Hospital Benefits from “Inside-the-Box” Thinking

BY Burns Mechanical IN Construction

Typical Before Retrofit

Typical Before Retrofit

AFTER: Insulation & Fan

Typical After Retrofit







Hospitals face ever-increasing scrutiny from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). We’re finding that enforcement of healthcare related critical space environmental standards are accelerating the capital planning timeline of HVAC upgrades, with a specific emphasis on air handling unit replacements.

Air handler replacements are rarely cheap and never easy. Modern, efficient air handling units don’t often fit into the same dimensional boxes as their older predecessors. Whole unit replacements can be surprisingly expensive because large swaths of mechanical room components need to be moved out of the way or replaced to make room for the new, larger machinery. The impact potentially can result in compromised schedules, disrupted operations and magnified costs.

Pardon the cliché, but effective hospital air handler upgrades often require outside-the-box thinking. However, when it comes to the pre-existing large scale custom-built air handling units in most hospitals, it’s what’s inside-the-box that usually needs to be replaced. The box itself — the structural frame and outer skin — can often last for generations to come. Such was the case for one of our long-time hospital clients.

Faced with repeated component failure and performance deterioration on 40-year old systems, this hospital recently undertook an aggressive air handling unit upgrade program. By re-building the air handling systems from the inside out, rather than simply replacing them, we cut the planned capital cost in half and minimized operational disruptions, all while helping them to meet present day environmental and redundancy standards.

Specifically, we performed the following work:

  • Replaced belt-driven fans with multiple direct-drive fans to improve efficiency, reliability and redundancy
  • Re-built, epoxy coated, and sterilized the condensate collection systems
  • Replaced coils with higher capacity, lower pressure drop designs
  • Replaced humidification systems
  • Replaced fiberglass and galvanized inner services with sterilized stainless steel sheeting
  • Replaced and upgraded the air filtration systems
  • Installed Ultraviolet light systems
  • Replaced systems controls and integrated them into the Building Automation System
  • Re-balanced and commissioned the systems to meet present-day hospital environmental standards

This design-build approach demanded trust and cooperation between the hospital staff and our engineers. It required extensive upfront time, creativity and diligence. However, the pay-off for our client was huge, with improved environmental conditions and enhanced system redundancy. From the owner’s perspective, the process of doing the upgrades went undetected by staff and patients; cost hundreds of thousands of dollars less than a traditional replacement program; and eliminated a difficult capital need for another generation.

The key to unusual success was collaboration between administrators, maintenance staff, engineers, service technicians / contractors, and vendors. In this case it was a sole-source design-build delivery model. But any design-construction delivery model that genuinely enhances collaboration between all stakeholders will have better outcomes than those that perpetuate traditional divisive behavior.