Earlier this year, the U.S. Green Building Council (USGBC) announced a new LEED® program for hospitals and other health care facilities. The LEED for Healthcare rating system goes beyond the LEED for New Construction rating system, combining it with strong elements of the Green Guide for Health Care (GGHC), its predecessor, which was introduced in 2007.

“The industry as a whole has clearly embraced the Green Guide’s proposal that, in the health care market, the definition of green building must be fundamentally tied to health care’s mission, to ‘first, do no harm,’ ” stated a report on the pilot program.

Building on the Green Guide

The “first, do no harm” principle was said to underlie new credits in the Green Guide for Health Care, which has carried over to LEED for Healthcare, said Melissa Gallagher-Rogers, LEED AP, director, Public Sector Programs, USGBC. New health-based credits include the “Places of Respite” credit, toxics credits (such as the mercury elimination and environmental quality credits), and the “Acoustic Environment” credit. All of these could be affected by the building’s mechanical systems, but require coordination with the building team to be fully optimized.

“LEED for Healthcare was able to build on the work done by GGHC and includes many of the same requirements as the GGHC document,” said Gallagher-Rogers. “However, LEED for Healthcare is a supplement to the LEED for New Construction rating system, so it also contains some credits from LEED for New Construction and some credits that are specific to LEED for Healthcare.

“LEED for Healthcare not only contains the intents and strategies created for the GGHC, but also includes performance requirements and prescriptive paths for credit achievement,” she said. “These are critical, since LEED includes third-party verifi-
cation of the project’s achievement of these targets.” This essentially requires those involved on a project to show their work.

In 2007, GGHC also released a document titled “A Prescriptive Path to Energy Efficiency Improvements for Hospitals.” According to this document, “in order to develop a prescriptive package that could be promoted as a national standard (such as would be the case if this package were used in GGHC or LEED for Healthcare),” the committee agreed that the package needed to meet certain goals, including the following:

• Use cost-effective strategies to reduce energy consumption.

• Base it on a single set of energy efficiency measures (EEMs) that can, as much as possible, be applied across the U.S. climate zones.

• Provide the targeted level of energy efficiency performance im-
provement “on any hospital project, in any U.S. climate zone,” with a high level of confidence.

With these goals in mind, here is what the prescriptive package includes in its EEMs (in addition to lighting and window requirements):

• Central VAV AHUs using chilled and heating hot water.

• Fan power reduced 10 percent less than the limit under ASHRAE 90.1-2004 Appendix G.

• Turn-down ratio of 30 percent on VAV boxes.

• Exterior lighting power 20 percent less than ASHRAE 90.1-2004.

• High-efficiency boiler plant (90 percent thermal operating efficiency).

• Turn-down ratio of 30 percent for heating hot water and chilled water pumps’ variable speed drives.

• High-efficiency, variable-speed chillers (0.52 kW/ton at full load, and 0.40 kW/ton IPLV [integrated part-load value]).

• Premium-efficiency motors for fans and pumps.

These measures apply to hospitals of 70,000 square feet or more. This group of EEMs is also proposed for use in LEED for Healthcare.


For mechanical engineers and contractors, “LEED for Healthcare references the most current and relevant standards for calculating ventilation rates,” said Sara Cederberg, manager, LEED, USGBC.

In addition to ventilation standard 62.1-2007, it references ASHRAE 170-2008, “Ventilation of Health Care Facilities,” and the 2010 Facilities Guidelines Institute (FGI) “Guidelines for Design and Construction of Health Care Facilities” in the Minimum Indoor Air Quality prerequisite.

“These standards outline proper filtration and air changes needed to address infection control concerns,” Cederberg said.

In addition, she explained, “Project teams are rewarded for efficient and effective mechanical system design under ‘Energy and Atmosphere Credit 1: Optimize Energy Performance.’ Where possible, strategies like reducing fan power or turndown ratios on VAV boxes can impact on the overall efficiency of the building.”

Cederberg continued, “We are trying to encourage the most current trends in ventilation design, like supporting diversity and VAV systems when infection control or pressurization relationships would not be compromised.” In addition, “Pilot Credit 4: Innovative Ventilation” (developed by the LEED for Healthcare Core Committee) is available in the Pilot Credit Library online. It offers incentives for natural or passive ventilation in health care settings, again where it would not compromise infection control or pressurization relationships.

LEED for Healthcare also references Joint Commission standards for infection control mitigation during construction for renovation projects, which should be of great interest to mechanical contractors, she said. IEQ Credit 3.1 includes the same requirements for filtration on AHUs and wrapping exposed ductwork during construction as LEED for New Construction.

“New requirements were added to limit noise exposure during construction both for neighbors and construction crew workers,” she said. “We also address patient comfort and acoustics by adding a new acoustics credit, IEQ credit 2, to LEED for Healthcare. The Room Noise criteria in Option 1 address background noise from mechanical equipment.”

Design Teams

One of the new requirements in LEED for Healthcare is a prerequisite for Integrated Project Planning and Design, said Gallagher-Rogers. “This prerequisite and the associated credit require that all members of the project team play an active role in the project planning and design.

“Integrated design, used early in the project and throughout the project’s life, can help to ensure that all of the green building goals are met and everyone on the project understands and achieves the green building goals,” she said.

In the Integrated Project Planning and Design prerequisite and credit, “we are trying to encourage design teams to work closely not just with C-level building owners and representatives, but also to bring practitioners and facility managers to the table early in design,” said Cederberg. “By working closely with the people who will ultimately work and operate the building, we hope that the design will better reflect their needs, and that the operations teams will have a better understanding of how to optimize the building’s ongoing performance.”

In Progress

As of October 2011, 33 projects have been registered under the LEED for Healthcare rating system. While these projects are pursuing certification under LEED for Healthcare, there were no certified projects at press time.

However, “healthcare projects have used LEED since the rating system was released,” said Gallagher-Rogers. More than 200 healthcare projects are certified under one of the LEED rating systems. “These are primarily LEED for New Construction projects.”

Whether you call them challenges or opportunities, “the biggest amount of work in a hospital setting is to become more efficient in their energy use; the second critical component is water efficiency. Health care facilities are energy intensive and often operate 24 hours a day,” she said, “so there is a huge opportunity to save energy in the operations of these facilities, which translates into a direct savings on energy bills.”

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Publication date: 10/31/2011