag into a monitored location will trigger an alarm at a local management
station and via local sounders.

Integration via the intelligent infrastructure to other systems will allow a more comprehensive
response in the event of such an alarm occurring. The access control system can be signalled
to lock a sequence of doors and the video surveillance system can be initiated to present
video on pre-defined monitors as well as securing video data for analysis.

By integrating in this way, a more secure environment can be maintained for staff and patients.

5.7 RFID Asset Protection

The use of radio frequency tags to identify and locate important equipment can have a
number of benefits. A range of wireless technologies can be deployed together with powered
and unpowered tags depending on the nature of the asset being monitored.

Assets can be located when scheduled maintenance is required on batteries or other components.

Assets can be protected from being removed from the hospital by

unauthorised individuals.

Emergency equipment can be located quickly when required to ensure patient safety.

Integration via the intelligent infrastructure with other systems, such as video surveillance, can
allow equipment to be watched using video analytics as well as RFID for maximum security.

Page 38
6 Operating Suites
The intelligent building infrastructure brings together multiple systems to ensure that the
quality and performance of services within the operating suites operate at maximum efficiency
to provide:
o Quality electrical and mechanical services
o Maximum availability of electrical and mechanical services
o Improved energy efficiency
o Improved staff productivity and satisfaction
o Improved patient satisfaction
The intelligent building infrastructure impacts the operating suite by enhanced performance of
the mechanical and electrical services, and presents the information via an intelligent touch
screen display as outlined in Figure 6-1.

Figure 6-1. Operating Room Layout with Service Details

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6.1 Electrical Power

Electrical power availability and quality are crucial to the safety of patients in the running of an
operating room. The operating room’s electrical installations must ensure continuity of care
and provide protection against electric shocks under all circumstances. The design of the
system to be implemented must therefore meet the following criteria:
o Design that fulfils the most stringent requirements in terms of reliability (reliable
products and approved electrical architecture)
o Increased reparability to limit downtime (easier troubleshooting, equipment
standardization, automatic alarms and remote diagnosis tools)
o Advanced monitoring of each room, allowing medical teams to make relevant
decisions in the event of major faults (important information display)
o Full traceability of alarms and events, allowing maintenance teams to make an
analysis
o Access to critical information for the maintenance staff
o Connection of switchboards to the intelligent hospital infrastructure network and
full interoperability with the other connected management systems (HVAC,
electrical distribution, security and access control)
The electrical installation shall comply with, or exceed, international or local medical standards.

The secure, tested and validated power distribution and monitoring solution shall consist of:
o An electrical cabinet for each operating room, installed on the periphery of the
operating room.
o An interactive information and monitoring touch screen panel installed in each
operating room.
o An operating room monitoring system, consisting of software programs installed
on the computer used by the supervision staff (head nurse) and displaying the
electrical and environmental conditions in each operating room. The
maintenance staff shall have the same information as the supervision staff
available via their own computer and shall be notified of any fault by text
message.
o An operating room monitoring system to allow the maintenance staff to view the
electrical and environmental conditions in each operating room.
o A UPS, if required, connected upstream of each operating room electrical cabinet.
The operating room electrical cabinets shall be interconnected in a data network (via their
acquisition, processing and communication modules) and connected to the intelligent hospital
infrastructure network to allow the supervision and maintenance staff to access the data and
to be connected to the heating, ventilation and air-conditioning system.

Page 40
6.1.1 System Description
The operating room is a room used for medical purposes and, consequently, it must comply
with the following criteria:
o Satisfying criticality level 1 (changeover < 0.5 s)
o Electric shocks in conformance with group 2
An overview of the system is shown in Figure 6-2.

Normal supply Emergency supply

Hospital BMS
UPS
Supervisor PC

Source changeover Maintenance PC

Monitoring Mobile
system phone

TNS system IT system Magelis touch

screen panel

Secondary supply Sockets for medical devices

Figure 6-2 Integrated Operating Theatre System Schematic

The operating room electrical cabinet shall be installed in the operating room corridor or in the
vicinity of each room.

It shall be possible for the protective devices to be controlled by the maintenance staff,
without risk of direct contact.

To ensure a high level of fault discrimination and increased power availability, a large number
of circuit breakers shall be used to protect short, separate circuits, in particular for the power
outlets (wall outlets or surgical/anaesthesia pendants):
o One circuit breaker per outlet
o One circuit breaker per group of three outlets, maximum
All the operating room electrical cabinets shall be wired and physically organised in the same way.
o The wiring shall be neatly installed in conformance with the recommendations of
IEC 60364-4-4-44, IEC 61000-6-2 and IEC 61000-6-3.
o The power and communication circuit routing shall be completely separate.
o Propagation of electrical fields shall be prevented by physical separation
systems (in accordance with IEC 61439-1).

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6.1.1.1 Environmental Conditions (Operating or Electrical Room)
o Situation: Indoors
o Altitude: ≤ 2000 m
o Maximum ambient temperature: 30°C
o Maximum relative humidity: 90%
o Power dissipated by the switchboard: 465 W
o Maximum sound level: Less than 30 dB, measured 1.0 m from the ground

6.1.1.2 Electrical Data

o Operating voltage: 230 V AC
o Operating frequency: 50-60 Hz
o Operating current: 63 A
o Prospective line Isc: 25 kA
o Neutral systems: IT and TNS
o 1 or 2 Transformer: 6.3, 8, or 10 kVA
6.1.2 Standards
The installation shall comply with the following standards:
o IEC 61439-1 and -2: "Low-voltage switchgear and control gear assemblies -
General Rules" and "Low-voltage switchgear and control gear assemblies -
Power switchgear and control gear assemblies."
o IEC 60364-7-710: "Electrical installations of buildings - Requirements for special
installations or locations - Medical locations."
o IEC 61557-8: "Electrical safety in low-voltage distribution systems up to 1000 V
AC and 1500 V DC - Equipment for testing, measuring or monitoring of
protective measures - Part 8: Insulation monitoring devices for IT systems."
o IEC 61558-2-15: "Safety of power transformers, power supply units and similar -
Part 2-15: Particular requirements for isolating transformers for the supply of
medical locations."
o IEC 60364-4-44: "Low-voltage electrical installations - Protection for safety -
Protection against voltage disturbances and electromagnetic disturbances."
o IEC 61000-6-2: "Electromagnetic compatibility (EMC) – Generic standards –
Immunity for industrial environments."
o IEC 61000-6-3: "Electromagnetic compatibility (EMC) – Generic standards –
Emission standard for residential, commercial and light-industrial environments."
The obligation to use the isolation transformer for medical use (EN-M) concerns only the
medical locations belonging to Group 2 and the related equipment situated in the patient area
or may enter the area.

Telephones and plugs installed inside the patient area, the lamps’ and scialitiche plugs that
breed appliances that can enter the patient during their use, should all be fed from the
transformer EN-M.

This system of power, in addition to ensuring a high level of safety in single fault isolation,
also allows improved continuity of service.

For this reason, it can be used also in local Group 1 and 0, at request of the designer and/or
health director or in establishments in forecasting future may change the intended use and fit
into those classified in Group 2.

6.2 Ventilation System

No area within the hospital requires more careful control of the aseptic condition of the
environment than the operating suite. The systems serving the operating suites need careful
design to minimise the concentration of airborne organisms. The systems shall be designed
and operated to ensure that both the availability of systems and quality of fresh air is at a
maximum. The system should be designed to provide the following functions:

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 o To dilute airborne contamination
o To control air movement within the suite and minimise the transfer of airborne
contaminants from less clean to cleaner air
o To control the temperature and the humidity of the space
o To ensure maximum availability through redundancy
6.2.1 Airborne Contamination
Within the operating theatre, there are four ways in which airborne containments can enter:
o Through the supply air
o Shed by operating staff
o Through surgical activities
o Transferred from adjacent spaces
Through the intelligent building infrastructure, systems can be implemented to help aid in the
reduction of routes for which airborne containments can travel.

6.2.1.1 Filtration

To maintain the strict regulations for outdoor air changes, the main ventilation system shall
provide fresh air into the operating room at a fixed volume, as defined in Figure 6-2. The fresh
air will pass through a series of filters installed in the main section of the ventilation system
which will reduce the level of airborne contamination in the air stream.

The filtration will be provided in stages, as described below:

o The first stage of filtration shall be via a general panel pre-filter, with a grade no
lower than G4. The pre-filter shall be provided to remove the heavier particles
found in the outdoor air. The particles which are removed by the pre-filter will
reduce the chance of particles blocking heater battery coils or settling in the air
distribution system.
o The second stage of filtration will be via a bag filter, with a grade no lower than
F7. The bag filter shall be provided to remove the very fine particles before the
air is supplied into operating theatres.
o Additional filters may be provided at grilles, dependent on the nature of the
operating theatre.
o The extract duct shall also be fitted with a panel filter, with a grade no lower than
G4, to remove the particles before been discharged into the outside air.
All filters will be monitored so that once they become dirty, maintenance teams can be notified
and clean filters can be installed.

To ensure that the operating theatre is supplied with the correct air volume to satisfy the air
change requirements when filters become dirty, the frequency inverters, fitted to the fan motors,
will automatically be ramped up to a higher speed.

The “dirty” status of filters and frequency inverter speeds will be logged so reports can be
generated to show increased energy usage from the dirty filters.

6.2.1.2 Ultraviolet Lamp System

High-output UVC emitters shall be installed in the supply ductwork to provide ultraviolet
germicidal irradiation (UVGI) to interrupt the transmission of pathogenic organisms, such as
mycobacterium tuberculosis (TB), influenza viruses, mold and possible bioterrorism agents.

The UVC emitters are to be mounted inside the ventilation duct, confining the UV energy to
the inside of the duct. A safety interlock will be needed, so if the fixture is removed from the
duct or an access door is opened, the lamps turn off to avoid accidental human exposure to
UV energy.

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The UVGI systems will be utilised to irradiate cooling coils, drain pans and other HVAC
components, and to disinfect the moving air.

6.2.2 Air Movement Control

The system should be designed to minimise the movement of contaminated air into clean air
supplies. From the central ventilation system, the volume of air supplied and extracted from
the areas should be maintained at the design volume set points to achieve the required air
changes as defined in Figure 6-2. Any deviation away from the designed volumes could lead
to changes in air movement within the operating suites. The air volume of the ventilation
system should be monitored by sensors in the main ductwork and the speed of the fans
should be variable to ensure that the designed loads are maintained.

In addition to transfer grills and pressure stabilisers, differential pressure sensors can be
installed to ensure that the pressure regimes are maintained and that they provide a local
display of current stats and visual and audible alarms to notify staff.

Monitoring of the doors will alert staff when doors have been left ajar, causing changes in the
pressure regime. Door contacts will be installed on the doors to allow staff to act upon doors
left open. The door contact can also be used to provide the air locks between zones in the
operating suite.

6.2.3 Control of temperature and Humidity

The ventilation system needs to be designed to ensure that the comfort levels of the medical
staff and patients are satisfied. The temperature and humidity should be closely monitored
and controlled by the control system to meet the design conditions as detailed in Figure 6-2.

All room air

Min. outdoor Min. total Air recirculation Design Design
Pressure exhausted
Function of space air changes air changes by means of relative temp
regime directly to
per hour per hour room units humidity (%) (°C)
outdoors

Class B and C
Positive 4 20 N/R No 20-60 20-23
operating room

Operating / surgical
Positive 4 20 N/R No 20-60 20-23
cystoscopic rooms

Class A operating /
Positive 3 15 N/R No 20-60 21-23
procedure room

6
Figure 6-2. Recommended Environmental Conditions

The medical staff should be provided with the ability to adjust the environmental conditions for
temperature and humidity to improve the comfort levels of the staff and patient as well as
when any specialised procedures, such as cardiac surgery for treating burn patients, are to be
carried out. Additional heating and cooling systems downstream of the main ventilation will be
needed for operating suites which carry out specialised procedures.

Sensors which are installed in actively ventilated areas of the operating suite (such as sampling
ducts) and can be easily accessible for maintenance, continually monitor the environment and
provide active controls for the main ventilation system. The current signals of the sensors are also
displayed on the intelligent touch screen display for the medical staff. The environmental
conditions are also displayed at the staff base areas and at the facilities engineer’s workstation.

6
taken from ASHRAE Standard 62.1-2010 – addendum ‘d

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6.2.4 Redundancy of Systems
Due to the complexity and cost of the procedures which take place in operating suites, it is
important that the ventilation system is designed to provide the maximum availability for
patient safety and for hospital budgets. A failure of the ventilation system serving the hospital
can lead to losses in hospital budgets due to lost revenue and unavailability fines for the
facilities contractors.

The ventilation systems should be designed with redundancy. There should be duty and stand-by
fans installed on the supply and extract fans. The variable frequency drives connected to these
fans should be configured so that, on a failure of a duty fan, the standby fan automatically starts.

The variable frequency drives should also be monitored remotely for maintenance purposes.
The current of the motors should be monitored, so when current figures begin to vary,
maintenance teams can be sent to investigate and eliminate problems (for instance, belt
slippage) before they occur and cause unscheduled loss of services.

The facilities teams should also be able to override the control system and keep the
ventilation system operating until at least the surgical procedure is complete. Manually
starting ventilation fans should allow the system to operate in a safe manner. For instance, all
safety locks associated with the system are healthy.

6.3 Booking Systems

6.3.1 Scheduling with Intelligent Building Infrastructure
The operating suites are typically not in use all the time – in general, they will operate no more
than 8 to 12 hours per day. Trauma centres and emergency departments are the exception. The
long periods when the operating theatre is not in use allows the facilities teams to take advantage
of energy conservation measures.

The ventilation systems can run in reduced modes, providing the positive pressure regime is
maintained, and the ventilation volume set points can be reduced to allow for reduced power
consumption of variable frequency drives. The environmental conditions can also be relaxed
and maintained at the minimum settings to reduce the energy consumption of heating coils.
The system would not provide cooling or humidity control during the reduced mode.

Should any of the environmental or pressure settings vary significantly from the design conditions,
the ventilation system will automatically return to normal operation.

Integrating the theatre booking system with the intelligent building infrastructure will allow the
ventilation system to operate in a reduced mode when the suite is not is use as defined by
actual booked surgical procedures.

The information will be shared both ways so that when a ventilation system needs to be put
into maintenance mode, the information will automatically update on the theatre booking
system database.

6.4 Monitoring and Display

6.4.1 Interactive Touch Screen
An intelligent integrated touch screen within the operating suite will provide the medical staff
(surgeons and nurses) with visual and audible information on the current status of services within the
room. The interactive touch screen will show the state of the electrical installation and information
regarding the environmental conditions. Audible alarms will be configured to warn the medical staff
of any conditions which could cause a detrimental effect to the safety and care of the patient.

The touch-sensitive screen approved for use in medical areas will have an ingress protection
level of IP67 and be suitable for cleaning and disinfection.

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Figure 6-3. An Intelligent Operating Suite Touch screen Preset screens allow the operator to view
and adjust the operating rooms environmental conditions set points (temperature and humidity) as
required by the different surgical operations to be carried out. The main ventilation system will
respond to the change in set points.

Information and alarm conditions from the main ventilation system will be displayed on the
touch screen.

An example of the information, functions and alarms available on the touch screen are:
o Electrical installation status
o Electrical installation alarms
o Ventilation operating in normal or reduced mode
o Ventilation system failed to operate
o Temperature and humidity values
o Temperature and humidity setpoint adjustments
o Filter dirty alarms
o Low humidity conditions
o Medical gas alarms
o Pressure regime conditions in room
o Doors left ajar
o Generators running
o Transformer isolation test
o Trend logs
All data (temperature and humidity logging, variation, exceeding alert thresholds, settings and so
on) will be stored and archived to provide audit and reporting of the operating room conditions.

The touch screen panel should be provided with a dedicated button which will carry out a
transformer isolation test and verify the actual operating safety.

6.4.2 Monitoring External to the Theatre Room

The external monitoring system will be at the staff bases and will be used to display the
electrical and environmental conditions in each operating room, providing real-time
information and traceability features.

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Figure 6-4. Remote Viewing of an Operating Suite

The purpose of the operating suite monitoring system is to allow the maintenance staff to view
the electrical and environmental conditions in each operating room, as well as current alarms
and events.

The maintenance staff can then identify the fault by connecting to the communication module of
each cabinet from any computer connected to the hospitals intelligent building infrastructure.

6.5 Remote Access for Maintenance Purposes

The maintenance staff shall be notified by text message whenever a fault occurs in an
operating room electrical cabinet.

The text message shall contain a text with the number of the operating room and the type of alarm.

When the operator acknowledges an alarm, information shall immediately be sent to the
touch screen panel in the operating room in question.

More detailed information shall be available from any computer and it shall be identical to that
provided to the supervision staff. Fault acknowledgement and the corrective action taken shall
be displayed on the screen located in the operating room. It shall be possible to generate an
event log.

The unavailability time of the isolated transformer outlets during an operation shall be < 0.04
minimum/year.

6.6 Medical Gas Monitoring

The intelligent building infrastructure will provide monitoring of all the medical gases used
in the operating theatre. The medical gas systems will be monitored by the intelligent
building management system in the operating suite and in the main service buildings.
When any alarm is generated, the alarm will be replicated at the effected operating
theatre touch screens and the maintenance staff will be informed.

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7 Medical Wards

7.1 Principles

An intelligent technology infrastructure in hospitals incorporates the principles of evidence-based

design to provide a significantly improved healthcare and recovery environment. The intelligent
infrastructure will be the foundation for improving energy efficiency, increasing patient and staff
safety, increasing patient satisfaction, assisting in patient recovery, increasing staff productivity
and helping staff retention. The intelligent technology infrastructure will be utilised throughout the
healthcare facility, from the energy centre to the patient room, ensuring the highest level of system
performance and providing the optimum patient comfort levels.

This infrastructure also provides a platform to accommodate new technologies as they

emerge without the need for major reconfiguration.

To achieve a significantly improved healthcare environment, integrated technologies will be

deployed which interoperate with each other and interact with the patient and staff in the
following key areas:

7.1.1 Energy Efficiency

o Occupancy-based functionality of services
o Intelligent, interactive patient and staff interfaces
o Intelligent metering and monitoring of consumption
o Enterprise level energy management and benchmarking

7.1.2 Patient Safety

o Security systems
o Infection control measures
o Life safety systems
o Nurse call systems
o Real-time location systems

7.1.3 Patient Environment

o Patient control of micro climate (temperature, light level, humidity and security)
o Air filtration and quality
o Acoustic monitoring
o Entertainment and communications
o Facilities for visitors

7.1.4 Staff Productivity and retention

o Integrated, skills-sensitive nurse call and workflow management
o Intelligent integrated staff base systems
o RFID locating systems
o Predictive maintenance technology
o Increased levels of automation to reduce workload
The various levels of technology deployment are illustrated in Figure 7-1:

Page 48
 Management

Medical Facilities Environmental

overview overview overview
Operational views

Patient Staff base Operating Workflow 24/7 Integrated Life Energy

interface theater Remote security systems analysis
access

TCP/ IP backbone
Open protocols
Integration

Wireless mesh networking

Automation/ interoperation between systems
Linked to a common IP based communications
infrastructure

Patient environment Patient safety Energy efficiency Staff productivity

Security Occupancy-based functionality Integrated workflow management
• Smart sensors
• Access control, intrusion detection • HVAC • Centrally controlled nurse call
• Temperature and humidity
Devices and functionality

• CCTV, intercom • Lighting and daylight linking • Intelligent task routing

• Air quality control and filtration
• RFID location systems • Non-essential power • Mobile audio interface
• Light and acoustic levels
• Setback operational modes
• Smart user interface Infection control Integrated staff base
• Android smart phone • Android smart phone Intelligent patient & staff interfaces • Central activity log
• Interactive touchpad • Air quality control and filtration • Behavioral change displays • RFID equipment location
• IP • Automatic water flushing • Green patient options • 3D user friendly interface
• iPod physical connections
• Web pages Life Safety Intelligent metering & monitoring Predictive maintenance technology
• Entertainment • Fire & smoke detection • Electricity • Intelligent alarms
• Communications • Gas leakage detection • Heating/ cooling • Failure prediction software
• Advanced incident management • Water consumption • Workflow integration
• Critical power Enterprise energy management Increased automation
• Nurse call
• Energy dashboard • Manual tasks automated centralized control
• Energy alarms functions

Figure 7-1. Intelligent Technology Infrastructure for Medical Areas

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7.2 Devices and Functionality

The key to the deployment of advanced technologies in medical areas is the delivery of
progressive evidence-based design features through the use of open, internationally
accredited communications standards that are linked by a robust infrastructure and provide
the intelligent interoperation of systems and high availability of services to patients and staff.

7.3 Patient Environment

Improving the patient environment is a key factor in improving patient recovery rates. The
main aspects of the patient environment where the intelligent technology infrastructure
performs a key role are:
o Thermal environment
o Lighting/daylighting environment
o Acoustic environment
o Air quality/cleanliness
o Infection control
o Entertainment and communications
o Clinical services
The intelligent control and monitoring of these aspects provide an overall environment which
mitigates patient anxiety, maximizes patient comfort and saves staff from performing time-
consuming tasks relating to these aspects of the patient environment that may reduce the
overall standard of care.

The concept is illustrated in Figure 7-2.

Figure 7-2. An Integrated Patient Room

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The patient is provided with a touch-sensitive interface which provides a full range of
entertainment, communications and clinical functions. The interface has a user-friendly menu
system for control of temperature, lighting level and individual light fittings, which are linked with
automatic solar blinds to provide maximum natural light levels to aid recovery as well as save
energy. Scene setting functions and medical staff override facilities will provide correct light levels
for any medical treatment or examination. The interactive user controls will also display
information on the calculated environmental impact of changing settings, such as the daily amount
of carbon saved or used for each degree of change requested. The screen must have a minimum
ingress protection level of IP67, be suitable for cleaning and disinfection and certified for use in
healthcare premises.

The advanced technology infrastructure will also support the use of the android operating
platform for personal communication devices with applications specifically designed to
provide user controls for the patient environment, which would allow patients to connect to the
infrastructure from their mobile handsets.

Connections for visitors to attach personal computing and communications equipment are
also required to encourage family stays in response to studies showing that families who visit
frequently and stay longer are more involved in patient care, helping to improve patient well-
being and facilitate healing.

To ensure an optimal patient environment is provided, sensors must be installed to centrally

2
monitor air quality in terms of CO, CO and airborne contaminants such as volatile organic
compounds (VOC). The system must also be capable of monitoring acoustic levels to ensure
good acoustical conditions are maintained, which have been recognized for improving patient
recovery rates as well as staff health and efficiency. The U.S Green Guide for Healthcare and
LEED Healthcare both include acoustical design credits.

7.4 Patient safety

Patient safety is one of the top concerns of healthcare organizations. The main aspects of the
patient safety where the intelligent technology infrastructure performs a key role are:
o Integrated security systems
o Infection control
o Life safety
o Nurse call integration
o Real-time location systems

7.4.1 Integrated Security System

Integrated security systems allow all aspects of hospital’s security systems to interoperate
with each other to improve to overall level of security for patients, visitors and staff as well as
improving the productivity of facilities and security personnel. The types of functionality
provided include:

7.4.1.1 CCTV
o Cameras automatically pan, tilt and zoom to points of intrusion, forced entry,
theft, infant abduction or personal attack alarm activation and record in high
resolution.
o Intelligent video analytics can identify obstructions or dangerous objects in busy
areas and use recognition techniques to identify undesirable persons seeking to
gain entry.
o Live images can be viewed remotely by police and/or routed to handheld
devices carried by security staff.
o Video intercoms can be integrated in an intelligent staff base touch screen
interface.

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7.4.1.2 Access Control
o Areas can be locked down in the event of attack, theft or infant abduction.
o Levels of security can be automatically changed in accordance with general
threat level.

7.4.2 Infection Control

Infection control can be improved in a number of ways through the intelligent infrastructure:
o Linking sensors in soap dispensers with staff entry to patient areas with either a
reminder alarm if hand washing has not been exercised or simply monitoring,
reporting and displaying the amount of hand washing per department to drive
improvements in hygiene through increased compliance.
o Accurate monitoring of filtration and airborne contaminants, which can alert
medical staff as well as facilities staff if any facilities related event, such as
negative pressure failure in isolation wards or other situations that could impact
patient safety.
o Automatic flushing of water systems based on temperature and flow volume
over time to prevent the growth of bacteria and save the work of periodic
manual flushing.

7.4.3 Life Safety

Life safety systems can interoperate with other systems to improve patient safety by:
o Interoperation of fire detection with CCTV and lighting for verification. For
example, in technical areas where electrical switchgear is located.
o Interoperation with staff base systems to identify which patients need assistance
to evacuate the building.
o Interoperation with digital signage to inform patients, visitors and staff of escape
routes and assembly points in three-dimensional walkthrough graphics.
o Monitoring of medical gas leakage combined with intelligent alarm routing to the
facilities and medical staff.
o Common holistic incident view of the entire hospital, providing a clearer picture
for more effective management and faster response.
o Advanced control and monitoring of critical power applications to provide higher
availability and reduced risk of adverse events.

7.4.4 Nurse Call

The nurse call system can interoperate with patient and staff attack systems to utilize the
audio communications infrastructure, provide clearer information and reduce false alarms.

7.4.5 Real-Time Location System

RFID location systems can interoperate with the intelligent infrastructure to improve patient
safety by:
o Alerting staff to patient elopement where certain patients may be at risk of self-
harm. Integration with access control and CCTV, staff base and intelligent alarm
routing in such cases can assist a rapid response.
o Tracking of hazardous materials to ensure patients and staff do not come into
contact with them and to raise appropriate alarms and guide responses to any
situations where hazardous materials are located in areas which may
compromise safety.
o Locating equipment, especially emergency life saving equipment, with
integration to staff bases and mobile communications devices.
o Detection and alarming of patient accidents or falls and interlinking with CCTV
and intelligent video analytics to identify, for example, a body on a floor.

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7.5 Energy Efficiency

Energy efficiency is a key area where healthcare organizations can reduce costs and improve
financial performance without compromising care or reducing staff. The advanced levels of
automation and information provided via the intelligent technology infrastructure perform a
key role in this. The main aspects are:
o Occupancy-based functionality
o Intelligent patient and staff interfaces
o Intelligent metering and monitoring
o Enterprise energy management
Occupancy-based functionality allows medical areas to function in a setback mode when
patients and staff are not present or the area is not in use. This can range from reduced air
change rates and control tolerances in operating rooms to a full shutdown of all services in
offices or examination rooms when not in use. The areas where the intelligent infrastructure
will provide occupancy-based functionality are listed below.

7.5.1 Heating, Ventilation and Air Conditioning (HVAC)

HVAC services in patient areas can function according to occupancy, which is detected
through a combination of motion detection, links to nurse call system to indicate which areas
are in use 24 hours, RFID verification and access control. When an area is unoccupied, a pre-
determined set back mode will be adopted automatically depending on the type of medical
area, which reduces air and water flow to services. Other simple interoperation can also take
place such as when windows are opened, the air-conditioning can switch off.

7.5.2 Lighting

Lighting/daylight linking will function according to occupancy and automatically dim or switch
off lights when an area is unoccupied. Interoperation with solar blinds can reduce glare and
excessive solar gain, whilst maintaining the maximum amount of natural light to save energy
and aid patient recovery.

7.5.3 Power Circuits

Non-essential power circuits can be deactivated when areas are not in use as electrical loads
in unoccupied, non-critical areas can be as high as 30% due to non-essential equipment
being left running.

7.5.4 Patient and Staff Interfaces

Intelligent patient and staff interfaces will act to inform and encourage behavioral change
towards energy efficiency in the following manner:
o Energy and water consumption can be displayed at staff bases and via digital
signage by department and against targets and benchmarks to raise awareness
and promote efficiency.
o Patient controls will inform the patient of the environmental impact of changes to
settings, which in certain European countries gains green design credits.
Intelligent metering and monitoring of the utilities consumption in individual medical areas provides
vital information to facilitate monitoring and targeting of the utilities consumption. The data
collected will be used at local level as described previously and at an enterprise level as follows:
o Energy/utilities dashboards identify key consumption data for the entire facility
against targets and benchmarks with user friendly, intuitive drill-down facilities to
building, department or individual medical areas.
o Energy/utilities alarms can activate when consumption exceeds pre-determined
levels which demand investigation and possible rectification.

Page 53
7.6 Staff Productivity and Retention

Staff productivity and retention are key concerns for healthcare organizations and the advanced levels
of automation and information provided via the intelligent technology infrastructure perform a key role in
improving both. The main aspects are:
o Integrated workflow management
o Integrated staff base systems
o Predictive maintenance technology
o Increased automation
Integrated workflow management intelligently routes real-time information and scheduled tasks to
the correct staff through the technology infrastructure via the most effective means in terms of
voice- or text-based instructions. These are sent directly to staff bases or mobile communication
devices such as Digital Enhanced Cordless Telecommunications (DECT) or personal digital
assistants (PDAs). Integration with the nurse call system is a key interface which increases
productivity through direct audio communication with the patient to identify the need and instigate
a more efficient roles-based response through the workflow system. Patient requests are triaged
either from a central operator, staff base or directly to the caregiver’s mobile communications
device, depending on the nature and scale of the particular medical area. Facilities related calls or
faults will be directed to facilities staff and real-time exchange of information between medical and
the facilities workflow will identify the completion of tasks as well allow medical staff to concentrate
on patient care issues. All events, activities and interactions are logged and are date and time
stamped to provide a complete audit trail, which will provide management with powerful tools to
improve services and the standards of patient care.

Integrated staff base systems provide a holistic, interactive view of each department or
medical area. The concept is illustrated in Figure 7-1.

Integrated staff base

• Life safety alarms
• Nurse call and workflow
• Facilities alarms
IP/VoIP connection

• Energy consumption data

• Security alarms
• Central control and adjustment
• Voice intercom
DECT PDA RFID • RFID location

Intelligent infrastructure

Security HVAC system & Medical gas Safety systems

systems patient system
environment Nurse call
systems

Figure 7-1. Intelligent Integrated Staff Base

Predictive maintenance technology forms part of the intelligent infrastructure and allows
facilities staff to carry out preventative maintenance on equipment in most need and to reduce
to amount of reactive maintenance required. Key functions of the predictive maintenance
technology are:
o Intelligent alarms whereby the inbuilt intelligence and diagnostics in devices is
unlocked through connectivity with the intelligent infrastructure and generates

Page 54
 intelligent alarms which give advanced notification of impending problems or
potential failure. Examples of these are excessive wear on switchgear contacts,
electric motors time to trip alarms from frequency inverters and abnormal
operating conditions.
o Operational data and alarms will be sent directly to workflow engines to enable
prioritization and appropriate response. Central analysis is made possible due to
the improved quality of information available. Many call outs can be avoided or
tasks can be grouped to allow more efficient working.
Increased automation is a key feature used to improve staff productivity and retention. Firstly,
mundane or repetitive manual tasks are negated such as opening and closing of window
blinds, periodic flushing of water systems, manual meter reading and equipment checking or
simply trying to locate people and equipment. Secondly, human error is reduced through
automation, which can result in improved efficiency and patient satisfaction. Automation will
also reduce workload at the management level through the production of automated reports,
which in some cases can help with joint commission compliance reporting.

7.7 Integration

Integration and interoperation take place throughout the intelligent infrastructure at the various levels
of the system and use appropriate communication techniques as best fits their respective
applications. In medical areas, integration and interoperation will take place mainly at device level,
where devices use a common open communications protocol which allows them to share
information directly with each other and thereby interoperate in the most effective manner possible.

The intelligent communications infrastructure will comply with the following standards:
o EMC Directive 89/336/EEC
o ISO 16484-5 and CEN TC247 at management and automation levels
o The IEEE 802.15.4 standard for wireless sections of the field network, with a
frequency range of 2.4 GHz
o CE 89/336/EWG Electromagnetic Compatibility & CE 1999/5/EC Radio and
Telecommunications Equipment Directive for wireless sensors or field devices
The intelligent communications infrastructure will use the following methods of connectivity to
achieve interoperation:
o Full native compatibility where systems and devices communicate with one
another at the network level without the use of gateways or similar devices, use
the same programming language and can be configured via the same computer
GUI.
o Open protocol compatibility where systems and devices from different
manufacturers share information using a common open protocol and
communicate at a peer to peer level.
o API links where systems and devices communicate via the Ethernet network
using application programming interface covering routines, data structures,
object classes and protocols.
o Protocol interfaces where the intelligent infrastructure communicates with
systems and devices systems using industry standard protocols such as
BACnet, LonWorks (LON), Modbus RTU or ASCII to RS485 networks or RS232
connections via a network controller. This may be full duplex where information
can be sent and received or simply a one-way data interchange for monitoring
purposes.
o Hardwired interfaces where the intelligent infrastructure uses field direct digital
controllers (DDC) to connect to volt-free contacts and control circuits.
Where wireless field networks are utilized for the DDC controllers, these shall be based on
the IEEE 802.15.4 standard, using a frequency range of 2.4GHz. Each node shall function as
a router and the mesh network shall have a proactive discovery function to constantly search
for and remember optimal linkages, providing a diverse routing capability. A wireless network
graphical commissioning and maintenance tool shall be used, where network display screens
graphically present the mesh network, all the devices in it and their connectivity levels. The

Page 55
ability to map the wireless network onto floor plans shall be provided to accurately reflect the
location of each wireless node.

Further information on integration is provided in Section 10 of this document.

7.8 Operational and Management Views

The intelligent infrastructure will connect to a number of integrated, interactive graphical user
interfaces to provide operational and management views to facilitate reporting and analysis of
data depending on the competence and authority of the user.

At a minimum, dedicated views will be provided for:

o Operating theatres
o Workflow
o 24/7 remote access
o Integrated security
o Life safety
o Energy
o Facilities management
o Environmental management
o Medical staff management
Each view will present overview information and contain user-friendly intuitive drill-down
facilities to department and medical area levels.

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8 Energy Efficiency

8.1 Introduction

The scope of this section covers the impact on energy efficiency and water consumption of
the active measurement and control facilitated by a fully integrated intelligent technology and
service infrastructure. Such an infrastructure will provide significant further savings in the
region of 10-15% over the accepted good design practice for a modern healthcare facility.

These further savings will be achieved in the following key areas:

o Active controls
o Occupancy-based interoperation of HVAC, lighting and power
o Advanced control techniques with increased levels of energy-saving automation
o Advanced technology
o Intelligent, interactive patient and staff interfaces to encourage energy efficiency
through behavioural change
o Advanced measurement
o Smart metering infrastructure
o Self-metering devices
o Advanced management and services
o Intelligent data analysis
o Real energy performance distributed dashboard techniques
o 24/7 remote specialist energy services
o Enterprise-level energy management and benchmarking
o Efficiency-based the facilities intervention
An illustration of the breakdown of anticipated energy use based on good practice design for a
new acute hospital with over 500 beds is shown in figures 8-1 and 8-2.

Hospital energy consumption

38% 34%
Fossil fuel heating

Fossil fuel base load

Electricity lighting

Electricity other

14% 14%
Further savings
10 -15%
7
Figure 8-1. Energy Consumption in a Hospital

7
Healthcare Buildings End Usage U.S Average. www.greenenergypayback.com

Page 57
 Electricity other breakdown

5% HVAC
6%
Other
35%
ICT data centre
21%
Supplementary heating
Personal small power

4% Medical equipment
Catering
10% 19%
8
Figure 8-2. Breakdown of Other Electricity Consumption

Notes: Fossil fuel base load is made up of domestic hot water services and process loads
such as sterilizers and distribution losses.

8
United Kingdom Department Of Health Energy Efficiency Guide. no.72

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The following table illustrates how the integrated technology and service infrastructure will
impact hospital energy consumption:

Energy use Active Advanced Advanced Details

controls measuring services

Heating Occupancy-based interoperation to set

back heating when not required

Interoperation with solar shading to

account for solar gain and set back
heating accordingly

Efficiency- based primary energy plant

control

Intelligent heat metering and corrective

actions

Behaviour-changing user controls

Base load Intelligent metering and usage pattern

analysis

Lighting Occupancy-based interoperation to dim

when natural light is available and
interact with solar shading

Intelligent metering and corrective

actions

High-frequency switching of external

lighting

HVAC Occupancy-based interoperation to set

(Electricity) back cooling when not required

Interoperation with solar shading to

account for solar gain and set back
heating accordingly

Efficiency-based primary energy plant

control

Intelligent heat metering and corrective

actions

Behaviour-changing user controls

Catering Intelligent metering and monitoring

Page 59
Energy use Active Advanced Advanced Details
controls measuring services

Other Occupancy-based interoperation to set

building back mode where applicable
services Power factor and advanced power
quality analytics and management
Smart grid utilisation
Enterprise-level energy management
functions
Load shedding
Maximum demand control

ICT data Fully integrated data centre physical

centre infrastructure (cooling, power, UPS,
security and data management)
Load balancing
Heat reclaim systems
In-row cooling
Advanced enterprise-level monitoring
and management

Electric Occupancy-based interoperation to set

heating back heating when not required
Interoperation with solar shading to
account for solar gain and set back
heating accordingly
Intelligent heat metering and corrective
actions
Behaviour-changing user controls

Personal Occupancy-, time schedule- or

small power maximum demand-based circuit
activation/deactivation

Intelligent metering

Medical Intelligent metering and monitoring

equipment

It is essential for a modern hospital to focus on the energy efficiency of its facilities and to install
the appropriate infrastructure to manage energy consumption effectively now and in the future.

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8.2 Regulatory Overview
8.2.1 EN 15232
It is important to recognise that European directives require building automation systems to
be designed and configured with energy savings as a key role in their functionality, as
outlined in EN 15232, “Energy performance of buildings – Impact of Building Automation,
Controls and Building Management.” This directive describes the four energy performance
classes and the objective is to try and achieve the maximum efficiency possible for the
hospital and its facilities.

BACS Energy Performance Classes EN 15232

CLASS A:
A High energy performance BACS and TBM

CLASS B:
B Advanced BACS and TBM

CLASS C:
C Standard BACS (used as reference)

CLASS D:
D Non-energy efficient BACS

9
Figure 8-3. Energy Performance Classes

BACS Efficiency Classes for Hospitals Efficiency factor for Efficiency factor for
to EN 15232 thermal energy electrical energy

A 0,86 0,96

B 0,91 0,98

C 1 1

D 1,31 1,05

10
Figure 8-4. Energy Efficiency Classes for Hospitals

By designing and operating the building in a manner that it achieves class A status, it is
possible to save between 5-15% more energy than a class C building.

9
Standard EN 15232
10
Functions having an impact on energy performance – Standard EN 15232 (Table 1).

Page 61
Measurement of energy consumption alone will not realise the energy savings. The building
automation and control system (BACs) has to include energy saving regimes and techniques
employing integration between technologies in energy saving cause-and-effect programs.
Utilising the systems connected to the intelligent building infrastructure and implementing the
functions outlined in Figure 8-5 (taken from EN 15232), energy performance of the hospital
can be improved.

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 Heating / Cooling Control Ventilation / Air Conditioning Control Lighting Control Blind Control

• Individual room control with communication • Demand or prescense dependent air flow control • Automatic daylight control • Combined light/blind HVAC control
between controlleres and BACS at room level • Automatic occupancy detection manual on /
• Demand based control of distribution network water • Automatic fair low or pressure control with auto off
temerature demand evaluation for all rooms • Automatic occupancy detection manual on /
A • Variable speed control of water pumps with demand • Variable setpoint with load dependent dimmed
evaluation compensation of supply temperature control • Automatic occupancy detection auto on /
• Total interlock between heating and cooling control • Room or exhaust or supply air humidity control auto off
• Automatic occupancy detection auto on /
dimmed

• Individual room control with communication • Time dependent air flow control at room level via • Manual daylight control • Motorized operation with automatic
between controllers and BACS time schedules • Automatic occupancy detection manual on / blind control
• Demand based control of distribution network water • Multi-stage control to reduce energy demand for auto off
temperature fan • Automatic occupancy detection manual on /
B • Multi-stage control of water pumps • Variable setpoint with outdoor compensation of dimmed
• Partial interlock between heating and cooling supply temperature control • Automatic occupancy detection auto on / off
control (dependent On HVAC system) • Room or exhaust air humidity control • Automatic occupancy detection auto on /
dimmed

• Individual room control by themostatic valves or • Time dependent air flow control at room level via • Manual daylight control • Motorized operation with manual blind
electronic controller time schedules • Manual on / off switch control
• Outside temperature compensated control of • On / Off control of air flow for the maximum load of • Manual on / off switch & additional sweeping
C distribution network water temperature all rooms extraction signal
• On / Off control of water pumps • Constant setpoint of supply temperature control
• Partial interlock between heating and cooling • Supply air humidity limitation for dew point control
control (dependent On HVAC system)

• No automatic control of room temperature • No air flow control at room level • Manual daylight control • Manual operation for blinds
• Nocontrol of distribution network water temperature • No automatic control of flow or pressure at AHU • Manual on /off switch
D • No interlocks between heating and cooling level • Manual on / off switch & additional sweeping
• No supply temperature control extraction signal
• No air humidity control

Fig 8-5. BACS (building automation and control system, TBM (technical building management system)

Page 63
8.2.2 EN 16001
Once the energy saving functions have been implemented, it is important that an effective
energy management system is integrated into the intelligent building infrastructure. The
energy management system can manage proper data collection and provide clear, accurate
information that allows the hospital energy managers to:
o Identify significant areas of consumption
o Target areas for energy reductions
o Develop and implement energy policies
Using an energy management system in accordance with EN 16001:2009, “Energy Management
Systems,” provides the users with the best practices for energy management and puts emphasis
on the checking phase for the implementation of the improvement process.

1 Measure Energy audit

and metering

Passive Energy Efficiency Active Energy Efficiency

Optimize through Monitor, 

2 Fix the basics 3 automation and 4 maintain, 
regulation improve
Lower-consumption Building management, Metering, monitoring 
devices, insulation material, power management, motor and consulting services,
power factor correction control, lighting control EE analysis software

Figure 8-6. The Steps to Energy Efficiency

The intelligent building infrastructure will play a key role in the collection of data from multiple
sources. The energy management system will be able to integrate data collection from all the
energy metering technology associated with services to the building, including water, air, gas,
electricity and steam.

The collection of data and its organisation within the database system is the first step towards
analysis and identification of areas of poor energy performance.

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8.3 Measurement Normalisation and Analysis of Consumption W.A.G.E.S.
(Water, Air, Gas, Electricity, Steam).
8.3.1 Electricity
Electrical consumption is monitored by various devices across the electrical distribution system.

Intelligent meters may be located in medium-voltage and low-voltage distribution boards. As

well as providing a local display, these meters will be networked to local gateways which are
connected to the intelligent building infrastructure.

In addition to stand-alone meters, it is possible to monitor electrical consumption from modern

circuit breakers that also have network capability.

By using a comprehensive electricity management supervisory system, these meters are able
to report full electrical performance and status information, including power factors and
harmonics, to ensure the electrical distribution system is operating efficiently at all times.

Electrical consumption may also be obtained from other intelligent devices controlled from the
BMS, including the variable speed drives managing pump and fan motors.

Energy consumption data may be distributed from the electrical supervisory system to the
BMS for analysis.

8.3.2 Heat
The measurement of energy consumed by systems using hot and chilled water will be
managed by heat meters. This will include domestic hot water circuits.

Energy consumption will be monitored on a floor and department basis to ensure full visibility
of the distribution of use.

Heat meters providing a local display will use flow and return temperature sensors combined with
an ultrasound flow meter to calculate thermal energy consumed. They will be able to report:
o Scope (instantaneous and total)
o Thermal energy (instantaneous and total)
o Outlet temperature
o Return temperature
o Temperature difference
These meters will communicate via the intelligent infrastructure using open protocol such as
LON, Modbus, or Meter-Bus (M-Bus). The system will trend log the data and make it available
to the energy management system.

8.3.3 Gas
Gas consumption will be obtained by monitoring of a volt-free, intrinsically safe pulse output
from the gas meter into the intelligent infrastructure and made available to the energy
management system.

8.3.4 Steam
Steam consumption will be monitored for:
o Rate of flow by monitoring of a 4-20mA signal
o Total consumption by monitoring a volt-free, intrinsically safe pulse output
The signals will be obtained from the steam meter local display unit, reordered into the intelligent
infrastructure and made available to the energy management system.

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8.3.5 Water
Incoming supply water consumption will be obtained by monitoring of a volt-free pulse output
from the water meter into the intelligent infrastructure and made available to the energy
management system.

8.3.6 Software Analysis Measures

In addition to the above-mentioned meters, the intelligent infrastructure will include an
integrated software module capable of receiving and managing all the information from
meters around the hospital.

This software module manages the energy resources of the area and provides the information
needed to reduce the costs of facility management.

An overview of the software architecture in the complete system is illustrated in Figure 8-7.

Figure 8-7. Software Architecture

The system will communicate with the different installed devices and manage the information
received through the Ethernet, capturing and storing information automatically on active and
reactive power quarter-hour by measuring points located in the installation. In this way, it will
then build a system for collecting information over the entire hospital facility.

The software will also highlight real-time conditions of energy distribution in the system,
analyse the quality and reliability of the energy supply and respond quickly to any alarms and
critical situations.

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These conditions are not related to conditions already monitored but to specific alarm
conditions related to energy carriers. Examples include the assignment of alert thresholds
linked to consumption of a department, or rapid increases in the consumption of a user load
and so on.

The system will also be capable of predicting future energy consumption based on past
trends and calculate the cost allocation for different users.

It is integrated into a software system for automatic generation of reports and charts which
show the major quantities linked to the quality of energy as the waveform, harmonics, peaks
and symmetrical components. The ability to set alarm thresholds and manage those
minimizes service disruptions and costs associated with unexpected events.

An example of the web portal of a hospital dashboard in the energy management system with
detailed information is illustrated in Figure 8-8.

Figure 8-8. An Energy Management System Dashboard

It is possible to perform analysis of energy quality, such as harmonics, holes and voltage
spikes, in accordance with EN50160 to verify these parameters correspond to those agreed
with the supplier by contract.

Software analysis of measures must be able, depending on the operation parameters of

buildings and according to the forecasts available (weather, local employment, program of
activities), to define a forecasting model of expected consumption for different energy carriers.

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Such a model can see a dual usage pattern:
o In the short term (i.e. even in real time), hospitals can find the cheapest source
of supply in the face of very short-term projections of forecast consumption.
o In the medium/long-term, this model can help steer decisions about programs to
use a hospital’s own sources of production (for instance, co-generation or tri-
generation)

8.4 Remote Energy Services

The ability to export data off-site to an external energy bureau service provides greater
capability for analysis by energy experts. The energy data can be reported back to the
hospital management via the Internet and, by making use of the cooperation with energy
consultants, real-time action can be taken to maintain energy efficiency.

Future energy performance may be predicted by use of existing energy profiles, regression
analysis and the effect of additional or reduced loads and their operating times.

By comparing energy consumption with similar facilities managed from the same bureau, a
continuous benchmark can be maintained ensuring the use of best practices for the sector.

Combining energy data with real-time system performance data, such as measurement of
control output against system set-points, can help to highlight other operational efficiencies.
This can allow poorly performing equipment to be identified and targeted efficiently.

8.5 Specific Energy Saving Techniques

Significant energy savings can be made by applying appropriate technology in the area of
data centres and external lighting.

8.5.1 Data Centres

Data centres are significant users of energy, as servers become more powerful and more
software tasks are virtualised. There is a significant scope for energy management and
energy savings compared with standard data centres if the right approach is taken.

In-row cooling combined with enclosed racks can allow the cooling load to be more accurately
matched with the power consumption of individual racks. Variable speed drives on the cooling
fans and chilled water supply further ensure that energy is used efficiently.

Electrical metering on individual outlets on each rack power distribution unit (PDU) enables
precise monitoring of server electricity consumption. This can help identify how server usage
affects electricity demand and can help IT specialists to equalise processing loads.

Active heat reclaim systems shall be installed to gain low- and medium-grade heat from the
data centre to contribute to the heating base load, thus reducing fossil fuel consumption.

8.5.2 External Lighting

Lighting of roadways and external car parks can add significantly to the energy consumption
of a hospital. Use of controllers for reducing the voltage of electrical supplies to external
lighting can significantly reduce costs of energy consumption and reduce maintenance costs
by extending the life of fittings.

The high-frequency switching techniques used are illustrated in Figure 8-9.

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Figure 8-9. High Frequency Switching Techniques

8.6 Specific Energy Cost Saving Techniques

The intelligent infrastructure uses specific techniques to take action to save the cost of energy in the hospital.

8.6.1 Bill Validation

By automatically checking utility bills against metered readings and consumption at point of use, typical
savings in the range of 3–10% are achieved through the elimination of estimated values by the utility,
mistaken demand and other levied charges.

8.6.2 Demand Response

Utility companies will often pay a substantial annual fee to the hospital for having the facility run on
generator power for short periods of particularly high demand for the utility company. This will
result in an overall energy cost saving for the hospital.

8.6.3 Smart Grid

A smart grid system will use a combination of on-site generation and real-time demand monitoring to
gain the most cost-effective means of energy supply for the hospital. This takes advantage of the
best rates from the utility company and limits peak demand whilst maximising energy efficiency.

8.7 Corporate and Social Responsibility

Corporations and public organizations, including hospitals, have a responsibility to manage

the use of energy as part of their relationship with society. The use of energy displays in
public spaces within a hospital can help demonstrate that a hospital is acting as effectively as
possible in this regard. Displays can present energy consumption savings in clear formats
and can either use data derived locally or via the Internet.

8.8 Patient and Staff Satisfaction

Good energy management will be reflected by increased patient comfort and reduced length
of hospital in-patient times. A patient that is comfortable will respond better to treatment and
allow the hospital to be more efficient. An energy efficient working environment will increase
staff comfort and enable them to be more productive.

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9 Operating and Maintenance

9.1 Introduction

The hospital facility needs consistent maintenance management and persistent control of the
utility of hospital assets, equipment and services to maintain a clean and healthy
environment. Operation and maintenance have a vital role in running the hospital facility
seamlessly. In order to provide the most efficient and effective system of operation and
maintenance possible, a fully integrated facilities management services and support system is
required. This system involves the following four key elements:
o An intelligent technology infrastructure
o 24/7 remote support with specialist energy services
o Integrated mobile communications technology
o Automated analysis and reporting
The concept is illustrated in Figure 9-1.

Integrated 24/7 Remote

Mobile Support Centre
Communications and Energy
Technology Bureau

+H
OS
PI
TA
L

Integrated Automated
Technology Analysis and
Infrastructure Reporting

Figure 9-1. Integrated Facilities Management Services

The key elements of the system work together to provide a higher level of automation, operation
and availability of services, which in turn provides a healthier, safer and more productive
environment for patients, staff and visitors. The integrated facilities management and support

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system will also function as the main vehicle to provide continuous improvement in terms of
environmental performance.

9.2 Intelligent Technology Infrastructure

The intelligent technology infrastructure unlocks the inbuilt intelligence and self-diagnostic
capabilities within the hospital’s services including:
o Main plant and equipment
o Chillers
o Boilers
o Generators
o Electrical HV/MV switchgear
o Data centres
o Medical services and equipment
o Nurse call
o Medical equipment
o Blood fridges and body stores
o Field equipment and devices
o Circuit breakers
o HVAC controllers
o CCTV cameras
o Data centre PDUs
o Light fittings
o Fire and smoke detectors
This information is made available to the integrated facilities management and support system,
which shall perform automated analysis and predictive maintenance software routines. This targets
and prioritizes maintenance tasks towards early preventative action in order to keep hospital
services fully operational and to highlight opportunities to improve operational and energy efficiency.

The intelligent technology infrastructure will also provide vital information to allow more effective
asset management through the condition-based monitoring of plant, equipment and devices.
Asset management services will also link to the location tracking capabilities of the intelligent
infrastructure to reduce time in locating mobile equipment or identifying fixed equipment.

9.3 24/7 Remote Support with Specialist Energy Services

The integrated facilities management services and support system uses a purpose-built remote
support centre, which operates 24 hours per day, 365 days per year. The support centre must
house an experienced team of specialists to provide the following remote services in support
of the hospital facilities team:
o 24-hour alarm response and analysis with online and telephone support facilities
o Plant and equipment performance analysis
o Notification and advanced warning of potential problems
o Remote authorised corrective actions
o Energy analysis and reporting
o Energy alarms
o Condition-based monitoring and predictive maintenance reporting and guidance
o Utility bill validation with real-time links to the billing systems of utility companies
o Load shaping and environmental performance analysis and reporting
o Identification of energy saving opportunities with detailed action plans
o Peak demand analysis
The combination of remote support services with hospital facilities management operations
provides an additional level of specialist technical support at a significantly reduced cost when
compared to full-time site base support and frequent call outs of specialist engineers to
investigate problems that are beyond the technical competency of the hospital facilities team.

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9.4 Integrated Mobile Communications Technology

A key component of the integrated facilities management services and support system is
mobile communications technology in the form of either DECT handsets, smart phones and/or
PDAs. The use of this equipment allows facilities management staff to receive real-time
alarms and information with specific instructions to allow a more rapid response to situations.
As well as information, mobile technology has the capacity to wirelessly connect to the
intelligent infrastructure and directly access the equipment concerned without having to
physically access it, saving time and possible shutdowns.

GPS and RFID locating systems can help direct tasks and information to the nearest member
of the facilities staff qualified to deal with the situation, thus improving response times.

Mobile communications devices will also incorporate facilities to confirm the completion of
tasks and add information and reports wirelessly via the intelligent infrastructure, saving
paperwork and administration. As tasks are completed, the information is available throughout
the infrastructure and, in certain cases, medical staff can be made aware automatically via
integrated staff bases or their own mobile communications technology where appropriate.

9.5 Automated Analysis and Reporting

Another key component of the integrated facilities management services and support system
is automated analysis and reporting, which takes full advantage of the additional information
delivered through the intelligent infrastructure and provides the facilities staff with accurate
information and instruction. The system shall perform a range of analysis and reporting, which
will include the following:
o Range of energy analysis and reports:
o Power factor
o Energy normalization
o Benchmarking
o Maximum demand, kVA
o Consumption
o Target forecast
o Load shaping
o Energy signature
o Energy profiles
o Range of analysis and reports for equipment and devices
o Performance
o Efficiency
o Problem areas
o Predictive analysis and preventative actions
o Equipment location maps
o Device faults and failures
o Failure rates analysis
o Spares and repairs procedures
o Detailed drill-down diagnostics
o Self-checking routines for equipment and devices
o Early warning intelligent maintenance alarm reports
o Self-generating service schedules
In order to assist the automated reporting systems, a real-time link to the electronic operating
and maintenance manuals is required to allow access to technical data, spares and
replacements, when needed.

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A typical layout for a dashboard report is illustrated in Figure 9-2.

Figure 9-2. Demand Report

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10 Architecture and Integration

10.1 Overview

The architecture of the intelligent technology infrastructure is configured to allow hospital

services to operate in the most efficient possible manner to best serve the needs of the
patients, staff, the healthcare organization and the environment, now and in the future.

The integration of the various systems and services connected via the intelligent technology
infrastructure provides an additional layer of intelligence and automation which provides
improvements in energy efficiency, patient safety, staff productivity and patient satisfaction.
This lays solid foundations for the cost-effective introduction of new and emerging
technologies throughout the life cycle of the healthcare facility.

The illustration in Figure 10-1 details the services within the healthcare facility which are
connected to the intelligent infrastructure.

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 Integrated Security Integrated Building Data Centre Physical
Lighting Control System
Systems Automation Infrastructure

Dimmer units IP CCTV HVAC controls Power distribution

Lighting controllers Access control Utilities metering UPS
Room switch units Staff attack Predictive maintenance In-row cooling units
Multi sensors Infant tagging SCADA Integrated security
Scene setting Video intercom Monitoring & targeting Room cooling
External lighting Intruder detection Energy reclaim

Hospital Intelligent Technology Infrastructure

24/ 7 remote services Servers

Fire alarm HV/ MV / LV switchgear
Energy modeling Digital video recording
Emergency lighting Transformers
Bill validation POE switches
Public address Generator integration
Dynamic energy pricing Firewalls
Voice evacuation Busbar trunking
Load shedding Quality of service
Fire// smoke dampers Plug & play distribution
Maximum demand Digital signage

Life Safety Systems Electrical Distribution Energy Management ICT

Figure 10-1. Services Connected to Hospital Intelligent Technology Infrastructure

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The design of the infrastructure is based on providing maximum “uptime” of systems through
an architecture that incorporates both high levels of resilience and intelligence distribution to
provide greater overall availability of systems and services than found in a conventional,
separate discrete systems model.

The architecture allows all the systems to interoperate and provide an intelligent healthcare facility.

The design of the infrastructure facilitates a distributed intelligence, allowing the systems to
interoperate in different ways within different departments of the facility. This includes
improving energy efficiency in the energy centre with control and monitoring of energy
sources, improving patient and staff safety in a mental health facility with staff protection and
access control systems and improving the environment in a patient room with nurse call
services, patient lighting and environmental control. The infrastructure is designed to allow
interoperability of all services in all areas of the healthcare facility, as detailed below in Figure
10-2. This provides the optimum healthcare environment for patients, visitors, facility and
healthcare staff and healthcare organisations.

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 Mental Health Midwifery
Operating Theatre General Wards Energy Centre Energy Department Nurse Stations
Units Lead Units

Electrical distribution Generator testing 24/7 remote services Nurse call

Electrical distribution Access control Environmental control
Environmental control Power factor Energy modelling Intelligent display units
Isolating transformers Video surveillance Visitor management
Nurse call Correction Bill validation Asset management
UPS Staff duress Access control
Bedhead services Smart grid Dynamic energy pricing Environmental
Surgeons panel Shatter resistant Infant protection conditions
Lighting control Boiler control Load shedding
Environmental control Outlets Video surveillance Medical service status
Hand hygiene Chiller control Maximum demand

HOSPITAL INTELLIGENT TECHNOLOGY INFRASTRUCTURE

Video wall Power distribution

Fire alarm Pressure regimes HVAC control Lighting/shade control
Intercom system UPS Utility monitoring
Emergency lighting Filtration monitoring Alarm handling Acoustic monitoring
Digital recording In row cooling units Medical gas monitoring
Public address Gas monitoring Remote access Entertainment systems
Access management Integrated security Water services
Voice evacuation Fume cupboard control Energy monitoring Environmental control
Alarm management Room cooling HVAC control
Fire/smoke dampers Environmental control Predictive maintenance Nurse call
RTLS management Energy reclaim

Facilities Private
Fire Officer Isolation Rooms Security Centre Data Centre Plantrooms
Management Ward Rooms

Figure 10-2. Services Connected to Hospital Intelligent Technology Infrastructure by Department

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10.2 Architecture

The physical architecture is based on a top-down design comprising various levels as follows:
o Level 1 Management Level - Central supervision and control through common
user interface
o Level 2 Network Level - Backbone network infrastructure
o Level 3 Automation Level - Distributed intelligent control and monitoring
o Level 4 Field Level - Intelligent system equipment and field control devices
This physical architecture facilitates levels of interoperation and integration, which in turn, provide
a range of views into the system. The three main types of view are:
o Business enterprise view
o Operational view
o Supervisory and control view
An illustration of the integrated systems and resulting views of the intelligent infrastructure is
provided below.
View

Executive
EnterpriseView

Dashboards
Reporting

Hospital Intelligent Technology Infrastructure

Executive

KPI reports
Energy efficiency
Indoor environment Energy efficiency
Staff efficiency
Security overview
Operational View

Operating Theatre
Fire Panel Nurse Station Patient Panel
Panel

Environment control Environment control

Lighting control Lighting control
UPS status
Fire alarms Nurse call Nurse call
Environmental control
Fireman's override Security information Security information
Alarm status
RFID location Internet connection
Video monitor Patient entertainment
Monitoring

Energy Building Security Data Centre

Management Management Management Management
Supervisory
and Control

24/7 remote services Predictive

Energy modeling maintenance Operations, capacity
Security dashboard
Bill validation SCADA and change
Video analytics
Dynamic energy Environmental control management
Expert

Access control
pricing Lighting control Energy efficiency
Safety control
Load shedding Monitoring & targeting Network management
Monitoring & targeting
Maximum demand Remote access Remote access

Integrated Building Lighting Control Integrated Security

Operating Theatre
Automation System Systems

Dimmer units IP CCTV

HVAC controls Lighting controllers Access control Electrical distribution
Integrated Systems

Utilities metering Room switch units Staff attack Isolating transformers

Room controllers Multi sensors Infant tagging UPS
Control panels Scene setting Video intercom Surgeon’s ’ panel
External lighting Intruder detection

Data Centre
Electrical Life Safety
Physical ICT Medical Areas
Distribution Infrastructure Systems

Servers
HV/MV/LV switchgear Power distribution Nurse call
Digital video Fire alarm
Transformers UPS Bedhead services
recording Emergency lighting
Generator integration In-row cooling units Patient entertainment
POE switches Public address
Busbar trunking Integrated security RFID location
Firewalls Voice evacuation
Plug & play Room cooling systems
Quality of service Fire/Smoke dampers
distribution Energy reclaim Patient environment
Digital signage

Figure 10-3. Holistic Views into the Hospital Intelligent Technology Infrastructure

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10.3 Business Enterprise View

The enterprise view provides an overview of the entire facility from a senior management or
executive perspective. The view comprises a web dashboard with drill-down facilities and will
typically contain live information such as:
o Security threat level
o Severe
o Substantial
o Moderate
o Low
o Key performance indicators (KPI’s) and compliance with national and
international standards
o Environmental performance overview
o Critical systems status (such as power, gas, water, heating, cooling and data)
o Space utilization and non-availability
o General color coded overview of the building areas whether fully operational or
in fault
Drill-down facilities provide further information if required and incorporate automatic links to
information and documentation from within the hospital intelligent infrastructure to allow further
understanding and investigation if required.

Automated executive reporting is a key requirement. This must be available on a routine or

on-demand basis.

10.4 Operational View

The operational view provides an overview of the key building systems and services having a
direct effect on the front-line services. Each view is comprised of an interactive, integrated
dashboard with drill-down capabilities to acknowledge events and execute commands as
necessary. The main operational views are:
o Life safety
o Nurses station
o Medical areas and patient rooms
o Operating theatres
Life safety systems are of particular importance in a hospital as a large proportion of patients
may be unable to escape from a life-threatening situation without assistance. The reasons
people may not be able to escape include mental or physical illness, age and security
measures that the occupants cannot directly control. It is therefore imperative to provide an
integrated command and control infrastructure to support a “defend-in-place” strategy in
response to a life safety threat that will involve the minimum possible movement of patients.
The integrated life safety view allows a more rapid isolation and accurate definition of the
threat in order that appropriate measures can be taken more effectively. An accurate
date/time stamped log of all events and activities also assists after the event to more
accurately determine the cause and the effectiveness of the actions taken.

Integrated, intelligent nurses’ stations provide a vital link between the hospital facilities and
building services and medical care. The operational view will provide an integrated, interactive
dashboard of the hospital services effecting patient care. These will include:
o Environmental conditions
o Lighting levels
o Nurse call operations
o Patient, staff and visitor security
The integrated nurse stations will assist medical staff to concentrate their activities on patient
care while increased levels of automation and efficient information transfer to the facilities
staff will allow facilities issues to be handled more rapidly and effectively.

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Integrated operational views of the complete medical area and patient room environment will
ensure optimal conditions are maintained for patient well-being and recovery, whilst operating
in the most energy efficient manner possible.

Fully integrated operating theatre views are an important tool to ensure all aspects of these
critical areas are closely controlled and monitored, including:
o Critical power supplies
o UPS
o Isolating transformers
o Environmental conditions
o Medical gases
Use interaction will be provided via a surgeon’s touch screen panel within the theatre itself,
remote operational views for the nursing and facilities staff as well as alarms and information
directed to mobile digital devices such as DECT handsets or PDAs.

10.5 Supervisory and Control

The supervisory and control view provides a detailed overview and analysis of key building
systems and services to provide users with a degree of expert knowledge of the appropriate
command and control capabilities to ensure key systems and services are both available and
operating at peak efficiency. Each view comprises an interactive, integrated front end with
drill-down facilities to acknowledge events and execute commands as necessary.

The main supervisory and control views are:

o Energy management
o Building management
o Security management
o Data centre management
The energy management expert view allows the hospital energy manager and the facilities
staff to monitor and target hospital energy consumption. This allows the staff to as the main
agent in the overall plan of continuous improvement of energy efficiency throughout the
healthcare facility. The key aspects within the energy management expert monitoring and
control view are:
o 24/7 remote services, whereby a remote team of expert energy specialists use a
combination of automated analysis alongside their expert knowledge to provide
the hospital with:
 Energy alarms
 Recommendations and return on investment (ROI) business cases
for energy saving projects
 Detailed analysis, highlighting any problem areas
 Targeted list of systems and equipment requiring investigation on the
grounds of energy efficiency
o Area occupancy studies with energy normalization reports
o Energy modeling
o Utility bill validation
o Dynamic energy pricing and “on-demand” management information
o Smart grid, load shedding and maximum demand management
The building management expert view allows the facilities staff to manage the hospital’s building
services and act as the main agent in the overall management of the healthcare facility. The key
aspects within the building management expert monitoring and control view are:
o Predictive maintenance
o Supervisory control and data acquisition (SCADA)
o Environmental control
o Lighting control
o 24/7 remote services for facilities management
o Links to the facilities workflow engine and task management software

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 o Dynamic links to interactive electronic operating and maintenance manuals
The security management expert view allows the security staff to manage the hospital’s
physical security services and act as the main command and control for security management
of the healthcare facility. The key aspects within the security management expert monitoring
and control view are:
o Overall threat level dashboard
o Integrated video wall incorporating CCTV with smart video analytics, access
control, intrusion detection, personal attack, RFID location and critical systems
overlay
o Visitor management
o Badge printing terminals
o Full event and activity log with audit trail
o Emergency response and real time links to law enforcement departments and
agencies
The data center management expert view allows facilities and IT staff to manage the
hospital’s physical ICT infrastructure to ensure maximum possible availability and energy
efficiency. The key aspects within the data center management expert monitoring and control
view are:
o Operations capacity and change management
o Control and monitoring of the hospital data centre physical infrastructure (DCPI)
o Critical power and back-up system management
o Energy efficiency
o Network load management and adaptation
o Remote access and data security
o Smart maintenance tools

10.6 Integrated Systems

An extensive range of systems connect and interoperate via the hospital intelligent
infrastructure. The method of connection and communication each system uses is designed
to provide the following:
o Maximum reliability
o No single point of failure
o High availability
o Diverse routed or meshed sub-network topologies
o Distributed intelligence
o Scalability to provide simple cost-effective expansion
o Future readiness to incorporate new and emerging technologies
o Flexibility to adapt the changing needs of the healthcare facility and organization
o Manageability
A table of the various systems connected to the intelligent infrastructure is provided below
and details the method of connection and communication together with the required indication
and user interaction capabilities.

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Integrated system Communications interface Indication Graphic interaction

Fire detection and alarm RS485 Addressable device status (normal, alarm, fault) for all devices Monitor progress of fire over split screens with
alarm history and ongoing mapped events;
Fire panel fault, test, and override isolate; silence; evacuate; test; link to
maintenance schedule

Smoke damper control system RS485 Damper open/closed/fault status View status and alarms.

Fully automated complete with reset facility Link to maintenance schedule.

Fireman’s override switch status

Fireman’s override RS485 Switch and LED indication status Monitoring, link to maintenance schedule

Chillers and heat pumps BACnet IP Operating status and efficiency Monitoring; scheduling set point adjustment
and link to maintenance schedule
Energy consumption

Alarms

Temperatures, flow switches etc.

Sustainability plant BACnet IP Operating status and efficiency Monitoring; scheduling set point & schedule
adjustment and link to maintenance schedule
(combined heat & power, RS485 BACnet MS/TP, LonWorks Energy consumption
biomass boilers, wind turbines,
solar panels, ground source Alarms
heat pumps, boreholes, etc..)
Temperatures, power output, flow switches etc.

‘Plug & Play’ air handling units RS485 BACnet MS/TP, LonWorks Operating status and efficiency Monitoring; scheduling set point adjustment
with integral controls and link to maintenance schedule
Energy consumption

Alarms

Temperatures, flow switches, etc.

Pressure regimes

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Integrated system Communications interface Indication Graphic interaction

Helipad fire-fighting systems Switch/Relay/Analog signal (Hard wired) Status (normal, alarm, fault) View status and alarms

Fire panel fault, test, and override Link to maintenance schedule

Electricity, water, energy and IP, RS485 Modbus, BACnet, Metered data, flow rates, cooling, power factor, KVA, Kvar, volts Monitoring; link to utilities management
steam meters per phase, current per phase software
Pulse counters (Hard wired)

Generators RS485 BACnet MS/TP, LonWorks Operating conditions Monitoring; scheduling; link to maintenance;
link to plant reinstatement and load shedding
RS232 Serial Interface Alarms
Power Output Automated testing schedule and
configuration
Critical HV and MV power network status and operational data

Remote automated testing operation

HV/LV switchgear RS 485 Modbus ACB status/tripped Monitoring; link to utilities

Bus Coupler status Management, load management software

and link to maintenance schedule
Power consumption

Number of operations

Contact Wear

Load profile information

Logged data

ASCO switch status

Fault and alarm conditions

UPS/IPS and battery status

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Integrated system Communications interface Indication Graphic interaction

Inverters RS 485 BACnet MS/TP Operating status Scheduling; link to maintenance; speed
control; changeover with flying start and link to
LonWorks Motor current consumption utilities management software

Time to trip alarms

Power consumption

Speed and frequency

Manual Override

Intrusion detection alarm Ethernet API Link Alarm zone status (set/ unset/ fault/ alarm) Monitoring; arm/disarm zones

Alarm panel fault Adjust zone time schedules

Access control Ethernet IP connection Door status, forced entry, invalid attempt, anti-pass back Card allocation; enrolment; video badging; set
violation, areas, personnel, reports, event log, personnel details. access privileges; set areas; set time zones to
doors personnel and areas; link to
maintenance schedule

CCTV Ethernet POE connection View live and recorded CCTV images embedded within graphical Camera/image selection, PTZ camera control,
displays. Matrix display with simultaneous playback from multiple smart searching of selected footage. Link to
cameras. maintenance schedule

Nurse call Ethernet IP connection Alarm, Call, Code Blue, Bed status, patient room status Full patient room Monitoring.
(vacant/occupied), room controls via nurse call handset, staff and
patient RFID location, link to maintenance schedule

Medical gas alarms Switch / relay / analog signal (hard wired) Alarm and fault Mimic gas alarms; monitor plant status and
local valve alarms; link to maintenance
schedule

Sprinklers Switch / relay / analog signal (hard wired) Valve and system status Monitoring of system operation and faults; link
to maintenance schedule

Gas Fire Extinguishing System Switch/Relay Operating Status Monitoring of system operation and faults, link
to maintenance schedule

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Integrated system Communications interface Indication Graphic interaction

IP telephony Ethernet IP Alarm and fault Fault monitoring

Operating Status

Major health equipment Switch / relay Operating status / fault Location track and seek facility

Power consumption

RFID location

Medical wards / patient rooms Ethernet IP Environmental conditions, acoustical monitoring, security, lighting Environmental scene setting and adjustment,
levels, HVAC plant and equipment, solar blinds, bed status, alarm acknowledgment and override facilities
RS485 nurse call, RFID location, staff attack, patient entertainment
systems operating status, medical gas alarms/status, power
monitoring, energy consumption and metering.
RS232

Wireless IEEE 802.15.4

Asset location system Ethernet IP Location via Mapping within 3m accuracy Location monitoring via RFID; view asset
details and operating status
RS485 Alarms

Asset details

Staff attack system Ethernet IP Attack alarms Monitoring; alarm annunciation; integration to
Staff location CCTV; access control and intelligent alarm
RS485 routing to mobile devices
Battery power levels and fault status

Staff pagers Ethernet IP Operating status Fault monitoring; link to maintenance schedule
RS485
Fault
RS232

Data centre physical Ethernet IP Rack temperatures, data loading, live CCTV, access control, Open / close access doors; set point
infrastructure (DCPI) including critical power switch gear status and operational data, power adjustment of cooling systems; CCTV camera
hub rooms, node rooms, distribution units operational data, UPS, IPS data, Cooling controls and switching; full control of power
server rooms, etc. equipment operational data and efficiency, heat recovery switchgear.
systems operational data and efficiency. Maintenance data.

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Integrated system Communications interface Indication Graphic interaction

Digital energy performance Ethernet IP System energy performance summation and graphic display. Full graphical configuration capabilities
certificate Rolling displays per department. Interdepartmental analysis and
comparisons. Live weather data.

Nurse base information Ethernet IP Nurse call status information, ventilation system faults, fire alarm, Door release via video intercom; alarm
patient room electrical faults, video intercom, access control door acknowledgment; patient room environmental
status, intrusion detection status, medical gas status & alarms, scene setting; RFID location search facilities
RFID location data, Energy data.

Department information Ethernet IP Electrical, heat, and cooling energy summation and graphic Full graphical configuration capabilities
display. Medical and hygiene performance data from hospital
enterprise network.

Operating theatre Ethernet IP Replication of surgeon’s panel display, IPS/UPS data, individual Remote setpoint change capability; scheduling;
power circuit status, mains/generator power indication, HVAC alarm acknowledgement; digital touch screen
Parameters, lighting level and status, occupied/setback status, surgeon’s panel
elapsed time for operation, electrical faults and warnings,
Medical gas alarms AGSS alarms.

Water distribution leak RS485 Major leak detection in water and heating service pipework from Auto flushing systems override; alarm
detection energy centre. Contamination or dangerous conditions for acknowledgement
RS232 bacteria growth.

Wireless IEEE 802.15.4

Energy centre water leak RS485 Leak detection in water tank bunds within energy centre. Monitoring. link to maintenance schedule
detection
RS232

Wireless IEEE 802.15.4

Energy centre fuel system RS485 Leak detection in fuel tank bunds within energy centre. Monitoring. link to maintenance schedule
leak detection
RS232

Wireless IEEE 802.15.4

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Fuel storage and pumping RS485 Operating status, fuel consumption, fuel levels; fill point and System monitoring; scheduling; link to
equipment level alarms maintenance schedule
RS232

Wireless IEEE 802.15.4

Switch / relay

Robotics (laundry, clinical Ethernet IP Operational data, critical faults, RFID location System monitoring
waste)
RS232

Pneumatic transfer systems Switch / relay System healthy Monitoring; link to maintenance schedule

Power supplies healthy

Specialist AC systems RS485 Temperature, humidity, plant status, fire status, leak detection Monitoring; scheduling; set point adjustment;
environment alarms link to maintenance schedule
RS232

Wireless IEEE 802.15.4

Switch / relay

Elevators Ethernet IP System healthy Critical alarm acknowledgement

Power supplies healthy

Elevator Motors operational and power consumption data
Car floor status, alarm, passenger loading and waiting time data
CCTV

Access control car call

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