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					   ENERGY EFFICIENCY OPPORTUNITIES
      FOR GOVERNMENT HOSPITALS
A report prepared under the
Malaysian - Danish Environmental Cooperation Programme
Renewable Energy and Energy Efficiency Component

                      by Azizah Kassim and Hassan Bathish

                                 Eco- Energy Sdn Bhd




The views expressed in this document, which has been reproduced without formal editing, are
those of the authors and do not necessarily reflect the views of the Government of Malaysia
nor DANIDA.
FINAL REPORT ON ENERGY EFFICIENCY OPPORTUNITIES FOR GOVERNMENT HOSPITAL

                                                           CONTENTS


1          INTRODUCTION ................................................................................................................ 3

2          GENERAL DESCRIPTION OF INVESTIGATED HOSPITAL BUILDINGS ................. 4
    2.1    Hospital A Buildings ............................................................................................................... 4
    2.2    Hospital B Buildings ................................................................................................................ 4
3          HOSPITAL ENERGY AND END-USE CONSUMPTIONS............................................... 5
    3.1    Hospital A’s energy consumption ........................................................................................... 5
    3.2    Hospital B’s energy consumption ........................................................................................... 8
4          ENERGY EFFICIENCY OPPORTUNITIES IN HOSPITAL BUILDING ..................... 10
    4.1  Adopting passive building design ......................................................................................... 10
       4.1.1   Building Orientation .............................................................................................. 10
       4.1.2   Building Envelope ................................................................................................. 11
    4.2 Use of energy efficient equipment and apply effective control system. ............................ 15
       4.2.1   Air-conditioning .................................................................................................... 16
       4.2.2   Water Heating ........................................................................................................ 21
       4.2.3   High Efficient Lighting Equipment ...................................................................... 22
       4.2.4   Building Operations and Maintenance ................................................................. 23




CONDUCTED BY: ECO ENERGY SDN BHD                                                                                                            2
FINAL REPORT ON ENERGY EFFICIENCY OPPORTUNITIES FOR GOVERNMENT HOSPITAL

1    Introduction
Energy cost is one of the highest utility operating cost elements in hospitals. Any health care
building including government hospital requires high indoor air quality in most part of their
building. Without an integrated approach of energy efficiency in the whole building design,
equipment and operation, this would easily lead to a high level of air-conditioning load, which
is one of the major energy end-uses in hospitals (about 60% of the total electricity
consumption). In other words, the high level of air-conditioning load in the current
government hospitals is associated with the need to comply with that specific indoor
requirement in the following ways:
    i)     High use of open air-conditioning systems, which employ 100% of outside air for
           ventilation.
    ii)    Use of conventional method of controlling indoor humidity by deep cooling of
           outside air and then reheating it again to avoid overcooling.
    iii)   High dependency on the air-conditioning system to deliver the required indoor air-
           quality and comfort level throughout the building.
Energy efficiency (EE) in commercial building like hospital is usually associated with better
comfort level, while not compromising the indoor air-quality. If considered early in the design
stage of the hospital complex, energy efficiency measures can be easily associated with these
requirements and achieves better result compared to retrofitting the currently operated hospital
complex. In addition, sustainability energy efficiency program integrated into the operation
and maintenance would lead to reducing energy operating cost effectively. However, the ever-
increasing electricity hospital bill and the relatively high Building Energy Index (BEI) as
shown in this Study show that EE is yet to be considered seriously in government hospitals.
All government hospital support services, which include the facilities engineering,
maintenance and nonmedical services, are currently privatised under a 15-years period
concession agreement since 1997 to three private companies. The government aims, through
this privatisation, to provide better health care services and improve efficiency of the support
services. Part of the government agreement with the three companies are required to undertake
EE programmes in their related hospitals for the purpose of reducing the ever increasing
hospital energy costs. An independent consultant body is appointed to closely monitor the
implementation of hospital support services provided by these concession companies.
However, under the current concession agreement, EE is not considered as a critical factor in
judging the performance of these companies and the hospital energy costs are paid from the
Ministry of Health budget, therefore EE is not addressed seriously.
This report addresses measures that can lead to reducing energy wastages in current, retrofitted
and newly designed hospitals, while not compromising the indoor air quality and comfort level
based on observations made on two typical operating government hospitals. One hospital is
fairly new hospital (commissioned in 1999) and has more advanced medical facilities and
modern utilities. The other hospital is more than 20 years old with essential utilities having
reached the end of their service lives.
The findings and recommendations addressed in this report are based on limited desktop data
made available to the Consultant, walk-through energy audits and data logging electricity
demands carried out for both hospitals. In addition, this report also highlights barriers
obstructing the adoption of sustainable EE programmes in government hospitals.

CONDUCTED BY: ECO ENERGY SDN BHD                                                              3
FINAL REPORT ON ENERGY EFFICIENCY OPPORTUNITIES FOR GOVERNMENT HOSPITAL

2      General Description of Investigated Hospital Buildings
This section provides general descriptions, functions, and utility operations and maintenance
of the 2 hospitals.


2.1      Hospital A

The Hospital comprises one 9-storey Block consisting of five (5) buildings and another 67
single-storey and multistorey buildings scattered around the Main Block. In addition, a 4 -
storey Ambulance Centre is currently under construction and located on the south side of the
Main Block. The Main Block is mainly used for administration, wards, operation theatres and
hospital operations. The other buildings are used for various purposes including wards,
policlinics, maternity clinics, engineering blocks, staff’s hostels, staff’s quarters, kindergarten,
cafeterias, stores, sport’s club, halls and guard houses.
The electricity is supplied by TNB under the C1 tariff. Most part of the building operates 24
hours, except some offices and policlinics, which operate 8:00 to 4:30 PM daily and 8:00 to
1:00 PM on alternate Saturdays. The annual electricity consumption for 2003 is 14,704,367
kWh with average Maximum Demand (MD) of 2.5MW, costing nearly RM 3.6 Million per
annum. The average annual Load Factor (LF) is 67%. This indicates that the hospital has
reasonable electricity load consumed during TNB off-peak (between 10:00 p.m. and 8:00 a.m.
next day).
With a total gross floor area of 161,195m2, of which 70% is occupied and a 50% are air-
conditioned, Building Electricity Index (BEI) for the occupied air-conditioned areas is 182
kWh/m2/year. In addition, the hospital has two Medium Fuel Oil (MFO) boilers used for
supplying steam for sterilisers and kitchen. The 2003 cost of MFO was RM 750,0001.
Further, the hospital uses Liquefied Petroleum Gas (LPG) as main fuel in the kitchen. In
addition, all laundry services are carried outside the hospital.
Combining both the electricity and fuel energy 2, the overall Energy Index over the total
occupied floor areas in the Hospital is 217 kWh/m2 /year.
The Hospital has about 1,000 beds. The bed occupancy rate throughout the year is 70%.


2.2      Hospital B

The Hospital is a fairly new hospital complex, commissioned in 1999. It comprises a 12–
storey building, staff’s quarters and hostels and visitors area in their vicinity. Its facilities and
operations are concentrated in one building, rather than being scattered in many small
buildings. The electricity is supplied by TNB under the C1 tariff, with most parts of the
building operating 24 hours and only two levels with policlinics and offices operating 8:00
AM to 4:30 PM daily and 8:00 AM to 1:00 PM on alternate Saturdays.
The annual 2003/2004 electricity consumption was 25,000 MWh with average Maximum
Demand (MD) of 3.6 MW, costing nearly RM 6 Million per annum. The average annual LF is


1
    Based on average 2003 MFO cost of RM0.82 per litre.
2
    1 litre diesel ~ 0.0365 mmBTU

CONDUCTED BY: ECO ENERGY SDN BHD                                                                   4
FINAL REPORT ON ENERGY EFFICIENCY OPPORTUNITIES FOR GOVERNMENT HOSPITAL

79%. This indicates that the hospital has substantial amount of electricity load consumed
during TNB off-peak period.
Compared to Hospital A which provides mainly general health care services, Hospital B
provides in addition to general health services, selected care services usually not provided by
other government hospitals in Malaysia. With the total occupied floor areas of 120,000m 2, of
which 75% are air-conditioned, the Building Energy Index for the occupied air-conditioned
areas is approximately 278kWh/m2/year.
In addition, LPG is used as main fuel for two boilers, one Hot water Boiler and one Steam
Boiler, costs up to RM 1.2 Million 3 per annum. LPG is also used as main fuel in the hospital
kitchen. Similar to Hospital A, all laundry services are carried out outside the hospital.
Combining both the electricity and fuel energy 4, the overall Energy Index over the total
occupied floor areas in Hospital B is 297 kWh/m2/year.
The Hospital has about 1,000 beds, with an occupancy rate throughout the year at 70%.


3      Hospital energy and end-use consumptions
Electricity and fuel including MFO and LPG are main sources of energy used in hospitals.
Electricity is used for driving all electrically driven hospital equipment, while fuel is mainly
used for generating hot water, steam and food preparation.

Electricity for both hospitals is supplied by TNB under C1 tariff, i.e. RM 0.208 per kWh and
RM 17.30 per kW Maximum Demand. Fuel prices vary from time to time and an average of
RM 0.82 (2003 price) and RM 1.30 (current price) per litre diesel; and RM 1.60 per kg LPG is
considered for the purpose of the Study analysis. The following sub-section provides an
overview of both hospitals energy end-use consumption:

3.1      Hospital A’s energy consumption

Based on 2003 monthly electricity bills, the Hospital’s annual electricity consumption is
estimated to be 14.7 GWh, with average 2.5MW Maximum Demand, costing nearly RM3.6
Million per annum. The average annual LF is 67%. This indicates that the hospital has fairly
large amount of electricity load consumed during TNB off-peak period. In addition, Diesel and
LPG are used as main fuel for Boilers and Kitchen. The 2003 annual fuel consumption is
estimated to be 9.2GWh per annum, costing up to RM 750,000 per year. In total the annual
energy consumption for the hospital is estimated to be 24.5GWh, costing approximately
RM4.3 Million per year.

In addition, the annual electricity consumption data (see Figure 1) indicate that the hospital
electricity consumptions increased between 2001 and 2003 by an average of 8% annually.




3
    Based on 2003 average LPG cost of RM 1.60 per kg
4
    1 kg LPG ~ 46,800 BTU. Total 2003 LPG consumption approximately 772,200 kg.

CONDUCTED BY: ECO ENERGY SDN BHD                                                               5
FINAL REPORT ON ENERGY EFFICIENCY OPPORTUNITIES FOR GOVERNMENT HOSPITAL


                          16,002,000                                                         4,000
                          14,002,000                                      14,704,367




                                                                                                     Maximum Demand, kW
       Consumption, kWh
                          12,002,000                       13,666,050                        3,000


         Annual Energy
                          10,002,000       12,707,017
                           8,002,000                                          2,536          2,000
                           6,002,000                          2,355
                           4,002,000          2,210                                          1,000
                           2,002,000
                                2,000                                                        -
                                              2001            2002           2003
                                                             Years
                                       Total Consumption, kWh     Average MD, kW


                          Figure 1, Three (3) years electricity bills trend for Hospital A
The total fuel energy represents about 38% of the Hospital’s total energy and the balance
(62%) of energy is supplied by electricity as shown in Figure 2. In addition, air-conditioning
consumes about 63% of the total annual electricity consumption, while lighting and general
equipment consume 22% and 15% of the total electricity consumption respectively, as shown
in Figure 3.
                                                 Fuel
                                               38% (9.2
                                                GWh)




                                                                          Electrici
                                                                          ty  62%
                                                                          (14.7
                                                                          GWh)


                      Figure 2, General annual energy use apportioning for Hospital A


                                        General
                                       Equipment
                                        15% (2.2
                                         GWh)



                            Lighting
                            22% (3.2                                            Air-
                             GWh)                                           Conditioning
                                                                              63% (9.3
                                                                               GWh)




      Figure 3, Annual end-use electricity consumption apportioning for Hospital A




CONDUCTED BY: ECO ENERGY SDN BHD                                                                                          6
FINAL REPORT ON ENERGY EFFICIENCY OPPORTUNITIES FOR GOVERNMENT HOSPITAL




                              General
                             Equipmen
                                 t
                              9% (2.2                                     Air-
                               GWh)                                    conditioni
                                                                          ng
                                                                        39% (9.3
             Heating                                                     GWh)
             38% (9.2
              GWh)
                                                      Lighting
                                                      14% (3.2
                                                       GWh)




                   Figure 4, End-use energy consumption apportioning

Figure 4 shows that air-conditioning and heating process represented equally high portion
from the Hospital’s annual energy consumption (as in 2003).

In total, 2003 annual energy cost for the Hospital is approximately RM 4.3 Million. The
annual end-uses energy consumption allocation is as shown in the following Figure 5.


                                 General
                               Equipment
                                12% (RM
                                530,000)
                   Heating                                               Air-
                  17% (RM                                             conditioning
                  750,000)                                           53% (RM 2.2
                                                                        Million)

                          Lighting
                         18% (RM
                         780,000)

                Figure 5, 2003 annual energy cost allocation for Hospital A



Figure 5 indicates that air-conditioning remains the highest energy operating cost for Hospital
A, i.e. 53% of the total energy operating cost in 2003, while heating process constitutes only
17% of the total annual energy operating cost.




CONDUCTED BY: ECO ENERGY SDN BHD                                                             7
FINAL REPORT ON ENERGY EFFICIENCY OPPORTUNITIES FOR GOVERNMENT HOSPITAL

3.2   Hospital B’s energy consumption

Based on 2003 to 2004 monthly electricity bills, the Hospital annual electricity consumption is
estimated to be 25GWh, with average 3.6MW Maximum Demand, costing nearly RM 6.0
Million per annum. In addition, LPG is used as main fuel for Boilers and Kitchen. The annual
fuel (LPG) consumption is estimated to be 10.6GWh per annum, costing up to RM 1.2 Million
per year. In total the annual energy consumption for the hospital is estimated to be 35.6GWh,
costing RM 7.2 Million per year.

LPG represents about 30% of the total Hospital energy and the balance (70%) of energy is
supplied by electricity as shown in Figure 6. In addition, air-conditioning consumes about
65% of the total annual electricity consumption, while lighting and general equipment
consume 18% and 17% of the total electricity consumption respectively, as shown in Figure 7.


                            Fuel
                          30% (10.6
                            GWh)




                                                                    Electricity
                                                                     70% (25
                                                                      GWh)



          Figure 6, General 2003 annual energy use apportioning for Hospital B




                             General
                            Equipment
                             17% (4.2
                              GWh)

                         Lighting
                         18% (4.5                            Air-
                          GWh)                           conditioning
                                                          65% (16.3
                                                            GWh)




      Figure 7, Annual end-use electricity consumption apportioning for Hospital B




CONDUCTED BY: ECO ENERGY SDN BHD                                                             8
FINAL REPORT ON ENERGY EFFICIENCY OPPORTUNITIES FOR GOVERNMENT HOSPITAL

Combining both electricity and fuel consumption, the annual end-users energy consumption
apportioning for Hospital B, is as shown in the following Figure 8.



                              General
                             Equipment
                              12% (4.2
                               GWh)                              Air-
                                                             conditioning
                                                              45% (16.3
                      Heating
                                                                GWh)
                     30% (10.6
                       GWh)
                                      Lighting
                                      13% (4.5
                                       GWh)




    Figure 8, 2003 Annual end-use energy consumption apportioning for Hospital B

Figure 8 shows that the hospital’s air-conditioning load represents the highest energy
consumption portion of the 2003 annual energy consumption.

 In total, 2003 annual energy cost for the Hospital is approximately RM 7.2 Million. The
annual end-uses energy consumption allocation is as shown in the following Figure 9.




                              General
                             Equipment
                             14% (RM 1
                              Million)
              Heating                                                 Air-
            17% (RM 1.2                                           conditioning
              Million)                                            54% (RM 3.9
                                                                    Million)


                     Lighting
                   15% (RM 1.1
                     Million)




               Figure 9, 2003 annual energy cost allocation for Hospital B




CONDUCTED BY: ECO ENERGY SDN BHD                                                       9
FINAL REPORT ON ENERGY EFFICIENCY OPPORTUNITIES FOR GOVERNMENT HOSPITAL

      Figure 9 indicates that air-conditioning remains the highest energy operating cost for the
      Hospital, i.e. 54% of the total energy operating cost in 2003, while heating process
      constitutes only 17% of the total annual energy operating cost.


4     Energy Efficiency Opportunities in Hospital Building
Designing and operating energy efficient and sustainable hospital buildings require an
integrated approach throughout the whole building lifecycle cost through the following
measures:

             i)     Adopting passive building design.

             ii)    Using high efficiency utility and general equipment; and

             iii)   Applying good house keeping (Operation and Maintenance).

Energy efficiency should be addressed as early as possible in the design process. Sometimes
energy efficiency design strategies may seem to be in conflict with one another. For example,
using reflective glass to limit the heat gain would also limit the amount of usable daylight. In
addition, the high indoor air-quality requirement leads to a high level of air-conditioning load
in the hospitals due to overcooling. But if all these issues are addressed early in the energy
efficiency design process, then conflicts can be resolved. In addition, sustainability energy
efficiency program integrated into the operation and maintenance would lead to reducing
energy operating cost effectively.

The following sub-sections discuss integrated energy efficiency elements that lead to the
efficient use of energy, good indoor air quality and comfort level in a new design and currently
operating hospital.

4.1     Adopting passive building design

The passive building design includes provision of building features that increase natural
ventilation and daylight, and reduces the building heat load. This includes:

4.1.1    Building Orientation
         Selecting the most optimal building orientation is one of the critical energy efficient
         design decisions that could have impact on building envelope energy performance, as it
         can be used to minimise the direct sun radiation into the hospital building through
         windows and building openings. Although the ability of selecting the building
         orientation is constrained by available land boundaries, the architect skill and talent can
         play an important role in coming up with an optimal orientation that suits the available
         land.

         In Malaysia, as a tropical country located in the northern (5 North) hemisphere, the
         building designer should endeavour to limit the amount of windows and wall area on
         the east and west facades. With a high cooling load, (where air-conditioning load
         usually accounts for average 60% of the hospital building energy cost) buildings


CONDUCTED BY: ECO ENERGY SDN BHD                                                                 10
FINAL REPORT ON ENERGY EFFICIENCY OPPORTUNITIES FOR GOVERNMENT HOSPITAL

        elongated on an east-west axis (Refer to Figure 9) and with a mix of north and south-
        facing windows generally achieves lower heat gain and consequently lower energy use.

        In addition, the orientation mentioned above also has an impact on the daylight
        effectiveness as it minimises the excessive brightness (glare) from direct sunlight from
        the east and west in the morning and afternoon.


4.1.2   Building Envelope
        Building envelope refers to the exterior structural materials and finishes that enclose
        space and separate inside from outside. This includes walls, roofs, windows, doors and
        floor surfaces. The following paragraphs discuss the impact of various building
        envelope elements on the building envelope energy performance related to the
        investigated hospitals in the Study:

        i.) External wall, roof material and insulation

           In a hot climate, such as in Malaysia, selecting low heat conductivity construction
           materials in building walls and roofs leads to reducing the building heat load and
           consequently allowing smaller cooling system to be installed and minimising the
           cooling system operating cost. Using such construction materials in non air-
           conditioned area would improve the building occupant’s comfort level.

           Optimal use of low heat conductivity and mass of materials used in the building
           helps in reducing heat transmission and shifting considerable amount of peak heat
           load to the off peak time, when there is no cooling required in the hospital. Portion
           of solar heat radiated on the building walls and roof absorbed into these materials
           and temporarily stored, until it is released into the building space after working
           hours.

           Adding insulation to the external wall is not practical and too expensive for
           existing buildings, but it is easy for the roof.

           (Hospital A’s roof is currently not insulated. Adding 50-mm of fibreglass or
           mineral wool insulation under the roof of air-conditioned building would provide
           considerable reduction of the total annual energy consumption. Use of vented attic
           space under the roof for accommodating AHU equipment as seen in Hospital B
           limited the insulation above the floor slab as there is concern about intake of fibres
           into the air handling systems. Roof should be insulated to minimise heat gain in the
           current AHU equipment, which affects the efficiency.)

        ii.) External Windows and Doors
           Solar heat gain through external windows and doors can account for the major part
           of the building envelope heat load and consequently the building air-conditioning
           load. In general, reduction of such heat gain can be achieved through:

              Using suitable window and door sizing and materials. Excessive window to
               wall ratio increases the level of building heat load. Therefore, sensible


CONDUCTED BY: ECO ENERGY SDN BHD                                                              11
FINAL REPORT ON ENERGY EFFICIENCY OPPORTUNITIES FOR GOVERNMENT HOSPITAL

               selection of window sizes, number and material will have effective impact on
               the building heat load.

              Using glazing with low Shading Coefficient (SC). Using special window
               glazing with low level of SC, such as spectrally selective film, that blocks or
               reduces the sun heat radiation from penetrating the external windows and doors
               and permits visual sun radiation to penetrate the building.

              Using window frames with low heat transmittance. The commonly used
               aluminium window frames allow substantial heat to leak into the building
               envelope. Using aluminium window frames with thermal break can reduce
               heat leak into the building. Refer to Figure 10 for the Schematic Diagram of
               Thermal Break in the window frame.




                                 Aluminium frame




                                                      thermal break

                             Figure 10, Thermal Break in the window frame

              Using suitable window shading. The most effective method of controlling
               solar radiation is to prevent its entry into the building by using external
               shading, such as overhang, side reveals or external louvres. Refer to Figure 11
               to 13 for various applications of shadings for the window.




                                        Figure 11, Overhang




                                       Figure 12, Side reveals


CONDUCTED BY: ECO ENERGY SDN BHD                                                           12
FINAL REPORT ON ENERGY EFFICIENCY OPPORTUNITIES FOR GOVERNMENT HOSPITAL




                                         Figure 13, Window shading by louvre



           Hospital A’s Main Building design has balconies on both sides of the longer facades,
           which effectively reduces heat gain into the building. (Refer to Figure 14). On the
           contrary, the latest trend in design approach for Hospital B which has high ratio of
           glass windows to the wall and with relatively less external shading like balconies and
           window reveals & overhangs, has in some way lead to the high heat gain into the
           building through the windows. However, the possibilities of adding external window
           shading to reduce energy was not explored in this Study, due to the limited data made
           available to the Study team.




                                     Figure 14, Balconies of a hospital

               iii.) Building Zoning and Space Planning

                    Building zoning and space planning in the hospital should maximise the use of
                    daylight and natural ventilation 5 throughout the building and wherever possible.
                    For example, wards and patient’s waiting areas can benefit from the daylight
                    and natural ventilation. On the other hand, operating theatres and laboratories


5
    Refer to sub-paragraph v), Natural and Mechanical Ventilation.

CONDUCTED BY: ECO ENERGY SDN BHD                                                                  13
FINAL REPORT ON ENERGY EFFICIENCY OPPORTUNITIES FOR GOVERNMENT HOSPITAL

              require highly controlled indoor air-quality and therefore they should be
              localised and specially air-conditioned.

              The high and controlled indoor air-quality requirement in certain areas of the
              hospital makes the air-conditioning process very energy intensive, if there is no
              proper building zoning to specially design air-conditioning for this purpose to
              the specified areas only.

              In addition, careful building zoning for areas with different occupancy schedule
              can offer effective and flexible way for operating building utility and
              consequently save energy costs. For example, separating the continuously
              occupied areas from the intermittently occupied areas allows greater flexibility
              in operating the air-conditioning system and consequently saving electricity
              costs.

           iv.) Natural Ventilation

           Natural ventilation can provide effective way to eliminate or limit the need for
           building air conditioning. The outside air can be used not only for ventilation, but
           also for pre-cooling the building. From the air quality perspective, natural
           ventilation is usually the best choice and should be considered in most spaces in the
           hospital, where there are no special indoor environment constraints.

           Indoor air quality and occupant comfort is also an issue in some part of a hospital
           building. Therefore, the best solution is to divide the building into separate zones
           (see previous paragraph iv, Building Zoning and Space Planning) for natural
           ventilation and mechanical ventilation. Accordingly, for the natural ventilation
           areas, greater attention should be focused on the building immediate surrounding,
           such as obstructions, landscaping, nearby sources of noise and dusts and the
           microclimate issues.

           In addition, to make sure that the natural ventilation works well, it is important to
           ensure that the building heat gain is minimised by means of shading devices like
           overhangs, awnings and fins. Use of good landscaping in the surrounding will help
           pre-cool the incoming air. It is also a good practice to avoid locating large asphalt
           parking lots near the building, especially on the upwind side and exposed to the
           direct sun radiations. This type of ground surface will absorb heat, reradiate back to
           the hospital buildings and increase the temperature of air used in ventilating the
           buildings.

           Natural ventilation is highly employed in Hospital A, but less in Hospital B.

           v.) Daylight

           Daylighting, if properly controlled can reduce the electricity consumption of
           electric lighting as well as creating a better living and working environment. To
           provide well-distributed and glare-free illumination, daylight can be diffused in a
           variety of ways, such as use of louvers and design light shelves to bounce daylight
           into the space and use of special shading devices to block direct sun penetration
           into the building.

CONDUCTED BY: ECO ENERGY SDN BHD                                                              14
FINAL REPORT ON ENERGY EFFICIENCY OPPORTUNITIES FOR GOVERNMENT HOSPITAL

           Turning off or dimming the electric lights in response to the amount of available
           daylight can result in considerable amount of electric lighting savings. However, if
           the total glazing area is not optimised, these savings can be offset by the increased
           in heat gain. It is important to prioritise strategies and select optimal combination
           of strategies in the energy efficient hospital design.

           Considering daylight as part of the design strategy in the hospital building requires
           preliminary lifecycle cost benefit analysis of daylighting as an integrated part of the
           total building. Use of computer simulation software, such as the IES Virtual
           Environment Software to perform the daylight studies, helps to establish the
           lighting control strategies, such as the use of zoning and selection of on-off
           switching circuits in the building.

           Increasing the use of daylight through the building design and automatically
           turning off light in the respective areas would provide up to 2% of the annual
           hospital energy consumption but with relatively high payback period (can be up to
           10 years).

           vi.) Landscaping and Exterior Wall Colour

           Creating suitable landscaping around the building can help in reducing the building
           heat load and creating conducive environment for building occupants. For
           example, planting trees and shrubs around the building helps blocking the direct
           sun radiations from getting into the building. However, tree are dynamic as it
           grows and changes with the time and their root can affect the building structure if
           they are not selected and planted carefully around the building.

           Further, using light colour of exterior walls and roofs can help in reducing the level
           of sun radiation absorptivity of the building structure and consequently lowering
           the building heat loads.

In general, adopting passive design measures in a new hospital building would provide
10 to 15% of energy savings. The payback period would be very attractive, i.e. 6 to 10
years.

4.2   Use of energy efficient equipment and apply effective control system.

      Use of energy efficient utility and general equipment, including air conditioning, water
      heating, lighting, pumps and motors can reduce the hospital building energy operating
      cost effectively. In addition, applying an effective control system may well improve the
      system efficiency and reduce the energy wastages.

      Energy operating cost for a typical hospital building can be apportioned in the following
      ways to each end-use:

                i)      Air-conditioning: 50% - 55%

                ii)     Water heating: 15 – 20%

                iii)    Lighting: 15 -20%

CONDUCTED BY: ECO ENERGY SDN BHD                                                               15
FINAL REPORT ON ENERGY EFFICIENCY OPPORTUNITIES FOR GOVERNMENT HOSPITAL

                   iv)    General Equipment, including refrigerators, ventilation fans,
                          compressors, sewerage and cold water pumps & motors, medical
                          instrument and office equipment: 10 - 15%.

        The following sub-section discusses potentials of various energy efficiency applications
        for the hospital building:


4.2.1    Air-conditioning

        Air-conditioning systems are intended to provide adequate cooling comfort,
        dehumidification, and ventilation to the occupied spaces at a reasonable cost. Highly
        controlled indoor air-quality is required in hospital buildings, therefore air-conditioning
        is playing a critical role to ensure this requirement is met. Moisture must be removed
        from the ventilation air with high portion of outside air, and with facilities that operates
        24 hours and located in a tropical country like Malaysia, this is especially challenging
        tasks for the hospital building air-conditioning system. In a conventional system, the
        ventilation air is cooled to a very low temperature to remove moisture and then reheated
        to avoid overcooling the building. The process of overcooling and reheating can be very
        energy intensive. Therefore, it is important to consider the energy-saving
        dehumidification techniques in a hospital air-conditioning system.

        The following paragraphs highlight the potential of savings and recommend EE
        approaches in the new design, retrofitting and current hospital building:

          i.)    Consider high efficient total reengineering approach.

                 During re-engineering it is required to examine the current and future hospital
                 heat loads and look at integrating the whole system replacement rather than
                 equipment replacement as what happened in Hospital A. The currently under
                 construction Ambulance Centre will have their own air-conditioning system.
                 Considering an integrated air-conditioning system supplying both Ambulance
                 Centre and Main Building will open to more feasible energy efficient air-
                 conditioning system, such as use of District Cooling Cogeneration and Thermal
                 Storage System.

                 Consider this approach in the new design and any re-engineering approach.

          ii.)   Use automatic chillers control to distribute chillers load in a manner that
                 minimises total plant operating cost

                 The automatic chillers control uses temperature sensor to sense the outside air
                 temperature and adjust the chillers load accordingly by increasing the leaving
                 chilled water temperature automatically. The higher the chilled water
                 temperature, the lower the compressor power required to matched the load.
                 Typically an increase of 1 degree Celsius in the chilled water temperature
                 reduces the compressor power by 2% to 4%.




CONDUCTED BY: ECO ENERGY SDN BHD                                                                 16
FINAL REPORT ON ENERGY EFFICIENCY OPPORTUNITIES FOR GOVERNMENT HOSPITAL

               Implementing this energy saving measures would provide up to 10% energy
               savings in the chillers load, thus representing approximately 3% of the hospital
               annual energy consumption with payback period of less than 1.5 years.

               However, this method may not be as effective on the Variable Flow Pumping
               System, as currently used in Hospital A. This system employs two pumping
               loops system, where the primary loop with chillers tend to be keep water flow
               constant, and the secondary loop changes pumping flow, with the use of
               Variable Speed Drives, according to the heat load. Raising the chillers water
               temperature requires more water to be pumped on the secondary loop,
               increasing the pump power.

               This measure is recommended in both new design and currently operated
               hospitals.

        iii.) Use of chilled water storage (and switch to C2 tariff)

               Both hospitals are currently taking electricity from TNB under C1 tariff. The
               high load factor for both hospitals, i.e. 69% and 79% respectively for Hospitals
               A and B, makes switching from C1 to C2 tariff feasible, and with the
               application of Chilled Water Storage the cost savings would be order of RM
               75,000 to RM 85,000 per annum.

               Chilled water storage is cheaper to build and more efficient to run and should be
               considered if there is no space constraint.

               Consider this measure in the new hospital design.

        iv.)   Proper zoning of areas.

               This measure open to more effective EE implementation in hospital building,
               such as use of VAV system, proper monitoring and control in each zone, higher
               possibilities of natural ventilation and daylight uses which reduce dependency
               on the electric.

               Considering this approach would be feasible in the new hospital design, while it
               might not be effective in the currently operated building.

       v)      Use of Variable Speed Drives (VSD) to control motors driving Chilled
               Water Pumps and Cooling Tower Fans; and replace all three-way valves at
               the return chilled water AHU with two-way valves

               Use of VSD to control motors driving the pumps may significantly reduce the
               pumping power, especially during the partial load. In the constant flow system,
               the use of VSD with chilled water pump motor should be accompanies with
               replacing all the bypass valves at the return chilled water sides (or the three-
               way valves) to the two way valves, to achieve the maximum savings.

               Use of VSD in the secondary loop of the Variable Flow System as in Hospital
               A is common. To achieve maximum savings from this, it is also recommended

CONDUCTED BY: ECO ENERGY SDN BHD                                                             17
FINAL REPORT ON ENERGY EFFICIENCY OPPORTUNITIES FOR GOVERNMENT HOSPITAL

              to replace all three-way valves at the return chilled water air-handling unit to
              two-way valve.

              It is also recommended to consider use of VSD with the motor driving cooling
              tower fans. The energy used for this fan is influenced by the difference in the
              condenser water temperature and the ambient wet bulb temperature. Therefore
              use of VSD for cooling tower fan will reduce energy used by the fans
              especially when the ambient wet bulb temperature is low at the night. The
              relatively small size of the fan may not justify the savings for retrofitting, but
              this is highly recommended in the new air-conditioning system design.

              Consider this approach in the currently operated building and new hospital
              design.

       vi)    Use of Variable Air Volume (VAV) system to serve areas according to the
              heat load requirement.

              In a centralised air-conditioning system, with AHU serving large area and with
              highly fluctuating occupancy schedule, use of Variable Air Volume (VAV) with
              proper zoning will greatly saves the AHU blower fans energy consumption. In
              Variable Flow System as in Hospital A, this will also significantly reduce the
              secondary loop pumping power (with VSD controlling the motor pump) and
              thus saves considerable energy.

              Considering this approach should be limited to the new design at most of the
              time. Further detail study on the building zoning is required to consider this in
              the currently operated building.

       vii)   Use of High Efficiency Motor (HEM) with all motors driving pumps and
              fans.

              Use of High Efficiency Motors (HEMs) instead of standard motors offers an
              attractive energy saving potential for motors that run for a long time. HEMs
              are generally 2-4% higher in efficiency for large motor sizes (above 5.5 kW)
              and 4-7% higher in efficiency for motors of smaller sizes (less than 5.5 kW).

              The premium price of HEM is between 20% and 40%. In general, the payback
              period for the incremental price of HEMs can be less than 3 years. It is
              important to note that the effectiveness of using HEMs is at the design stage or
              when there is a need for motor replacement. In other words, replacement of
              currently run standard motors with HEMs is difficult to justify economically.

              Specifying only HEMs during the motors replacement or during the air-
              conditioning system design offer savings of up to 1.5% of the hospital’s total
              electricity consumption.

              Considering this measure is limited to the new design and when motor is burnt
              only and requires replacement or rewinding.



CONDUCTED BY: ECO ENERGY SDN BHD                                                             18
FINAL REPORT ON ENERGY EFFICIENCY OPPORTUNITIES FOR GOVERNMENT HOSPITAL

       viii)   Provide localised cooling system occupied room after normal working
               hours and turn off the Air-Handling Equipment serving the large areas
               with low occupancy level.

               This measure is to be considered if there is large area served by packaged unit
               air-conditioning system, operates with different schedules and have highly
               fluctuating occupancy level in the current building. It is recommended to
               provide split unit in only occupied rooms after the normal working hours and
               turn off the Air-Handling Units, which serves most of the unoccupied areas.
               This provides an alternative to the non-feasible VAV in the currently occupied
               building.

               This measure would be effective in Hospital A as it uses high number of
               Packaged Air-Conditioning Units for the other scattered buildings around the
               main building. (Only the Main Building is served by a centralised air-
               conditioning system).

               The potential of energy savings is minimal but this measure is simple and
               requires very low investment cost. It is therefore recommended to check all
               possibilities in both Hospitals for this measure and implement it immediately.

               This measure should be applied immediately if there is large savings resulted
               from high usage of packaged air-conditioning system in many buildings.
               Further analysis on the individual areas occupancy and working schedule is
               required.

       ix)     Use of high efficient dehumidification system

               The use of conventional method to cool air to very low temperature, to remove
               moisture and reheated to avoid overcooling is very energy intensive and should
               not be used. There are basically two types of dehumidification: cooling based
               systems and heat wheel desiccant systems. Cooling based systems extract
               moisture in a liquid state by using coils to cool the air to very low temperature,
               while desiccant systems directly extract moisture from the air in a vapour state.
               This occurs without a cooling effect and produces air with a higher temperature
               and lower humidity content.

               Hospital B employs a mix of both systems in 30% of their air handling unit
               installations, where the heat wheel with desiccant is used especially for the
               critical areas like operating theatres. On the other hands, Hospital A employs
               the heat pipe cooling based system for the same purpose. Both systems have
               their own advantages and disadvantages in terms of energy consumption in air-
               conditioning. The following issues arise from both systems and require further
               life-cycle cost-benefit analysis on a holistic approach:

               i.   For both the heat pipe and heat wheel desiccant systems, increase in
                    pressure drop and eventually in the fan power size must be taken into
                    account accordingly in the total energy savings.



CONDUCTED BY: ECO ENERGY SDN BHD                                                              19
FINAL REPORT ON ENERGY EFFICIENCY OPPORTUNITIES FOR GOVERNMENT HOSPITAL

              ii. In systems that use liquid as a heat transfer medium, pump power is also
                  required. Control of the system is essential, or if the system is not well
                  matched to the application, the additional fan and pump power may negate
                  a large part of savings.

       Consider this approach in the new design and currently operated building.

         x.     Use efficient methods to control the operation of multiple split units.

         In a fairly large air-conditioned area of more than 4,000m2, the first rule is to avoid
         use of multiple split units due to its low efficiency compared to the packaged air-
         conditioning units. In smaller buildings, as can be seen across Hospital A, use of
         split units might be extensive and not efficiently controlled in terms of starting and
         stopping to suit the occupancy and working schedule. Therefore, it is highly
         recommended to implement a method of controlling the starting and stopping these
         spit units by means of following:

                i)      Occupancy Sensor

                        Occupancy sensor provides the most effective way to sense the
                        presence of human in the area and it can be used to turn on and off the
                        split unit automatically. There are a few types of occupancy sensors
                        with different sensing technology in the market, i.e. ultrasonic,
                        passive infrared and a combination of the both. Each type of sensor
                        prices differently and will suit well in different activity mode in such
                        area.

                        With a contactor, the same sensor can be used to turn off lighting in
                        the area according to the presence of human. Advanced occupancy
                        sensor may have good quality daylight sensor in-built. This opens
                        opportunity to the use of daylight.

                        The opportunity of energy savings varies among hospitals, depending
                        on the level of split unit loads to the total air-conditioning load used
                        in the hospital.

                ii)     Time Control

                        In controlled occupancy area with fixed time schedule, it is worth
                        using a time control split unit to turn off the split units on time. This
                        will eliminate any possibilities that the split units will be left on
                        unnecessarily.

                        The opportunity of energy savings also varies among hospitals,
                        depend on the level of split unit loads to the total air-conditioning
                        load used in the hospitals.

              Consider this approach in the new design and currently operated building.



CONDUCTED BY: ECO ENERGY SDN BHD                                                              20
FINAL REPORT ON ENERGY EFFICIENCY OPPORTUNITIES FOR GOVERNMENT HOSPITAL




         In general, considering all the above approaches would provide savings in the
         order of 15 – 20% of the electricity consumption for new buildings; and 10 -15%
         of the currently operating hospital buildings, with payback period less than 3
         years for both conditions (new and currently operating).


4.2.2    Water Heating

Hot water and steam demand in hospital is also one of the major energy consumers to the high
intensive of water heating process. Hot water and steam is extensively used in hospital
buildings, especially for cooking and steaming equipment in the kitchen, operating washers,
dryers and ironers in laundry, autoclaving and sterilisation process. Steam is also used for the
hospital hot water system and air-conditioning reheating system.

Water heating process constitutes approximately 30 to 40% of the hospital building energy
operating cost and it is therefore important to implement the most efficient method. Steam
Boilers are used to produce steam at certain pressure depending on the steam pressure demand.
The following paragraphs outline the potential of energy savings as regard to the water heating
process in hospitals:

        1. Replace all faulty steam traps

        Faulty steam traps waste a lot of steam through leakages and hence waste a lot more of
        energy. The faulty steam traps can be identified through good preventive maintenance
        practice, such as use of thermography methods to identify the leakages.

        The potential of savings can be very attractive as the fuel consumption can be reduced
        greatly. In one of the government hospitals in Malaysia (not covered in this Study), this
        measure is proven to have saved their annual fuel consumption by 30% and this
        represented approximately 15% of the energy cost savings. The payback period can be
        very fast, less than 6 months.

        2. Adjust the steam pressure produced according to the steam demand

        In Hospital B, steam is produced at 10 bars, while the requirement is between 2 to 5 bars
        only. This implies that the steam is oversupplied and does not match the load, therefore
        gives an opportunity to adjust the steam pressure accordingly and hence to save fuel
        consumption. Taking a conservative saving of 10% of fuel consumption would reflect in
        energy operating cost savings in the order of 3-5% depending on the fuel price of LPG.

        In addition, the trend of outsourcing their laundry to the third party increases opportunity
        to reduce the steam demand further. Hospital A has recently outsourced its laundry and
        revised their steam demand accordingly. By adjusting the steam pressure from 10 to 8
        bar, it was able to shut down one of the running boiler and saved on fuel consumption by
        50%, representing in average 25% of their annual energy operating cost. The cost of
        outsourcing the laundry is not available.


CONDUCTED BY: ECO ENERGY SDN BHD                                                                 21
FINAL REPORT ON ENERGY EFFICIENCY OPPORTUNITIES FOR GOVERNMENT HOSPITAL

   3. Use of heat pumps that use air-conditioning condenser water as heat sink for
      generating hospital hot water

        Considering heat pump, which recovers heat rejected from the condenser water to
        generate hot water for the hospital will reduce the dependency on boilers to generate
        hot water. This will also increase the heat rejection performance of the cooling tower,
        which increases the overall air-conditioning efficiency, while electricity used by the
        heat pump compressor is marginally small.

        Consider this approach in the new design and also currently operated hospital building.

Considering all the above measures would provide up to 20% energy savings, especially
in the currently operating buildings. Payback period would be 2-3 years in the currently
operating buildings (particularly item 1 & 2) and less than 1 year (item 3) in the new
building design.


4.2.3   High Efficient Lighting Equipment

The hospital lighting and general office equipment, which is the next largest electricity
consuming end use, represents an average 20% of the total hospital energy consumption.

   1. Use of triphoshor instead of monophosphor fluorescent lamps, 6-W low loss
      ballast and high efficient luminnaires.

        By selecting efficient lighting system including using triphosphor fluorescent lamps, 6-
        W low loss ballasts and good quality luminaires with suitable occupancy sensors and
        photosensors can offer substantial reduction in building lighting loads.

   2. Use of lighting control system.

        The possibility to turn off (or dimming, with the use of electronic ballast) the light
        circuit automatically due to unoccupied areas and high penetration of daylight level in
        certain part of the hospital building was not considered in any of the hospitals during
        their design stage. Most of the time, the busy working staffs tend to leave the light on
        at these areas, especially along the corridors throughout the day and this wastes
        considerable amount of energy.

   3. Delamp overlit areas

        MS 1525 standard is a good guide for designing energy efficient building equipment.
        For example, the Study showed that hospitals and any clinical waiting areas are highly
        illuminated, with average illumination level of 200 - 300 lux, although the MS 1525
        recommends using 100 lux only.

        This provides an opportunity to de-lamp the light fitting (or turn off certain light
        circuits) in the existing installation, as it is very easy and cheap to be carried out,
        although the energy savings would be very significant, in order of 1% of the total
        electricity energy consumption.


CONDUCTED BY: ECO ENERGY SDN BHD                                                             22
FINAL REPORT ON ENERGY EFFICIENCY OPPORTUNITIES FOR GOVERNMENT HOSPITAL

         The use of energy efficient lighting and other equipment not only helps in reducing the
         electricity consumed by the equipment, but also reducing the building heat load and
         consequently reducing air conditioning system electricity consumptions.

         In addition to the above, it is recommended to consider use of daylight in most areas,
         which would benefit from it directly, such as waiting areas, visitors lobby and most of
         the wards. Since this area covers almost 30% of the hospital floor occupied floor areas,
         optimising use of daylight with proper light control and good ventilation system will be
         very attractive

Considering all the above measures would provide up to 5% electricity savings in the
currently operating buildings and new building design. Payback period would be 4 - 5
years in the currently operating buildings and much faster (less than 3 years) in the new
building design.


4.2.4    Building Operations and Maintenance
        The following paragraphs highlight major areas where the Operation and Maintenance
        can play important roles in reducing the energy wastages in the currently occupied
        hospital building:

          i.    Reduce the excessive outside air infiltration.

                This phenomenon is quite common in a hospital building, where the need to
                comply with high indoor air-quality has given a wrong impression to the building
                operators to allow the excessive outside air into the building. With the advanced
                technology in the currently implemented air-handling unit to treat the air
                differently from ventilation air used in the other part of building, the air-
                conditioned building is not needed to be open to the outside air uncontrollably.

          i.) Increase indoor temperature and relative humidity to maintain acceptable
              level of comfort.

                This phenomenon is also quite common in buildings where the temperature
                setting is adjusted over time to compensate for the inadequate or poor system
                design and operation. The fact that the currently used air-conditioning system in
                both hospitals employs fairly efficient dehumidification methods, which treats
                the air-quality separately for the critical areas makes increasing the indoor
                temperature and humidity, without affecting the indoor air quality possible.

                In both of the hospitals in this Study, the temperature and humidity are found to
                be within the comfort level throughout the buildings and within the
                recommended indoor air quality for certain controlled areas.

         iii.    Delamp overlit areas

                 MS 1525 standard is a good guide for designing energy efficient building
                 equipment. For example, the Study showed that hospitals and any clinical
                 waiting areas are highly illuminated, with average illumination level of 200 -
                 300 lux, although the MS 1525 recommends using 100 lux only.

CONDUCTED BY: ECO ENERGY SDN BHD                                                              23
FINAL REPORT ON ENERGY EFFICIENCY OPPORTUNITIES FOR GOVERNMENT HOSPITAL

               This provides an opportunity to de-lamp the light fitting (or turn off certain
               light circuits) in the existing installation, as it is very easy and cheap to be
               carried out, although the energy savings would be very significant, in the order
               of 1% of the total electricity energy consumption.

       iv.      Balancing of water and air systems in centralised air conditioning systems.

               It is common that maintenance does not pay particular attention on the air-
               distribution throughout the conditioned areas being served from the centralised
               air-conditioning system. This leads to the uneven air-distribution in some parts
               of the building. While this affects the overall comfort level, it leads to other
               unexpected wastages such as reduction in the chilled water temperature and
               high usage of additional split unit to compensate the problem.

         v.     Turn off air conditioning and light systems serving unoccupied areas.

               Most of the time the unoccupied areas being air-conditioned and lit
               unnecessarily. There is no proper control on this and amount of saving can be
               reasonably high.

         vi.     Apply EE oriented maintenance.

               Under the current concession agreement, the performance of support serving
               companies are evaluated on the availability of air conditioning, lighting, hot
               water and steam. Practice shows that in most cases focusing on availability of
               the services leads to excessive energy wastes through low temperature and
               humidity of air conditioned areas, leaving air conditioning system and lighting
               running when the areas are not occupied. Therefore, it is essential to review the
               current utility maintenance to include EE performance indicators, such as
               Building Energy Indices for Air Conditioning, Lighting and total energy
               consumption.

It is well proven that applying energy efficient maintenance and operation as outlined
above would provide considerable energy savings of between 5% to 7% of the building’s
annual energy consumption.




CONDUCTED BY: ECO ENERGY SDN BHD                                                             24

				
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