Medical Office Buildings
The medical office building is an important adjunct to the health care industry. Many are located close to the hospitals that the doctors are affiliated with. Others are satellites, located to serve fringe regions. A medical office can range in size from serving two doctors to multistory facilities with completely modern diagnostic and treatment equipment. Small offices may only have basic HVAC, lighting, and plumbing, while large facilities can include extensive plumbing, fire protection, emergency power, and medical gas (oxygen and vacuum) systems, along with energy systems specifically for diagnostic and treatment equipment.
Typical medical office suites will include an office for each doctor, exam rooms (approximately 3 per doctor), equipment and special procedure rooms, as well as a laboratory, X-ray and dark room, nurse's station, staff lounge (some with kitchen equipment), reception room, business office, storage, and restrooms. Larger facilities may include more elaborate facilities. (See Outpatient Facilities)
Many buildings that medical offices are located in require tenants to facilitate and pay for their own utilities. This requirement influences many decisions about the facility including construction, lighting, and HVAC.
The HVAC systems will vary widely and are largely dependent on low- versus high-rise design, the amount of specialized equipment, and the type of medicine practiced by the resident doctors. High-rise medical office buildings tend to use central systems with many zones and individual occupant control or geothermal heat-pump systems. In climates with low heating loads, electric resistance heating is often utilized. Small and/or low-rise medical buildings are typically designed with one or more unitary systems that use roof-top heating and cooling units; one per zone.
Special purpose spaces require separate designs. For instance, reception rooms have high occupancy and lighting. In most cases, exam rooms require separate zoning due to the various stages of undress of patients. Dialysis and chemotherapy patients feel cold during treatment, so these rooms must be kept warmer. In addition, laboratories and dark rooms for X-ray development both require exhaust air and acid-resistant plumbing.
Loads can vary widely and must quickly switch from heating to cooling regardless of the size of the facility, and must still require only automatic, simple-to-operate controls.
Proper ventilation is necessary to control odors and avoid "sick building" syndrome and provision should be made to shut any outdoor air dampers when individual zones are unoccupied. Many places have stringent codes covering fire, smoke, building design, ventilation, and noise control. In many cases, noise production and protection from vandalism must be taken into consideration. As an alternative, geothermal heat-pump systems are becoming increasingly popular, because they have no outdoor equipment to create noise or get damaged.
Energy conservation concepts are simple: cooling interior spaces with outdoor air using economizer cycles, night setback in individual areas, and outdoor air damper control during system shutdown at night and other such times. Water-loop heat-pump systems will also conserve energy if the building has significant interior zones. Some designs also have thermal storage so that excess heat generated during the day can be used for heating at night.
Energy Saving Recommendations
- Older and/or inefficient systems should be inspected for potential upgrading or replacement opportunities, particularly if CFC refrigerants are used.
- Where demand and/or on-peak energy costs are high, look into thermal storage.
- Energy conservation concepts discussed above that are not currently implemented, or antiquated, or inappropriate control systems all represent energy saving opportunities.
Water heating is not a major energy user with applications typically limited to hand washing and cleaning purposes. Most water heating is done separate from the building heating system and uses direct resistance or gas heaters; and in some cases, point-of-use heaters. Some buildings use central distribution systems with storage and constant recirculation where it is desirable to have hot water continuously available at the fixtures. When multiple tenants occupy the building, individual storage heaters for each tenant space are often used and separately metered.
Energy Saving Recommendations
If existing systems are inefficient and/or inadequate, replace them with efficient, modern equipment as soon as possible. If a source of excess/waste heat (i.e. tower water) is available, consider a water-to-water heat-pump heater.
The doctors occupying the medical office building require facilities that are attractive as well as functional. Therefore, the lighting design must be up to the standards mandated by the specific medical field, as well as attractive and comfortable to use for extended periods of time. Ideally, the lighting should support the healing process.
It is recommended that 20 to 50 footcandles of light is provided in physical, occupational, and inhalation therapy areas. Radiation therapy light levels should be 5 to 10 footcandles. And dialysis areas need 100 to 200 footcandles.
For maximum comfort and utility, choose lamp sources with a color temperature of 3500k to 4100k and at least 80 CRI. Triphosphor fluorescent and compact fluorescent lamps are both good choices.
If there are monitors or VDT screens in the area, choose low glare, high VCP fluorescent fixtures. Indirect fluorescent lighting may also be appropriate, especially in dialysis units where patients face the ceiling for several hours at a time.
Energy Saving Recommendations
Incandescent and fluorescent exit signs should be replaced with LED exit signs if at all possible. T-12 fluorescent lamps with magnetic ballasts should be replaced with T-8 lamps and electronic ballasts. Make sure that the electronic ballast selected is compatible with any sensitive medical equipment.
Please note that parking lot, security and façade lighting may contain incandescent and mercury vapor lamps. These should be replaced with metal halide systems, because the color of high pressure sodium is frequently uncomfortable for the doctors.