La valutazione energetico-ambientale dell’ospedale per acuti in fase d’uso. Criteri, indicatori, metodologie di verifica.Energetic and environmental operational hospital buildings assessment. Criteria, indicators and verification methods.

ENERGETIC AND ENVIRONMENTAL OPERATIONAL HOSPITAL BUILDINGS ASSESSMENT. CRITERIA, INDICATORS AND VERIFICATION METHODS. Author: Teresa Pochettino. Tutor: Prof. Ing. C. Caldera, Co-Tutor: Prof. Ing. S. Corgnati, Prof. Arch. S. Belforte, Lighting External supervisor: Prof. Arch. C. Aghemo, Arch. V. Lo Verso. RESEARCH THEME INTRODUCTION: The acute hospital constitutes a complex organizational and functional system that it is not possible to standardize according to the typology, the architectural solutions and the plant characteristics. The functional areas the hospital consists of represent both a working place for the staff people (medical, administrative and technical employees), and a living environment, for the patients. Sometimes the different categories overlay, which results in conflicting requirements. The Italian national scene is characterized by very old health care buildings (more than 60% achieved before 1970) subject to, during the course of the years, numerous interventions (on buildings systems, components and plants) characterized by partial visions (mainly focused on the aim of "humanization") and by a sector-based planning, in which medical requirements and demands have being prevailing. Economic resources absorbed by hospital settlements represent an average of 50% of the economic expenses allocated by the different European Countries for the health care costs. The energy consumption costs, despite their amount, have in this panorama an average of 2 -2.5% of the total management expenses, which are mainly absorbed by the staff salaries. The hospital resources consumption and emissions footprints have found, over the last years, great interest in many international and national research projects which showed the opportunity of producing significant energy savings and economic and environmental benefits. The reasons for this attention are mainly due to the awareness that the huge consumptions and the significant environment impact may offer a great potential for intervention and improvement, and to the need to cope with the basic contradiction inherent the effect that the hospital produces with its energy demand and related emissions on people health. The great building-plants system complexity and the situations variability, make it difficult to operate hospital presidia evaluation that can be generalized, and requires: the definition of targeted instruments to apply for the existing buildings analysis, definition of critical aspects, evaluation of the proposed measures effectiveness and definition of action priorities, especially facing the lack of financial resources availability, within the national and regional health planning. A strategy to deal with this complexity is offered by energetic and environmental assessment methodologies which integrate energetic aspects with environmental, comfort and operational ones, whose balance and synergy are needed conditions in health care buildings. The main energetic and environmental methodologies, (BREEAM, LEED, HQE), have developed specific assessment protocols for the hospital buildings designing phase, while SBMethod proposes a reference grid, which can be used to develop criteria and indicators coherent with the relevant building practices in the various nations, for both the design and the operative phases. RESEARCH OBJECTIVES: The research had the goal to define a set of criteria and indicators to assess operative acute hospitals’ environmental performances, identify the most critical situations and define the intervention/financing priorities, on the basis of their potential environmental and energetic effectiveness. METHODOLOGICAL ACTIONS: To define a list of specific criteria as well as to process them, the systemic approach proposed by the buildings environmental and energetic assessment methodologies, mainly available for the design phase, adapted for the operational phase, was chosen to be used as reference through the following path: - identification of the macro-themes shared by the investigated methodologies (BREEAM, LEED, SBMethod, HQE); - comparison between the criteria classification adopted by the investigated methodologies and the alignment according to the identified macro-themes; - integration of the criteria that were missing into the SBMethod evaluation grid for the operational phase; - extrapolation of a criteria set for the acute hospital operational evaluation phase; - Identification of assessment indicators and methods for each one of the selected criteria in the operational phase and definition of the benchmark levels; - field monitoring, evaluations and measurements, to support the validation of the alternative assessment methods and proposed benchmark; - definition of assessment criteria and procedure evaluation ; Because of the specificity and the complexity of some of the addressed topics, it was necessary to cooperate with experts related to different disciplinary areas such as: - architectural technology - building physics and services (for the energetic and lighting aspects); - working places hygiene (with the Turin University, and C. T. O. Hospital, Industrial toxicology and epidemiology Technical Service) Moreover, in the context of the developed research, confronting with the responsible management operators (internal and external to the cribs) played a crucial role, both for the competence and for the support needed to the in-the-field monitoring and investigations activities. RESULTS: Forty-five criteria, each with the relative evaluation cards, were processed in the research path, divided into the five SBMethod reference macro areas (site quality, resource consumption, environmental emission, environmental indoor quality, service quality). For each of the identified criteria indicators, testing methods and benchmark levels were defined and developed, based on laws and technical standards and then supported by a process to verify their applicability to the assessment of the operational acute hospital (or to its specific areas). For 21 of these criteria it has been possible to carry out field monitoring, instrumental measurements, and in some cases even dynamic simulations, which have supported the definition of the operability of the verification process and the identified performance levels reliability. INNOVATION ASPECTS: The definition of a specific set of criteria, indicators, verification methodologies, appropriately calibrated to evaluate the hospitals during its operational phase, represents, in itself, an innovative aspect. It is considered of particular interest, moreover, the definition of certain criteria which were not provided within the framework of the investigated instruments, such as: the indoor air quality as a function of the VOC presence; the energy demand for electric lighting, in addition to the in-depth, adaptations, and integrations of a large number of available criteria (radon, asbestos, etc.). As for the lighting comfort aspects it has been possible to integrate the parameters of environmental physics with considerations related to the healing design concepts (on the basis of contextual subjective and objective evaluations), which lead to considerations that are particularly significant in the people healthcare contexts. As for the energy aspects, it is necessary to underline the selection of an assessment proposal based on the different functional/energetic hospital areas, and the adoption of benchmark related to the individual case study. This approach allowed to overcome the limitations of the parameterization referred at the hospital bedside or at the surface unit. FUTURE DEVELOPMENT: It is possible to identify the following possible research developments, for the short and the long-term period: - the extension of the evaluation to further hospital functional areas and to other case studies; - the weighting process of the selected criteria based on a comparison shared with the stakeholders (technicians, specialists, medical staff); On the basis of the research process product of the assessments development on the existing assets it will, then, be possible, to define: - guidelines and performance levels for the acute hospitals design phase with an high energetic and environmental quality; - an assessment protocol to evaluate the hospital design phase.