This year I was lucky to be able to attend my first in-person conference in about 4 years – it was a joint conference between the International Federation of Healthcare Engineering (IFHE) and the Canadian Healthcare Engineering Society (CHES). The last time I attended the CHES conference was as a presenter back in 2018 in Newfoundland and quite a lot has changed since then. The conference was in Toronto this year, so I was able to commute there by bike! Given that CHES was sharing the stage with IFHE, the conference included various international presenters, including from the US, Japan, and Iran and included delegates from all over the world.
The biggest shift I noticed was the prominence of the climate crisis in most sessions and urgency of tackling decarbonization. UHN has been focused on climate action for many years and it is very exciting to see the entire industry shifting along with us to achieve decarbonization of our sector as quickly as possible. Here are some of my highlights from the conference.
To open the conference, we were treated to a motivational speech by Canadian hockey legend Haley Wickenheiser. She told of training for her fourth Olympics and an intense team-building exercise to cycle to the summit of Apex Mountain. Well, cutting fossil fuels and fortifying our hospitals against the climate crisis in order to maintain and enhance health care services for patients is our industry’s Apex Mountain/Olympics.
The second keynote speaker Dave Williams, a former astronaut and hospital CEO, literally gave us the big picture view of the world with his photos and videos of the earth from his space walks at the International Space Station!
Microgrids! Powering the future of Healthcare Power, Sustainability, and High-Value Financial Performance
In this session, Walter Vernon of Mazetti discussed the potential for healthcare campuses to develop internal microgrids that integrate utility grid power, renewable energy, battery and thermal energy storage, combined heat and power, etc. The purpose of such a microgrid is to allow for decarbonization of energy sources, insulate the healthcare facility from utility outages, decrease utility costs, improve efficiency, and decrease costs associated with emergency power. He highlighted that the latest National Electric Code (in USA) has allowed hospitals to use microgrids for emergency backup power and the US government is deploying financial incentives to implement such microgrids. Canadian code still requires on-site fuel storage for emergency backup power (i.e. diesel generators), but American standards do have a way of eventually migrating north.
Placing the Patient First: Innovative Infrastructure Renewal and Energy Efficiencies for Nova Scotia Health
Robert Barss of Nova Scotia Health eloquently described their Energy Master Plan, usage of lifecycle costing, and delivery of high efficiency systems on a low budget. He introduced the idea of “cost avoidance” as opposed to “cost savings” as the latter can be confusing to understand in the context of variable weather, operations, utility pricing, etc.
He described high value, low cost projects, such as:
- Recommissioning VFDs
- Air balancing
- BAS recommissioning
Robert also recommended using the knowledge gained from recommissioning activities to feed into master planning, capital planning, and continuous staff training to foster a long term commitment to energy efficiency. After all, he concluded, success is determined by a mix of people, process, and technology.
Design for Cold Climate Heat Pumps
Kurt Monteiro and William Rea of Smith & Anderson and HTS, respectively, delivered an extremely informative presentation about heat pumps, a critical technology for reducing fossil fuel consumption. This presentation included practical learnings from their implementation of an air-water heat pump system with resistance backup at a Toronto procedure clinic. The heat pump system, located on the roof, provides cooling and heating down to -13C outside temperature at which point electric resistance backup coils take over. Their key design takeaways were the following:
- Buffer tanks on the supply and return side can be beneficial in maintaining stable operation, especially during defrost cycles
- Restarting the machine at cold temperatures (for example after temperature rises back above -13C) was an issue. According to the presenters, installing an electric boiler on the water side rather than electric coils on the air side may have been a better choice as it would have maintained loop water temperatures, thereby avoiding cold starts of the refrigeration cycle.
- Defrost is an important design consideration for air source heat pumps (ASHPs). During the defrost cycle, heat is extracted from the building and heating water temperatures can vary.
- One way to mitigate the impact of defrost proposed was to incorporate multiple refrigerant circuits in the system in order to stagger the defrost timings for more consistent operations.
- Additionally, during the defrost cycle considerable water is melted off the unit. Heat tracing of the pan and drains must be incorporated to prevent ice buildup.
- Heat pump technology is improving at low temperatures, however there are limits to the refrigeration cycle, and there are many options for auxiliary power. As mentioned, resistance electric is common, but given the small quantity of hours at least in the GTA where temperatures are at the limits, even using gas as a backup source will yield huge GHG emissions reductions.
- Low ambient cutout temperature can vary according to wind, humidity, and temperatures. Machines with vapour injected compressors and VFDs enable even better low temperature performance.
- Key takeaway was that heat pump technology is “not new to the world, but is new to us” so it is very important to implement more training than typical. For example, include a training session prior to the first cooling season and then again prior to the first heating season. Also, remote monitoring for troubleshooting was mentioned as a good way to stay on top of any potential issues.
- The final message was the heat pumps work well in cold climates and can be energy as well as cost efficient, but proper care has to be taken in the design process to account for the operating characteristics of these systems.
Overall, this was one of the most valuable presentations of the conference as heat pumps will be a big part of UHN’s decarbonization plan. We do have experience with heat pumps for wastewater energy transfer and air side heat recovery and I know my heat pump works at home, but we don’t have any ASHPs installed yet at UHN. That’s why the sharing of this information is so valuable.
This presentation by Jeff Urlab of Salas O’Brien consulting firm laid out a roadmap of how to design a hospital without fossil fuel. He discussed key concepts of electrification, including design and integration of various technologies to end reliance on fossil fuel:
- Ground source heat pumps (aka “geothermal”). One key consideration is that the heating and cooling demands on the ground source field must be balanced to avoid depleting the heat available over time.
- Heating water temperatures must be reduced to about 120F in order to optimize heat pump efficiency. UHN is currently converting all AHU heating coils at the Toronto Western campus for this reason as part of the WET System project.
- Air source heat pumps can be a great compliment to ground source because they can pick up a large amount of load during winter allowing the ground field to be more balanced. This may be a key consideration for decarbonizing the Toronto Rehab Lyndhurst/Rumsey campus.
- Coil design: oval cross section tubes can reduce fan energy by up to 40% compared to round tubes!
- Heat pumps using CO2 refrigerant can be used for domestic hot water up to a COP of 7.4 when using chilled water return as the heat source.
- Desiccant wheels reduce de-humidification loads on the mechanical cooling systems.
- Air handling units do not need air side economizers as it can be achieved more efficiently with water side economizers (heat recovery chillers). Higher outdoor air changes can improve indoor air quality as well.
- Humidification is achieved with low temperature atomization of reverse osmosis water instead of steam (this may not be possible in Canada yet due to codes) and sterilization processes are fed by local electric steam generators
The final plenary was a call by Ryan Duffy of Blackstone Energy Services to “be the change” and tackle the three C’s – consumption, cost, and carbon. The presentation highlighted the risk of being caught standing still when carbon taxes are heading higher, legislation is forcing transparency in emissions accounting, and other institutions are pulling towards net zero carbon emissions.
The presenter called for healthcare engineers to develop emissions forecasts to 2030 and 2050, create a net zero roadmap, push for clean procurement, cultivate a purpose driven organization, and most important of all START now!
My apologies for the “wall of text” style blog, but photos of slideshow presentations aren’t great and, given the conference was at home, I didn’t do much site seeing this time around!