Healthcare Functional Design Brief

Document Information
This document is the functional design brief for Schneider Electrics EcoStruxure offer for
Healthcare Projects
This Version
Authored by:
Name:
Chris Roberts
Position:
Healthcare - Applications and Solutions Architect
Date:
6 June 2011
Name:
Graeme Robertson
Position:
Business Development Director Healthcare
Date:
13th June 2011
Name:
Chris Roberts
Position:
Healthcare - Applications and Solutions Architect
Date:
27th July 2011
th
Reviewed by:
Authorised for issue by:
Version History
Version
Date
Status
Changes Overview
2.0
27/07/2011
For issue
Second draft
Page 1
Healthcare
Functional Design Brief
This document showcases the use of
Schneider Electrics solutions for constructing
high performance healthcare buildings.
July 2011
Make the most of your energy
SM
Page 2
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
o
o
A comprehensive description of all the possible functionalities that Schneider Electric can
deliver in a healthcare facility.
A detailed technical specification of each technical system Schneider Electric
can deliver.
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
o
o
o
o
improved financial performance

a welcoming, safe, and secure environment for patients, staff, visitors, and assets
improved productivity
improved patient satisfaction
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
clients functional design brief.
This is a global document. It needs to be adapted locally in each country according to:
o
o
o
o
o
o
local energy regulations

local Green building certification
local standards
local construction codes
Schneider Electric products and services available in the country
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 customers business needs, the owners 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.
Page 3
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
2.1.2
2.2
Cabling, Construction and Network Devices........................................................................... 11
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

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
3.2.4
Shock Sensitivity ..................................................................................................................... 16
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
3.2.6
TYPICAL ARCHITECTURE ....................................................................................18

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 WATER 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
3.3.1.6
Infection Control, Legionella.................................................................................................... 26
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
3.3.4
EQUIPMENT AND SOFTWARE ..............................................................................28

OPERATING AND MAINTENANCE SERVICES .........................................................28
Page 4
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 WATER 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
5.4 INTRUSION DETECTION .................................................................................................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
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
Page 5
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. (WATER,
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 OPERATING AND MAINTENANCE ...........................................................................................70
9.1
9.2
9.3
9.4
INTRODUCTION ............................................................................................................70
INTELLIGENT TECHNOLOGY INFRASTRUCTURE ...............................................................71
24/7 REMOTE SUPPORT WITH SPECIALIST ENERGY SERVICES .......................................71
INTEGRATED MOBILE COMMUNICATIONS TECHNOLOGY ..................................................72
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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
Page 7
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
o
o
o
1.1.2
Patient Safety
o
o
o
o
o
1.1.3
Patient control of micro climate (temperature, light level, humidity and security)
Air filtration and quality
Acoustic monitoring
Entertainment and communications
Facilities for visitors
Staff Productivity and Retention

o
o
o
o
o
1.2
Security systems
Infection control measures
Life safety systems
Nurse call systems
Real-time location systems
Patient Environment
o
o
o
o
o
1.1.4
Occupancy-based functionality of services

Intelligent, interactive patient and staff interfaces
Intelligent metering and monitoring of consumption
Enterprise-level energy management and benchmarking
Integrated, skills-sensitive nurse call and workflow management

Intelligent, integrated staff-based systems
Radio frequency identification (RFID) locating systems
Predictive maintenance technology
Increased levels of automation to reduce workload
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.
Page 8
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.
Lighting Control System
Integrated Security
Systems
Integrated Building
Automation
Dimmer units
Lighting controllers
Room switch units
Multi sensors
Scene setting
External lighting
IP CCTV
Access control
Staff attack
Infant tagging
Video intercom
Intruder detection
HVAC controls
Utilities metering
Predictive maintenance
SCADA
Monitoring & targeting
Data Centre Physical

Infrastructure
Power distribution
UPS
In-row cooling units
Integrated security
Room cooling
Energy reclaim
Hospital Intelligent Technology Infrastructure
Fire alarm
Emergency lighting
Public address
Voice evacuation
Fire// smoke dampers
HV/ MV / LV switchgear
Transformers
Generator integration
Busbar trunking
Plug & play distribution
24/ 7 remote services

Energy modeling
Bill validation
Dynamic energy pricing
Load shedding
Maximum demand
Servers
Digital video recording
POE switches
Firewalls
Quality of service
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.
Page 9
A full description of the architecture and system integration and interoperation is provided in Section 10 of this document.
Figure 1-2. Services Connected to the Hospital Intelligent Technology Infrastructure by Department
Page 10
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
2.1.1.1
2.1.2
2.1.2.1
CAPEX Cost Benefits

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 doesnt require its own switches or network equipment. The
switch capacity can be better optimized, which leads to reduction in cost.
OPEX Cost Benefits
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.
Page 11
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.
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.
Targeted monitoring and control offers views to different management tasks. For
example, HVAC, camera, access control, electrical, energy efficiency, data
centre and network.
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.
Page 12
Figure 2-1. Hospital Integrated System Functional Design
Field Devices
& control views
Operational views
Executive
TCP/ IP backbone
Page 13
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.
Power
BMS
Security
Access
+ Fire
Other
Power
Wiring cabinet 1
BMS
Security
Access
+ Fire
Other
Wiring cabinet 2
POE Switch
Fiber S/M 1Gb/s
POE Switch
Disabled by spanning tree

protocol
2xFiber S/M 1Gb/s

For redundancy
2xFiber S/M 1Gb/s

For redundancy
Hospital Datacenter
Access to other networks

(Med IT, Internet)
Servers and camera
recorders
Stacked switches
For redundancy
Firewall
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
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:
--
Figure 3-1. The Three Pillars of System Resilience

The main services where it is most important to achieve this balance are:
o
o
3.2
3.2.1
Electrical power distribution system

Heating, ventilation and air conditioning (HVAC) and water distribution system
Electrical Power Distribution

Hospital Constraints and Pain Points
Healthcare facilities are often complex and integrate several different processes.
Among them are:
o
o
o
o
o
Critical medical processes: Operating theatres, intensive care and labs

Critical non-medical processes: Patient data systems (server rooms and data
centres)
Important medical processes: Hospitalization (patient rooms), normal care and
radiology rooms
Non-critical medical: Ambulatory
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.
Page 15
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 hospitals 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
Criticality
level
Continuity of
service
requirements
Maximum duration
for power cut and
switching to a
backup power
source
Minimum endurance of the

backup source
Permanent power
supply
< 0,5 Second
3 hours
Brief interruption
< 15 seconds
24 hours
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
level
Technical installations
Hospitalization
Area
o
o
o
o
Operating theatre
Obstetrics
Intensive care units
Emergency ward
Attentive care
Intensive care
Standard care
Medical imaging
Administration
Laboratories
Pharmacy
Equipment room
Fire safety
A
B
C
Elevators
Medical air conditioning
HVAC
Cold room
Automation systems
Detection
Smoke extraction
A = Computer and monitoring equipment
B = IT equipment
C = Automated analysis equipment
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 hospitals 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 facilitys different levels of criticality in terms of:
Page 17
o
o
o
o
3.2.4.2
Design and sizing of installations with redundancy

Analysis of electrical risks
Studies of dependability, coordination, lightning and harmonics
Monitoring and control
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
o
o
o
o
o
o
3.2.4.3
MV network, MV loop reconfiguration

Generator set
Automated load shedding system
LV switchboards
Operating theatre switchboard
Power monitoring system
UPSs for uninterrupted power and static transfer switch (STS)
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:
3.2.5
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
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 hospitals 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:
MV loop monitoring and reconfiguration
Status of devices and equipment
Status of the reconfiguration electrical distribution process
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
Requirements
o
o
o
o
3.2.7
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 patients recovery. In some cases, the
control of the environment can play a significant part in a patients 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:
3.3.1
3.3.1.1
o Environmental control
o Infection control
o Hazard control
o Life safety
o Energy efficiency
Environmental Control
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.
Burch, G.E., and De Pasquale. Hot Climates, Man and His Heart. Thomas, Springfield, III.
1962.
Page 22
Function of space
Pressure
regime
Min.
outdoor
air
changes
per hour
Min. total
air
changes
per hour
All room air

exhausted
directly to
outdoors
Air
recirculation by
means of room
units
Design
relative
humidity
(%)
Design
temp
(C)
Class B and C
operating room
Positive
20
N/R
No
20-60
20-23
Operating / surgical
cystoscopic rooms
Positive
20
N/R
No
20-60
20-23
Class A operating /
procedure room
Positive
15
N/R
No
20-60
21-23
Delivery room
Positive
20
N/R
No
30-60
20-23
Treatment room
Positive
12
N/R
No
30-60
22-26
Recovery room
N/R
No
20-60
24,
+/-1
Triage areas
Negative
12
Yes
21-24
Patient room
30 (W)
50 (S)
21-24
Airborne infection
isolation room
Negative
12
Yes
No
30-60
21-24
Figure 3-3. Recommended Environmental Conditions 2

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
American Society of Heating, Refrigeration and Air Conditioning (ASHRAE) Standard 62.12010 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
detection, CO, CO2 and airborne contaminants such as volatile organic compounds (VOC).
In office areas the ventilation system can operate via demand control, fan speeds and
volumes can be varied according to the quantity of staff in the department. The CO2 sensor
will monitor the air to ensure that the ventilation system reacts to high levels of CO2 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
as well as staff health and efficiency. The U.S Green Guide for Healthcare 3 and LEED
Healthcare 4 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/
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
o
o
o
o
Through the supply air

Transferred from adjacent spaces
Shed by operating staff
Shed by patient
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
o
o
o
The first stage of filtration shall be via a general panel pre-filter, with a grade no
lower than G4 5 . 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.
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.
Additional filters may be provided at grilles, dependent on the nature of the
operating theatre.
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.
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 60C. 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 50C 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 70C, 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
o
o
o
3.3.2.1
Distributed power architecture serving major plants and equipment

Distributed intelligence
Native interoperability utilizing peer-to-peer communications
Highly resilient communications infrastructure
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
Different locations
Different functions
Common language
Shared information
Interoperability
Improved performance
Increased efficiency
Increased reliability
Fig 3-5. Peer-to-Peer Communications
In Figure 3-5, the diagram illustrates the principle of native peerto-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:
3.3.4
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
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
o
o
o
o
o
o
o
o
o
24-hour alarms
Repeated alarms
duration from alarm acknowledgement to clearance
unacknowledged alarm duration
Hardware point alarms
alarm failure pattern
alarms regarding Mean time to repair (MTTR) and Mean time between failures
(MTBF) control-loop performance and usage
optimiser performance at occupancy time
access to system
modified points and manual overrides on a per-user basis
Page 28
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.
Page 31
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.
Page 32
5
5.1
Security
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
o
o
o
o
o
o
o
o
Access control
Digital video surveillance (CCTV)
Intercom systems
Intrusion detection
Staff assault
Infant tagging
Patient elopement
RFID asset protection
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
station
Integrated digital video

surveillance system
HD IP CCTV cameras
System management &
video recording
BAS VLAN on
hospital FM
network
Hospital Intelligent Infrastructure
BAS
controller
DAS
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
o
5.2.1
Nursing and facilities management staff: Access card readers

Patients, visitors and unauthorised staff: Video entry, audio entry and remote
release push buttons
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
individuals and/or departmental work groups 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 accesscontrolled door.
Page 34
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.
Page 35
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
o
o
5.2.11
General open patient records

Level 2 medical supplies
Level 3 critical drugs
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.
Page 36
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 preconfigured 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.
Page 37
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
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
o
o
o
o
Quality electrical and mechanical services

Maximum availability of electrical and mechanical services
Improved energy efficiency
Improved staff productivity and satisfaction
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
Page 39
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 rooms 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
o
o
o
o
o
Design that fulfils the most stringent requirements in terms of reliability (reliable
products and approved electrical architecture)
Increased reparability to limit downtime (easier troubleshooting, equipment
standardization, automatic alarms and remote diagnosis tools)
Advanced monitoring of each room, allowing medical teams to make relevant
decisions in the event of major faults (important information display)
Full traceability of alarms and events, allowing maintenance teams to make an
analysis
Access to critical information for the maintenance staff
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:
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.
o
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
o
Satisfying criticality level 1 (changeover < 0.5 s)

Electric shocks in conformance with group 2
An overview of the system is shown in Figure 6-2.
-
-
--
--
--
-
-
- -
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
o
One circuit breaker per outlet

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
o
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.
The power and communication circuit routing shall be completely separate.
Propagation of electrical fields shall be prevented by physical separation
systems (in accordance with IEC 61439-1).
Page 41
6.1.1.1
6.1.1.2
6.1.2
Environmental Conditions (Operating or Electrical Room)

o Situation: Indoors
o Altitude: 2000 m
o Maximum ambient temperature: 30C
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
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
Standards
The installation shall comply with the following standards:

o
o
o
o
o
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."
IEC 60364-7-710: "Electrical installations of buildings - Requirements for special
installations or locations - Medical locations."
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."
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."
IEC 60364-4-44: "Low-voltage electrical installations - Protection for safety Protection against voltage disturbances and electromagnetic disturbances."
IEC 61000-6-2: "Electromagnetic compatibility (EMC) Generic standards
Immunity for industrial environments."
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:
Page 42
To dilute airborne contamination

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
Airborne Contamination
o
o
6.2.1
Within the operating theatre, there are four ways in which airborne containments can enter:
o
o
o
o
Through the supply air

Shed by operating staff
Through surgical activities
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
o
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.
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.
Additional filters may be provided at grilles, dependent on the nature of the
operating theatre.
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.
Page 43
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.
Function of space
Pressure
regime
Min. outdoor
air changes
per hour
Min. total
air changes
per hour
All room air

exhausted
directly to
outdoors
Air recirculation
by means of
room units
Design
relative
humidity (%)
Design
temp
(C)
Class B and C
operating room
Positive
20
N/R
No
20-60
20-23
Operating / surgical
cystoscopic rooms
Positive
20
N/R
No
20-60
20-23
Class A operating /
procedure room
Positive
15
N/R
No
20-60
21-23
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 engineers workstation.
taken from ASHRAE Standard 62.1-2010 addendum d

Page 44
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
6.3.1
Booking Systems
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
6.4.1
Monitoring and Display

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.
Page 45
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
o
o
o
o
o
o
o
o
o
o
o
o
o
Electrical installation status

Electrical installation alarms
Ventilation operating in normal or reduced mode
Ventilation system failed to operate
Temperature and humidity values
Temperature and humidity setpoint adjustments
Filter dirty alarms
Low humidity conditions
Medical gas alarms
Pressure regime conditions in room
Doors left ajar
Generators running
Transformer isolation test
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.
Page 46
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.
Page 47
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
o
o
o
7.1.2
Patient Safety
o
o
o
o
o
7.1.3
Security systems
Infection control measures
Life safety systems
Nurse call systems
Patient Environment
o
o
o
o
o
7.1.4
Occupancy-based functionality of services

Intelligent, interactive patient and staff interfaces
Intelligent metering and monitoring of consumption
Enterprise level energy management and benchmarking
Patient control of micro climate (temperature, light level, humidity and security)
Air filtration and quality
Acoustic monitoring
Facilities for visitors
Staff Productivity and retention

o
o
o
o
o
Integrated, skills-sensitive nurse call and workflow management

Intelligent integrated staff base systems
RFID locating systems
Increased levels of automation to reduce workload
The various levels of technology deployment are illustrated in Figure 7-1:
Page 48
Figure 7-1. Intelligent Technology Infrastructure for Medical Areas
Devices and functionality
Integration
Operational views
Management
Page 49
TCP/ IP backbone
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
o
o
o
o
o
o
Thermal environment
Lighting/daylighting environment
Acoustic environment
Air quality/cleanliness
Infection control
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 timeconsuming 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
Page 50
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 wellbeing and facilitate healing.
To ensure an optimal patient environment is provided, sensors must be installed to centrally
monitor air quality in terms of CO, CO2 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
o
o
o
o
7.4.1
Integrated security systems

Infection control
Life safety
Nurse call integration
Integrated Security System
Integrated security systems allow all aspects of hospitals 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
7.4.2
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.
Infection Control
Infection control can be improved in a number of ways through the intelligent infrastructure:
o
7.4.3
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.
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.
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.
Life Safety
Life safety systems can interoperate with other systems to improve patient safety by:
o
o
o
o
o
o
7.4.4
Interoperation of fire detection with CCTV and lighting for verification. For
example, in technical areas where electrical switchgear is located.
Interoperation with staff base systems to identify which patients need assistance
to evacuate the building.
Interoperation with digital signage to inform patients, visitors and staff of escape
routes and assembly points in three-dimensional walkthrough graphics.
Monitoring of medical gas leakage combined with intelligent alarm routing to the
facilities and medical staff.
Common holistic incident view of the entire hospital, providing a clearer picture
for more effective management and faster response.
Advanced control and monitoring of critical power applications to provide higher
availability and reduced risk of adverse events.
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
o
o
Alerting staff to patient elopement where certain patients may be at risk of selfharm. Integration with access control and CCTV, staff base and intelligent alarm
routing in such cases can assist a rapid response.
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.
Locating equipment, especially emergency life saving equipment, with
integration to staff bases and mobile communications devices.
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.
Page 52
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
o
o
o
Occupancy-based functionality
Intelligent patient and staff interfaces
Intelligent metering and monitoring
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 predetermined 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:
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.
o
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
o
o
o
Integrated workflow management

Integrated staff base systems
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 caregivers 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.
DECT
PDA
RFID
Integrated staff base

Life safety alarms
Nurse call and workflow
Facilities alarms
Energy consumption data
Security alarms
Central control and adjustment
Voice intercom
RFID location
Intelligent infrastructure
Security
systems
HVAC system &

patient
environment
Medical gas
system
Safety systems
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
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
o
o
o
EMC Directive 89/336/EEC

ISO 16484-5 and CEN TC247 at management and automation levels
The IEEE 802.15.4 standard for wireless sections of the field network, with a
frequency range of 2.4 GHz
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.
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.
API links where systems and devices communicate via the Ethernet network
using application programming interface covering routines, data structures,
object classes and protocols.
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.
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
o
o
o
o
o
o
o
o
Operating theatres
Workflow
24/7 remote access
Integrated security
Life safety
Energy
Facilities management
Environmental management
Medical staff management
Each view will present overview information and contain user-friendly intuitive drill-down
facilities to department and medical area levels.
Page 56
8
8.1
Energy Efficiency
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:
Active controls
Occupancy-based interoperation of HVAC, lighting and power
Advanced control techniques with increased levels of energy-saving automation
Advanced technology
Intelligent, interactive patient and staff interfaces to encourage energy efficiency
through behavioural change
Advanced measurement
Smart metering infrastructure
Self-metering devices
Advanced management and services
Intelligent data analysis
Real energy performance distributed dashboard techniques
24/7 remote specialist energy services
Enterprise-level energy management and benchmarking
Efficiency-based the facilities intervention
o
o
o
o
o
o
o
o
o
o
o
o
o
o
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%
Figure 8-1. Energy Consumption in a Hospital

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

Page 57
Electricity other breakdown

6%
5%
HVAC
35%
21%
Other
ICT data centre
Supplementary heating
Personal small power
Medical equipment
4%
10%
19%
Catering
Figure 8-2. Breakdown of Other Electricity Consumption 8

Notes: Fossil fuel base load is made up of domestic hot water services and process loads
such as sterilizers and distribution losses.
United Kingdom Department Of Health Energy Efficiency Guide. no.72

Page 58
The following table illustrates how the integrated technology and service infrastructure will
impact hospital energy consumption:
Energy use
Heating
Active
controls
Advanced
measuring
Advanced
services
Details
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
(Electricity)

back cooling when not required
heating accordingly
Efficiency-based primary energy plant
control
actions
Catering
Page 59
Energy use
Other
building
services
Active
controls
Advanced
measuring
Advanced
services
Details
back mode where applicable
Power factor and advanced power
quality analytics and management
Smart grid utilisation
Enterprise-level energy management
functions
Load shedding
Maximum demand control
ICT data
centre
Fully integrated data centre physical

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

back heating when not required
heating accordingly
actions
Personal
small power
Occupancy-, time schedule- or

maximum demand-based circuit
activation/deactivation
Intelligent metering
Medical
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.
Page 60
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:
High energy performance BACS and TBM
CLASS B:
Advanced BACS and TBM
CLASS C:
Standard BACS (used as reference)
CLASS D:
Non-energy efficient BACS
Figure 8-3. Energy Performance Classes 9
Efficiency factor for

thermal energy
Efficiency factor for

electrical energy
0,86
0,96
0,91
0,98
1,31
1,05
BACS Efficiency Classes for Hospitals

to EN 15232
Figure 8-4. Energy Efficiency Classes for Hospitals 10

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
Functions having an impact on energy performance Standard EN 15232 (Table 1).
10
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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.
Page 62
Ventilation / Air Conditioning Control
Fig 8-5. BACS (building automation and control system, TBM (technical building management system)
Heating / Cooling Control
Lighting Control
Blind Control
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
o
o
Identify significant areas of consumption

Target areas for energy reductions
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.
--
--
-
- -

- --
-- -
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.
Page 64
8.3
8.3.1
Measurement Normalisation and Analysis of Consumption W.A.G.E.S.

(Water, Air, Gas, Electricity, Steam).
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
o
o
o
o
Scope (instantaneous and total)

Thermal energy (instantaneous and total)
Outlet temperature
Return temperature
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
o
Rate of flow by monitoring of a 4-20mA signal

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.
Page 66
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.
Page 67
Such a model can see a dual usage pattern:

o
o
8.4
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.
In the medium/long-term, this model can help steer decisions about programs to
use a hospitals own sources of production (for instance, co-generation or trigeneration)
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 310% 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.
Page 69
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
o
o
o
An intelligent technology infrastructure

24/7 remote support with specialist energy services
Integrated mobile communications technology
Automated analysis and reporting
The concept is illustrated in Figure 9-1.
Integrated
Mobile
Communications
Technology
24/7 Remote
Support Centre
and Energy
Bureau
Integrated
Technology
Infrastructure
Automated
Analysis and
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
Page 70
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 hospitals services including:
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Main plant and equipment

Chillers
Boilers
Generators
Electrical HV/MV switchgear
Data centres
Medical services and equipment
Nurse call
Medical equipment
Blood fridges and body stores
Field equipment and devices
Circuit breakers
HVAC controllers
CCTV cameras
Data centre PDUs
Light fittings
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
o
o
o
o
o
o
o
o
o
o
24-hour alarm response and analysis with online and telephone support facilities
Plant and equipment performance analysis
Notification and advanced warning of potential problems
Remote authorised corrective actions
Energy analysis and reporting
Energy alarms
Condition-based monitoring and predictive maintenance reporting and guidance
Utility bill validation with real-time links to the billing systems of utility companies
Load shaping and environmental performance analysis and reporting
Identification of energy saving opportunities with detailed action plans
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.
Page 71
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
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Range of energy analysis and reports:

Power factor
Energy normalization
Benchmarking
Maximum demand, kVA
Consumption
Target forecast
Load shaping
Energy signature
Energy profiles
Range of analysis and reports for equipment and devices
Performance
Efficiency
Problem areas
Predictive analysis and preventative actions
Equipment location maps
Device faults and failures
Failure rates analysis
Spares and repairs procedures
Detailed drill-down diagnostics
Self-checking routines for equipment and devices
Early warning intelligent maintenance alarm reports
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.
Page 72
A typical layout for a dashboard report is illustrated in Figure 9-2.
Figure 9-2. Demand Report
Page 73
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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Figure 10-1. Services Connected to Hospital Intelligent Technology Infrastructure
Page 75
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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Figure 10-2. Services Connected to Hospital Intelligent Technology Infrastructure by Department
Page 77
10.2 Architecture
The physical architecture is based on a top-down design comprising various levels as follows:
o
o
o
o
Level 1 Management Level - Central supervision and control through common

user interface
Level 2 Network Level - Backbone network infrastructure
Level 3 Automation Level - Distributed intelligent control and monitoring
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
o
o
Business enterprise view

Operational view
Supervisory and control view
An illustration of the integrated systems and resulting views of the intelligent infrastructure is
provided below.
Executive
Reporting
Dashboards
KPI reports
Energy efficiency
Indoor environment
Staff efficiency
Security overview
Energy efficiency
Fire Panel
Nurse Station
Patient Panel
Operating Theatre
Panel
Fire alarms
Fireman's override
Environment control
Lighting control
Nurse call
Security information
RFID location
Video monitor
Environment control
Lighting control
Nurse call
Security information
Internet connection
Patient entertainment
UPS status
Environmental control
Alarm status
Energy
Management
Building
Management
Security
Management
Data Centre
Management
24/7 remote services

Energy modeling
Bill validation
Dynamic energy
pricing
Load shedding
Maximum demand
Predictive
maintenance
SCADA
Lighting control
Remote access
Security dashboard
Video analytics
Access control
Safety control
Operations, capacity
and change
management
Energy efficiency
Network management
Remote access
Integrated Building
Automation
Lighting Control
System
Integrated Security
Systems
Operating Theatre
HVAC controls
Utilities metering
Room controllers
Control panels
Dimmer units
Lighting controllers
Room switch units
Multi sensors
Scene setting
External lighting
IP CCTV
Access control
Staff attack
Infant tagging
Video intercom
Intruder detection
Electrical distribution
Isolating transformers
UPS
Surgeons
panel
Electrical
Distribution
Data Centre
Physical
Infrastructure
ICT
Life Safety
Systems
Medical Areas
HV/MV/LV switchgear
Transformers
Generator integration
Busbar trunking
Plug & play
distribution
Power distribution
UPS
In-row cooling units
Integrated security
Room cooling
Energy reclaim
Servers
Digital video
recording
POE switches
Firewalls
Quality of service
Digital signage
Fire alarm
Emergency lighting
Public address
Voice evacuation
Fire/Smoke dampers
Nurse call
Bedhead services
Patient entertainment
RFID location
systems
Patient environment
Figure 10-3. Holistic Views into the Hospital Intelligent Technology Infrastructure
Page 78
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
o
o
o
o
o
o
o
o
o
Security threat level

Severe
Substantial
Moderate
Low
Key performance indicators (KPIs) and compliance with national and
international standards
Environmental performance overview
Critical systems status (such as power, gas, water, heating, cooling and data)
Space utilization and non-availability
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
o
o
o
Life safety
Nurses station
Medical areas and patient rooms
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
o
o
o
Environmental conditions
Lighting levels
Nurse call operations
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.
Page 79
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
o
o
o
o
Critical power supplies

UPS
Isolating transformers
Environmental conditions
Medical gases
Use interaction will be provided via a surgeons 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
o
o
o
Energy management
Building management
Security management
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
o
o
o
o
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
Area occupancy studies with energy normalization reports
Energy modeling
Utility bill validation
Dynamic energy pricing and on-demand management information
Smart grid, load shedding and maximum demand management
The building management expert view allows the facilities staff to manage the hospitals 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
o
o
o
o
o
Predictive maintenance
Supervisory control and data acquisition (SCADA)
Lighting control
24/7 remote services for facilities management
Links to the facilities workflow engine and task management software
Page 80
Dynamic links to interactive electronic operating and maintenance manuals
The security management expert view allows the security staff to manage the hospitals
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
o
o
o
o
o
Overall threat level dashboard

Integrated video wall incorporating CCTV with smart video analytics, access
control, intrusion detection, personal attack, RFID location and critical systems
overlay
Visitor management
Badge printing terminals
Full event and activity log with audit trail
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
hospitals 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
o
o
o
o
o
o
Operations capacity and change management

Control and monitoring of the hospital data centre physical infrastructure (DCPI)
Critical power and back-up system management
Energy efficiency
Network load management and adaptation
Remote access and data security
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
o
o
o
o
o
o
o
o
Maximum reliability
No single point of failure
High availability
Diverse routed or meshed sub-network topologies
Distributed intelligence
Scalability to provide simple cost-effective expansion
Future readiness to incorporate new and emerging technologies
Flexibility to adapt the changing needs of the healthcare facility and organization
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.
Page 81
Communications interface
RS485
RS485
RS485
BACnet IP
BACnet IP
RS485 BACnet MS/TP, LonWorks
Integrated system
Fire detection and alarm
Smoke damper control system
Firemans override
Chillers and heat pumps
Sustainability plant
(combined heat & power,

biomass boilers, wind turbines,
solar panels, ground source
heat pumps, boreholes, etc..)
Plug & Play air handling units

with integral controls
Pressure regimes
Temperatures, flow switches, etc.
Alarms
Energy consumption
Operating status and efficiency
Temperatures, power output, flow switches etc.
Alarms
Energy consumption
Temperatures, flow switches etc.
Alarms
Energy consumption
Switch and LED indication status
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Monitoring; scheduling set point adjustment

and link to maintenance schedule
Monitoring; scheduling set point & schedule

adjustment and link to maintenance schedule
Monitoring; scheduling set point adjustment

Monitoring, link to maintenance schedule
Link to maintenance schedule.
Fully automated complete with reset facility

Firemans override switch status
View status and alarms.
Monitor progress of fire over split screens with

alarm history and ongoing mapped events;
isolate; silence; evacuate; test; link to
maintenance schedule
Graphic interaction
Damper open/closed/fault status
Fire panel fault, test, and override
Addressable device status (normal, alarm, fault) for all devices
Indication
IP, RS485 Modbus, BACnet,
Electricity, water, energy and

steam meters
HV/LV switchgear
Generators
Switch/Relay/Analog signal (Hard wired)
Helipad fire-fighting systems
RS 485 Modbus
RS232 Serial Interface
Pulse counters (Hard wired)
Integrated system
UPS/IPS and battery status
Fault and alarm conditions
ASCO switch status
Logged data
Load profile information
Contact Wear
Number of operations
Page 83
Management, load management software

Bus Coupler status

Power consumption
Monitoring; link to utilities
Automated testing schedule and

configuration
Monitoring; scheduling; link to maintenance;

link to plant reinstatement and load shedding
ACB status/tripped
Remote automated testing operation
Critical HV and MV power network status and operational data
Power Output
Alarms
Operating conditions
Monitoring; link to utilities management

software
Link to maintenance schedule
Fire panel fault, test, and override
Metered data, flow rates, cooling, power factor, KVA, Kvar, volts
per phase, current per phase
View status and alarms
Graphic interaction
Status (normal, alarm, fault)
Indication
Ethernet API Link
Ethernet IP connection
Ethernet POE connection
Ethernet IP connection
Switch / relay / analog signal (hard wired)
Switch / relay / analog signal (hard wired)
Switch/Relay
Intrusion detection alarm
Access control
CCTV
Nurse call
Medical gas alarms
Sprinklers
Gas Fire Extinguishing System
Motor current consumption
LonWorks
Operating Status
Valve and system status
Alarm and fault
Alarm, Call, Code Blue, Bed status, patient room status

(vacant/occupied), room controls via nurse call handset, staff and
patient RFID location,
View live and recorded CCTV images embedded within graphical

displays. Matrix display with simultaneous playback from multiple
cameras.
Page 84
Monitoring of system operation and faults, link

to maintenance schedule
Monitoring of system operation and faults; link

to maintenance schedule
Mimic gas alarms; monitor plant status and

local valve alarms; link to maintenance
schedule
link to maintenance schedule
Full patient room Monitoring.
Camera/image selection, PTZ camera control,

smart searching of selected footage. Link to
Card allocation; enrolment; video badging; set

access privileges; set areas; set time zones to
doors personnel and areas; link to
Adjust zone time schedules
Alarm panel fault

Door status, forced entry, invalid attempt, anti-pass back
violation, areas, personnel, reports, event log, personnel details.
Monitoring; arm/disarm zones
Scheduling; link to maintenance; speed

control; changeover with flying start and link to
utilities management software
Graphic interaction
Alarm zone status (set/ unset/ fault/ alarm)
Manual Override
Speed and frequency
Power consumption
Time to trip alarms
Operating status
RS 485 BACnet MS/TP
Inverters
Indication
Integrated system
Switch / relay
Ethernet IP
Major health equipment
Medical wards / patient rooms
Data centre physical

infrastructure (DCPI) including
hub rooms, node rooms,
server rooms, etc.
Staff pagers
Staff attack system
Asset location system
Ethernet IP
IP telephony
Ethernet IP
RS232
RS485
Ethernet IP
RS485
Ethernet IP
RS485
Ethernet IP
Wireless IEEE 802.15.4
RS232
RS485
Integrated system
Rack temperatures, data loading, live CCTV, access control,

critical power switch gear status and operational data, power
distribution units operational data, UPS, IPS data, Cooling
equipment operational data and efficiency, heat recovery
systems operational data and efficiency. Maintenance data.
Fault
Operating status
Battery power levels and fault status
Staff location
Attack alarms
Asset details
Alarms
Location via Mapping within 3m accuracy
Environmental conditions, acoustical monitoring, security, lighting

levels, HVAC plant and equipment, solar blinds, bed status,
nurse call, RFID location, staff attack, patient entertainment
systems operating status, medical gas alarms/status, power
monitoring, energy consumption and metering.
RFID location
Power consumption
Operating status / fault
Operating Status
Alarm and fault
Indication
Page 85
Open / close access doors; set point

adjustment of cooling systems; CCTV camera
controls and switching; full control of power
switchgear.
Fault monitoring; link to maintenance schedule
Monitoring; alarm annunciation; integration to

CCTV; access control and intelligent alarm
routing to mobile devices
Location monitoring via RFID; view asset

details and operating status
Environmental scene setting and adjustment,

alarm acknowledgment and override facilities
Location track and seek facility
Fault monitoring
Graphic interaction
Ethernet IP
Ethernet IP
Ethernet IP
RS485
Nurse base information
Department information
Operating theatre
Water distribution leak

detection
Energy centre fuel system

leak detection
Energy centre water leak

detection
Ethernet IP
Digital energy performance

certificate
RS232
RS485
RS232
RS485
RS232
Integrated system
Leak detection in fuel tank bunds within energy centre.
Leak detection in water tank bunds within energy centre.
Major leak detection in water and heating service pipework from

energy centre. Contamination or dangerous conditions for
bacteria growth.
Replication of surgeons panel display, IPS/UPS data, individual

power circuit status, mains/generator power indication, HVAC
Parameters, lighting level and status, occupied/setback status,
elapsed time for operation, electrical faults and warnings,
Medical gas alarms AGSS alarms.
Electrical, heat, and cooling energy summation and graphic

display. Medical and hygiene performance data from hospital
enterprise network.
Nurse call status information, ventilation system faults, fire alarm,

patient room electrical faults, video intercom, access control door
status, intrusion detection status, medical gas status & alarms,
RFID location data, Energy data.
System energy performance summation and graphic display.

Rolling displays per department. Interdepartmental analysis and
comparisons. Live weather data.
Indication
Page 86
Monitoring. link to maintenance schedule
Monitoring. link to maintenance schedule
Auto flushing systems override; alarm

acknowledgement
Remote setpoint change capability; scheduling;

alarm acknowledgement; digital touch screen
surgeons panel
Full graphical configuration capabilities
Door release via video intercom; alarm

acknowledgment; patient room environmental
scene setting; RFID location search facilities
Full graphical configuration capabilities
Graphic interaction
Elevators
RS485
Specialist AC systems
Ethernet IP
Switch / relay
RS232
Switch / relay
RS232
Ethernet IP
Switch / relay
Pneumatic transfer systems
Robotics (laundry, clinical

waste)
RS485
Fuel storage and pumping

equipment
RS232
Integrated system
Access control car call
CCTV
Car floor status, alarm, passenger loading and waiting time data
Elevator Motors operational and power consumption data
Power supplies healthy
System healthy
Temperature, humidity, plant status, fire status, leak detection

environment alarms
Power supplies healthy
System healthy
Operational data, critical faults, RFID location
Operating status, fuel consumption, fuel levels; fill point and

level alarms
Indication
Critical alarm acknowledgement
Page 87
Monitoring; scheduling; set point adjustment;

link to maintenance schedule
Monitoring; link to maintenance schedule
System monitoring
System monitoring; scheduling; link to

Graphic interaction

Healthcare Functional Design Brief

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Healthcare - Applications and Solutions Architect

Business Development Director Healthcare

13th June 2011

Healthcare - Applications and Solutions Architect

27th July 2011

Authorised for issue by:

Make the most of your energy

Functional Design Brief Usage Guidelines

Target readers and users

improved financial performance

local energy regulations

Cabling, Construction and Network Devices........................................................................... 11

OPEX COST BENEFITS ......................................................................................11

Network Operating Resilience.................................................................................................11

Staff Productivity .....................................................................................................................12

2.1.2.3 Patient Satisfaction and Safety ...............................................................................................12

3 MECHANICAL AND ELECTRICAL SERVICES ............................................................................15

Shock Sensitivity ..................................................................................................................... 16

ELECTRICAL POWER DISTRIBUTION ....................................................................17

Electrical Distribution and Power Monitoring Architecture ...................................................... 17

Equipment and Software .........................................................................................................18

Operating and Maintenance Services ..................................................................................... 18

TYPICAL ARCHITECTURE ....................................................................................18

Utility Incomer and Utility Backup Source ...............................................................................20

MV Substation and MV Loop Distribution ...............................................................................20

Backup Power ......................................................................................................................... 20

High-Quality LV Switchboard ..................................................................................................20

Operating Theatres .................................................................................................................21

Operation and Maintenance ....................................................................................................21

Power Monitoring and Control System....................................................................................21

The MV Level .......................................................................................................................... 21

3.2.7.2 The LV Level ...........................................................................................................................21

Air Conditioning .......................................................................................................................22

Infection Control, Airborne Contamination .............................................................................. 25

Infection Control, Legionella.................................................................................................... 26

HVAC CONTROL AND MONITORING ARCHITECTURE ............................................27

Distributed Intelligence ............................................................................................................27

Peer-to-Peer Communications ................................................................................................ 28

EQUIPMENT AND SOFTWARE ..............................................................................28

4 LIFE SAFETY ........................................................................................................................29

Access Control ........................................................................................................................ 30

Digital Signage ........................................................................................................................30

Nurses Station Display ...........................................................................................................30

4.1.5 LIFE CYCLE .......................................................................................................30

Environmental Conditions (Operating or Electrical Room)......................................................42

Electrical Data ......................................................................................................................... 42

6.1.2 STANDARDS ......................................................................................................42

Ultraviolet Lamp System ......................................................................................................... 43

6.2.2 AIR MOVEMENT CONTROL..................................................................................44

6.4 MONITORING AND DISPLAY ...........................................................................................45

Access Control ........................................................................................................................ 52

7.4.2 INFECTION CONTROL .........................................................................................52

9.5 AUTOMATED ANALYSIS AND REPORTING .......................................................................72

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

Staff Productivity and Retention

Occupancy-based functionality of services

Integrated, skills-sensitive nurse call and workflow management

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

Data Centre Physical

Hospital Intelligent Technology Infrastructure

24/ 7 remote services

Life Safety Systems