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3 Reasons Healthcare Facilities Need to be Commissioned

Buildings in the healthcare field MUST run well. When patient outcomes are at stake, it is not just a matter of saving energy/money and occupant comfort, it can literally be a matter of life and death. I admit that is a dramatic statement, but for patients to have the best possible outcomes, you must have confidence your mechanical systems are working AS INTENDED to, and for an example, not harbor or spread pathogens.


I have an extensive background in working in healthcare facilities. I spent 28 years as Director of Facilities/Engineer at St. Alexius Medical Center in Bismarck, ND. More recently I have become a commissioning agent and have 3 years’ experience working in all types of facilities including K-12 schools, state and federal government buildings, manufacturing facilities, and hospitals. I believe the commissioning process is necessary for any commercial building to function efficiently, and nowhere is this more critical than in the healthcare setting due to the nature of the occupants of the building: the patients!

In addition to the general benefits we see when commissioning any building:

  • lower energy costs

  • fewer equipment issues

  • fewer contractor call-backs

  • better trained maintenance staff

There are issues specific to the healthcare industry that call for a building to be commissioned thoroughly by an experienced and detail-oriented team. I’ll organize those issues into the following three categories:

  1. A well-functioning building protects patients

  2. Risk-reduction during the construction process

  3. Code requirements specific to health care facilities

Today, I will outline those categories, and then next week you will see more detailed posts about each.

1. A well-functioning building protects patients.

Building commissioning aims to reduce building energy use (thereby saving utility costs), reduce problems in the mechanical systems, and increase occupant comfort. In healthcare facilities, the additional (and critical) issue of patient safety is of vital importance. A poorly functioning building can negatively affect patients. Some examples:

  • Legionnaire’s disease can be caused by untreated water systems such as cooling towers, stagnant water in showers and faucets, decorative water features (waterfalls and pools).

  • Hospital acquired infections such as MRSA, sepsis, and surgical site infections may be caused by improper airflow relationships, poor air filtration, and improper maintenance of HVAC equipment.

  • Low humidity levels can contribute to the spread of the influenza virus. Conversely, high humidity levels can lead to mold and bacteria growth. Careful control is critical to patient health and safety.

Commissioning addresses these issues by testing individual equipment, the building system-as-a-whole, and ensuring that the building performs according to the design intent. This includes:

  • Airflow and pressure relationships

  • Humidity control

  • Proper operation & maintenance (O&M) of the building systems

  • Additional training for building maintenance staff to improve their understanding of health care issues

2. Risk Reduction during the construction process.

Remodeling and construction projects involving additions to buildings can have an adverse effect on a building that is still in use during those projects. Healthcare facilities take on greater risk during renovation projects than other types of buildings. The following issues that can arise during construction (the consequences of such issues are more serious in the healthcare setting than say an office building!):

  • Fire and Life Safety systems can be impacted by construction

  • Medical gas systems can be disrupted

  • Emergency power may be affected

  • Airflow and pressure relationships need to be carefully controlled to maintain a sterile environment

  • Noise generated during construction can affect patients and staff

  • Vibrations created during construction can affect systems like MRIs

  • Odors created by construction need to be controlled

Commissioning addresses these issues by looking at the project both from a bird’s-eye-view and seeing the gritty details. A good commissioning team will ask: How might a change in one system affect a seemingly different system? AND are all individual pieces of equipment, sensors, and sequences installed and working appropriately.

  • Does the HVAC system work in concert during a fire to control the spread of smoke?

  • Will the generator system perform properly during a power loss?

  • Do air handling systems perform properly over the entire range of outside conditions they may experience?

3. Code Requirements specific to healthcare facilities.

A number of building codes exist at the state, national, and international level to ensure that healthcare facilities test their mechanical systems for compliance with regards to air quality and other items related to their mechanical systems. For example, FGI Guidelines & Joint Commission both follow the ASHRAE 170 Ventilation of Healthcare Facilities Guidelines which has stringent requirements for acceptable airflow in healthcare facilities. These include:

  • The required minimum amount of outside air for the space served

  • The required minimum air exchange rate for each area served

  • The minimum and maximum temperature for each of these spaces

  • The minimum and maximum humidity levels for each space

  • The minimum filtration levels required

  • The pressure relationships between spaces

All these requirements could be verified during the commissioning process.

Commissioning addresses these issues by being an independent advocate for the Owner of the facility. By having a 3rd-party commissioning team perform testing, the Owner can be assured individual equipment is functioning properly AS WELL AS being assured that that all the systems and sub-systems are interacting with one another properly to ensure the building as-a-whole is functioning properly.

Cost of Commissioning:

As far as cost and return on investment (ROI) for commissioning projects, study after study show that the money invested in having your building commissioned is recouped in energy savings. In some cases, in as little as 1 year of building operation. In addition, the labor-hours saved in trouble-shooting problems and bringing Contractors back on-site to fix issues that could have been prevented with commissioning is a cost you don’t want to have in a new (or newly renovated, or ANY) building.

I’ll be elaborating on (and sharing specific studies related to) costs and ROI in an upcoming post as well. (You can also see THIS LINK and THIS ONE for some specific numbers. This LINK is specific to retro-commissioning.). As far as healthcare facilities go, the cost of commissioning your building is not only recouped in energy and labor-hour savings, but more importantly in better patient outcomes.

Watch for my posts over the next couple of weeks where I will be expanding on each of the items I outlined above.

If you are unfamiliar with commissioning in general, please see this post LINK and this other post LINK about commissioning and how we approach it here at Cooper Commissioning.

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