Positioning the John Muir Medical Center to welcome the future of healthcare

Staying Current

With regulatory compliance driving a seismic upgrade of the existing John Muir Medical Center, the hospital replacement created a sanctuary environment for patients while equipping staff with upgraded medical equipment and increased capacity for patients.

The overall project included increased bed capacity and single patient rooms, expanded Trauma Center/Emergency Dept. (ED) treatment space, additional OR capacity and additional parking. The new tower features single patient rooms for Intensive Care Unit (ICU), medical surgical, acute inpatient rehabilitation, ante/postpartum care and a new neonatal ICU (NICU) nursery with 33 private rooms.

Technology updates were implemented in the new areas, specifically within the surgical suites, adding space for current and future technology, as will pre-operative and recovery spaces. The NICU now has a combination of private and semi-private noise-reducing rooms for critically ill newborns, with sleep chairs for parents. Each room features lighting that mimics day/night cycles facilitating maximum comfort for newborns. And ICU rooms are now equipped with additional support through remote, 24/7 audio and video monitoring of patients.

Increased Capacity

Key areas were identified for expansion early in the project–emergency, trauma, imaging, surgery, critical care, pediatrics and birth, neonatal ICU, orthopedics, neurosciences, and rehabilitation.  The new hospital delivers on these focus areas in the hospital expansion and creates a distinctly modern experience for patients.

The total bed capacity was increased from 308 to 414 beds with 242 licensed beds in the new tower. Trauma Care/ED was nearly doubled to 30,500 sf to handle a volume of 65,000 patient visits per year! Three new cath labs and three new OR’s comprise the major elements of this project. Secondary increases include 24 new, private critical care rooms (12 designated for trauma and 12 for neuroscience), an increase of NICU beds, and an increase in inpatient surgical suites.

To increase operational efficiency, the helistop was relocated to the patient tower rooftop, nearby an elevator bank that is one stop away from the Emergency Department.

A Healing Environment for Patients

In order to promote a “non-institutional” environment, the hospital facilitates copious natural light, includes six roof gardens, a central courtyard, and a variety of colors and textures on the interiors. A co-generation power plant, skylights, LED lighting, and low VOC (volatile organic compounds) flooring promote a sustainable, environmentally friendly space to heal.

Special attention was given to noise reduction/tempering, lighting (both natural and artificial) in patient care areas. The team used the new Institute of Medicine (IOM) recommendations to create an environment that allows care to be provided in a manner that is safe, effective, patient-centered, timely, efficient, and equitable.

1st West Coast LEED Platinum Children’s Hospital.

Read more about the certification here. 

Lucile Packard Children’s embodies innovation and a true commitment to environmental sustainability to better serve its patients–children and expectant mothers. To accommodate growing capacity needs. It’s the only hospital in the Bay Area designed to combine pediatric, obstetric and newborn services in a central location and is intended to be one of the most technologically advanced, sustainable children’s hospitals in the country.

“We have so much pride for this project… Driving success for this project stemmed from its leaders and donors that wanted to create a ‘different’ environment–integrate art, beauty, and light into the healing process. This was the original vision, and this is what we proudly delivered.”

– Senior Mechanical Engineer Brian Hans (Mazzetti)

Resilience

Our client wanted to establish a disaster-ready, resilient hospital, fully functional even in the most extreme disasters. Mazzetti designed an expansion hospital with many levels of resilience, while being resourceful and financially aware. The MEP phases contributed to resiliency. Mechanical infrastructure use special water and air systems to heat, cool, and maintain the hospitals functionalities, each with back-up functionality beyond code requirements. Electrical systems facilitate emergency power for medical equipment. Specialized disaster-detection functionalities were integrated, including smoke evacuation systems, fire-detection and alarm system annunciator, among other safety features.

The building is also equipped to withstand an 8.0 or “greater” earthquake, providing full-function in this event. Read more about Stanford’s emergency capabilities here.

Water & Energy Efficiency

The existing Lucile Packard Children’s Hospital Stanford was designed during the 1980’s drought. (The hospital later opened in 1991.) Water resiliency has been a priority for the client well before the most recent CA drought crisis. Through intelligent design and planning, this project is projected to save approximately 800,000 gallons of water per year and use, on average, 38 percent less water than comparable hospitals. One of the many water-sensitive features include a rain water catchment system, storing captured water in two underground water tanks. These tanks will also receive water used for medical equipment purposes. A condensation capture system, located in the air handling units, will also funnel water to these tanks. And the tank water will help support the plant irrigation system. The client will reap financial savings, while preserving natural resources, without impacting patient care delivery.

Displacement Ventilation

Packard Children’s is the first major hospital in California to implement the use of a displacement ventilation (DV) system and the first hospital in the country to use it in all acute care patient rooms. Displacement ventilation foregoes the traditional approach of blowing cool air from ceiling registers, which requires more energy to push the air down. Instead, it brings air into rooms at the floor level. Displacement ventilation provides:

• lower construction cost
• lower energy consumption
• reduced risk of infection from airborne contaminants
• reduces audible ventilation noise.

Curious to learn more about the origin of DV use in Healthcare, discover more about the research we spearheaded to impact codes.

Optimized Exterior Facade

We developed a fixed external shading strategy which was optimized with the mechanical systems to eliminate direct solar heat gain and facilitate the implementation of the displacement ventilation system for the patient rooms.

Daylighting

The use of daylighting has been optimized to maximize natural light, access to views, and mitigate energy consumption in many areas of the hospital. The patient rooms and corridors have been optimized to mitigate direct solar gain while leveraging daylighting and access to views.

Other areas such as the PACU have used skylights to bring in natural light to minimize lighting energy use and facilitate connection to the outdoors.

Anesthetic gas recovery

We designed an innovative anesthetic gas recovery system to collect and ultimately reprocess the waste gas to mitigate greenhouse gas emissions and recycle the released gasses for future use. (This is one of the first installations of this technology in the U.S.)

Patient Experience/ Unique additions

Quality patient experience is typically a high priority for any hospital, Packard Children’s Hospital being no exception. The building incorporates natural elements seamlessly–almost four acres of gardens and green space for patients, families, visitors, and staff to enjoy.

The expansion hospital opened in December 2017.

“One of the most sustainable, technologically advanced hospitals in the U.S.”

– Robin Guenther, Principal (Perkins+Will)

Canadian media group aims for American market penetration through strategic data center purchases and upgrades

Market Penetration

This client had a clear objective–to position themselves at the forefront of the outsourced cloud computing and outsourced server management among mid-market companies. Mazzetti was able to deliver both a highly functional and sustainable design at their new data center to keep their facilities aligned with this objective. We upgraded the chilled water plant to N+1 redundancy, inclusive of new chillers and towers, plus free-cooling heat exchangers to take advantage of the dryer weather and KW footprint.

A Sustainable Facility

Chiller KW efficiencies were improved using modern chiller configurations that included VFD driven soft starts and incorporated a rapid chiller ramp up that reduced any temperature fluctuations. Chiller and condenser water pumps use bump-less HAO soft start technologies. To save on chiller run time (KW) and equipment, free Cooling was implemented that takes advantage of tower efficiencies in the Colorado dry climate. Free cooling should be available 9-10 months of the year.

N+1 upgrades and a complete building automation system overhaul were implemented to supply a fully modern experience

Technically Advanced Equipment

Reliability was key. We were tasked to reduce data center downtime in critical situations during the upgrade. Moving the data center to a N+1 redundancy increases uptime and reliability. In upgrading the legacy BAS, Mazzetti was able to promote operational efficiency by improving control system reliability, user-friendly code and modern graphics. The chiller plant upgrade added CHW flow capabilities to the adjacent data center chilled water plant. This allowed backup capabilities for the dual data center chiller plants.

Key Takeaways

The upgraded data center will leverage free-cooling heat exchangers to take advantage of the dry Colorado weather. And due to the increased energy efficiency, the owner received over $400,000 in rebates from local utility provider.

Overcoming limited resources by maximizing efficiency

This project started with a vision to create a place of healing for an island community of 2,287 inhabitants. (No prior medical center had existed on the island.) Evident in the location, this place would need to cultivate a culture of peace and serenity as a crucial part of the healing process, while minimizing impact on the already strapped island infrastructure. However, the nature of the building type presented real challenges. Overcoming these challenges, PeaceHealth Peace Island Medical Center (PIMC) is living that vision in Friday Harbor, WA.

The multi-building campus houses an emergency department, surgery suite, imaging, patient beds, public spaces, cancer care, and a clinic. The project was designed using Revit/BIM.

Sustainability Design on an Island

Island resources are limited, making sustainable choices vital and simple system design essential. “Doing more with less” set the tone for the project. The intent was to incorporate the community’s values into the design of the facilities, sustainability. The design team used the Living Building Challenge 2.0 as a roadmap and developed sustainable strategies through simplified systems that a single facility manager can operate.

Energy Efficiency

The Net Zero Ready facility is highlighted by a mechanical system comprised of ground source wells, water-to-water heat pumps, radiant heat, chilled beams, four pipe fan coils in the healthcare areas, and operable windows for natural ventilation in the public and clinical spaces. PIMC is achieving an average Energy Use Intensity (EUI) of 87.7 kBtu/ft2 • yr (276.7 kWh/m2 • yr).

Promoting a Natural, Serene Healing Environment

The project was designed to optimize daylighting and reduce lighting loads as recommended by the daylighting studies performed by a private consultant. This facilitates a better circadian rhythm for patients and staff. The design emphasizes a visual connection to the outdoors and leverages the health benefits of biophilia – people’s biological need to connect to nature.

Awards & Accolades

Peace Island Medical Center is a 1st Place ASHRAE Technology Award Winner. ASHRAE Technology Awards recognize outstanding achievement in the design and operation of energy efficient buildings. Performance is proven through one year’s actual, verifiable operating data. Projects are judged based on the following criteria: Energy Efficiency, Indoor Air Quality and Thermal Comfort, Innovation, Operation and Maintenance, Cost Effectiveness, and Environmental Impact.

• 2013 American Institute of Architects Healthcare Design Award Recipient for the best healthcare building design

• 2015 ASHRE Technology Award for best heating and airflow design among new hospitals.

This project instills confidence & inspires us to always push the envelope to do better, even with less.

Overcoming climate and culture challenges to add a Medical Office Building to an already existing hospital

Mazzetti provided mechanical, plumbing, electrical, lighting design and low voltage engineering services for the design of a new Medical Office Building.  The building was an addition to the existing hospital campus of a multi-phase project.  The building houses general practitioner spaces, exam rooms, a pharmacy designed to USP 797 standards, MRI, CT and support spaces.

Environmentally friendly

The project showcases a welcoming three-story entrance lobby within slab hot water radiant heat and a lighting layout to simulate the rugged Alaskan outdoors. A comprehensive energy model was performed to determine the most energy efficient HVAC system.  Based on the results of the energy modeling, we selected a water-cooled Variable Refrigerant Flow (VRF) system with supplemental hot water heating. The mechanical system utilizes rooftop dry coolers, supplemental boilers and a Dedicated Outdoor Air System (DOAS), and an underfloor radiant heat system as well as overhead perimeter radiant heating. The hot water system also serves as a snow melt system for the adjacent sidewalks to minimize the use of snow melt chemicals, thus helping to preserve the pristine Alaskan wildlife.

Patient & Community

Quality patient experience is the everlasting goal for every hospital. Central Peninsula took this one step further, illustrating the focus on the people. Quality, patients/community, caregivers, medical facilities and financials are the five goals to make this hospital the best in Alaska and a top contender in the nation. The strategic Medical Office Building addition–sustainable, environmentally friendly, and “like-able” for all patient experience–was a big step toward achieving these goals.

Providing a Permanent Solution to help Heal a Cholera-Inflicted Community

In 2010, shortly after the catastrophic earthquake impacting millions of people, Haiti was soon afflicted with a rampant cholera epidemic. Cholera is an infectious disease caused by eating food or drinking water contaminated with a bacteria called “Vibrio Cholerae.” Due to the displacement of many people after the earthquake, the already existing Cholera epidemic resurfaced with vengeance. The overcrowding communities coupled with poor sanitation in facilities, caused many illnesses, some leading to death. A vaccine was produced to help counteract this ongoing epidemic but providing treatment required an immense amount of support. Check out the video to learn more about the devastating earthquake.

Temporary Solution Challenges

Emergency medical crews established temporary tent stations, providing immediate aid to cholera victims. The tents were never intended as a long-term plan. They lacked piped-toilets, pumped water systems, and any decontamination facilities.

“There were no piped toilets or wastewater decontamination in the tents,” says Michael Murphy, MASS cofounder and executive director, “And the method of dealing with the crisis (i.e., privatized collection and removal) was not happening appropriately.”

A treatment facility with proper sanitation, including clean water & sewage capabilities was needed to not only care for patients, but for setting an example of proper facility standards for the community and nation as a whole. New standards needed to be precedented.

Facility Solutions

Mazzetti provided design development support of the plumbing system and ventilation design for the GHESKIO Cholera Treatment Center (CTC). The CTC added to the services of the existing GHESKIO Hospital. The CTC treats all of its waste-water onsite and increases well-source water supply with a rainwater collection system. The rainwater is purified and used for all treatment needs. The “anaerobic bio-digester” is a quad-chamber system, incorporating a chlorine-purifying process. The reinforced-concrete and steel structure is earthquake and hurricane resistant; that is, CTC was erected on a three-foot platform in the event of a flood. This also contributes to the rain-water cache system.

Delivering a LEED Platinum Certified work environment for scientists researching renewable energy technologies

Mazzetti provided total building commissioning for the Energy Systems Integration Facility (ESIF). The 185,000sf facility provides laboratory and research capabilities for a broad range of renewable energy generation.

Sustainable Capabilities

Each energy experiment is carefully managed to produce results, while able to harvest and reuse energy throughout the building. Giant 15-foot skylights were implemented to counteract light usage, while illuminating most of the building. Leading innovation in the use of energy, the lab’s mission is to analyze and better understand alternative energy technologies, starting with its own facility–LEED Platinum Certified.

Unique Integrated Systems

This is the nation’s only facility conducting integrated megawatt-scale testing of the components and strategies needed to safely move clean energy technologies onto the electrical grid in-flight at the speed and scale required to meet federal policy. As a multi-story building, the ESIF offers office space for approximately 200 researchers and support staff, including 15 laboratories, outdoor test areas, Insight Visualization Center, high-performance computing data center, and high bay control room. Data analysis is a huge factor that uses unique capabilities to test power electronic components. Systems such as supervisory control and data acquisition (SCADA) are used to analyze high electrical distribution simulations. A high performance computing data center (HPCDC) is one of the world’s fastest computing systems that is used for energy efficiency, renewable energies, and the future energy options that help further advance our energy capabilities. With vast energy capability and standards, this laboratory sets the example for the use of sustainable energy and management through the use of clean energy.

Delivering a visually attractive and concealed facility to preserve history

The Santa Clarita Film Archives Center is the second largest moving image archive in the United States after the Library of Congress and is the largest university-based media archive.

“Hidden” Creativity

Cellulose nitrate film stock, which is a highly flammable material, was commonly used to capture and store films, now residing in these facilities. Designing a top notch fire protection system was a prime necessity. The system required a highly invasive fire sprinkler system with large pipes, valves, and heads–hardware not conducive for aesthetic appeal; thus, we needed to conceal hardware as much as possible. The large pipes, valves, and heads were creatively “hidden” into the design, not distracting from the décor. The HVAC system and rainwater drainage systems were also designed to be visually invisible. This design served function protection without diminishing the visual appeal.

Preservation Motive

This project was designed to preserve the scenery and wildlife presence around the 37,000sf L-shaped, ancient greek “stoa-feel” structure. Located on a 64.5 acre site in Santa Clarita, CA, this film archive center is nationally recognized as one of the largest film preservation drivers to date. This two-part project consisted of a collection storage & central plant facilities. Preservation work rooms and labs, which do not require natural light, are on the uphill / below-grade side of the building, and the staff offices are on the downhill side of the building to take advantage of the light and views.  Preservation measures included: digital moving image and audio, film preservation, and preservation of a paper storage archive. Ensuring preservation of these priceless films was a significant factor for the design implementations of this project, requiring steady measures to keep this archive a safe haven into the future.

Storage Design

The Packard Humanitarian Institute includes a Collection Storage, Collection Service, and a Central Plant. The two-story facility is approximately 90ft x 322ft, approximately a 58,000 GSF building, housing low-temperature and humidity-controlled, high density, rack storage of film and digital media.

The Central Plant has the capacity to serve future expansion of the Collection Storage Building and a future research library. Emergency generators and fuel storage are housed in a free standing structure to the west of the loading dock. The Film Archive Building includes associated site work: underground utility connections to existing infrastructure, connection of Central Plant to Nitrate Vaults, roads, parking, and landscaping.

Facilitating revolutionary intraoperative equipment for a revolutionary hospital

Providing a revolutionary MRI experience

The iMRI Suite is the first pediatric intraoperative MRI facility on the West Coast; this modern marvel of medical equipment is unusual to have in a children’s hospital and is a “game changer” according to Dr. Nathan Selden, the Chair of Department of Neurological Surgery. He describes this equipment as holding the promise to have “a very high impact for OHSU adult and pediatric patients.” In summary, the iMRI provides real-time MRI scanning data during operations, reducing patient discomfort and minimizing a surgery cycle to achieve operational excellence in a timely manner.

Installing these technically advanced medical devices required specific attention to existing and other new equipment, including a new surgery air handler, which now back-feeds the existing surgery suite, in addition to an emergency exhaust system, and an oxygen monitoring system to maintain safety in the iMRI suites.  Numerous modifications to existing electrical and hydronic infrastructure were employed to support this new imaging suite. Watch the video below to hear how the new iMRI is a total “game changer”.

Overcoming infrastructure and space constraints

Mazzetti, as MEP Lead, collaborated with the entire project team on the iMRI installation in the operating room. Building Information Modeling (BIM) was used extensively to facilitate the integration of the many different equipment pieces and their respective infrastructure tie-ins.

Interestingly, the entire multi-building OHSU hospital expansion was physically being carved into a hillside. This emphasized the need for greater team coordination to communicate potential utility and leveling issues before they became a roadblock to progress.

Providing the additional space and services needed to care for an aging population

Mazzetti designed the mechanical, plumbing, technology and electrical systems for the new 330,00sf U.S. Department of Veterans Affairs medical office building/ambulatory care unit. The project included house dialysis, nephrology, oncology, prosthetics, as well as elements of primary care, dental, mental health, women’s health and various other services.

“We have been waiting for this day for a long, long time.”

– Barbara Fallen, Medical Center Director

Additional Space

The new three-story building will provide the additional space and medical services needed to care for the aging population, particularly men, in the area. And, with the additional mental health services to be provided, the intent is to reduce the number of veteran suicides.

Expanded Services

With the expanded functional space, come expanded (and new) services including: expanded operating and procedure rooms, physical therapy, occupational therapy, a radiology and ultrasound department, dentistry area and oral surgery center, mental health area (with social work employees), psychology offices, lab facilities, infectious isolation rooms, a pharmacy, prosthetic laboratory, gynecology offices, and X-ray rooms.

A major emphasis has been placed on the psychological care portion of the new medical building. Psychological resources on-site coupled with primary care creates a “one stop shop” for veterans to simplify their medical care experience.

Patient Experience

With the goal of efficiency being built into the patient experience, the new building features more functional spaces than its predecessor. With open spaces and more examination rooms, the building will be more conducive to doctors visiting patients more efficiently, attending to rooms of patients who have been pre-screened to reduce patient wait times.

Additionally, the facility will feature more green spaces for patient well-being, complete with a reflective pool at the front entrance. A city park is located adjacent to the ambulatory care site; the outside fence line will be open for patients and their visitors to read, play chess, or enjoy a game of bocce ball.

Other amenity-driven areas include a cafeteria, patient/staff lounge areas, resident education areas, a coffee shop, staff locker rooms and showers, and a retail store.