Energy Efficiency in Hospitals

ENERGY EFFICIENCY
IN HOSPITALS
.A NET ZERO APPROACH.
SAROTA CLEMENT ONYIEGO

ENERGY EFFICIENCY IN HOSPITALS
A NET ZERO APPROACH
The Technical University of Kenya

Faculty of Engineering and the Built Environment
School of Architecture and Spatial Planning
Department of Architecture and Environmental Design
EAAQ/ 00636/ 2015

SAROTA CLEMENT ONYIEGO
A research thesis submitted in partial fulfillment of the requirements for the award of a Bachelor of Architecture degree in
the Department of Architecture and Building Science at the Technical University of Kenya.
©2022
i
DECLARATION
This thesis is my original work and, to the best of my knowledge, has never been submitted at any other
institution for a bachelor’s degree or equivalent award.
It is hereby submitted in partial fulfillment of the examination requirements for the award of the Bachelor of Architecture
degree at the Technical University of Kenya’s Department of Architecture and Environmental Design.
Signature…………………………….…....................... Date………………………………..................................
Sarota Clement O.
Author.
Signature…………………………….…....................... Date………………………………..................................
Arch. David Konde Matole
Supervisor
Signature…………………………….…....................... Date………………………………..................................
Dr. Joseph Kedogo
Academic Team Leader
Department of Architecture and Building Science
School of the Architecture and Spatial Planning
ii
DEDICATION
I dedicate this thesis to God, my family,

all health and NZEB exponents
and
to you, the reader.
iii
ACKNOWLEDGEMENTS
I acknowledge God, for grantig me good health and grace during the research and writing of
this thesis.
My supervisor - Arch. David Matole - for his guidance and encouragement. Our year master,
our chair - Academic Team Leader, architecture department - and the rest of the supervising and
examining panel. Your knowledge was highly valued and your guidance appreciated. Jonah,
Matthew, Faith, Jimmy, Evans, and the rest of the 2023 Bachelor of Architecture class, for your
encouragement and always challenging me to do better through the years.
The administrative and technical teams at Aga Khan University Hospital-Nairobi, and Koma-
rock Modern Hospital-Utawala. For granting me access to your institutions to carry out my
research, and for taking the time to show and explain the inner workings to me.
My family, who have always offered me unwavering support, encouragement and

understanding. I would not be half the person i am without you. I cherish you.
My non-archie friends, who in one way or another, helped me out during this period.
I cannot mention you all nor the myriad of ways that you helped me.
I value and appreciate you all.
And last, but certainly not least, myself,

for persevering and putting in the work.
I am eternally grateful.
iv
ABSTRACT
At one point or another, for a myriad of reasons, we have all stepped foot inside a hospital to
seek treatment. By definition, ‘a hospital is an institution that is built, staffed and equipped
for the diagnosis of disease; for the treatment, both medical and surgical, of the sick and the
injured; and for their housing during this process’ (Britannica, 2022). As such, its importance
cannot be understated. In the endeavor to provide the aforementioned services in a good and
timely manner, hospitals have to depend on a number of factors, key among them being access
to energy. As facilities set up to improve the human condition in matters health, it should follow
that hospitals should not only heal people but also seek to improve the environment in which
the people live. The World Health Organization (WHO) defines health as not merely the ab-
sence of disease and infirmity, but a state of complete physical, mental and social well-being.
While they, hospitals, cannot fix all of societies problems, they can at least try to reduce their
carbon footprint by switching to clean energy and live true to the doctors mantra of ‘do no
harm’. This can be done by fully stopping their use of energy that has been sourced from
non-renewable sources, reducing the use of energy and sourcing the required energy from
clean renewable sources. ‘Clean energy comes from sources that do not produce any kind of
pollution, notably greenhouse gases, which cause climate change’ (Iberdrola, 2022). Hospitals
use a lot of energy on a daily basis and as such, making them energy efficient will be a big step
towards making them sustainable.
Since, Energy Efficiency and Conservation is one of the key pillars of sustainable development
in Kenya. This research will seek to identify the ways in which hospitals can be made energy
efficient through the analysis of energy demand and supply, that is: what parts of the hospital
demand energy and from what supply sources do the hospitals get their energy. Literature re-
views, simulations, energy modelling and sample hospitals bench-marking are the methodolo-
gies that will be employed to answer the research question(s).
v
vi
TABLE OF CONTENTS
Chapter 01:Introduction
1.1: Background..........................................................................................................................2
1.2: Problem Statement...............................................................................................................3
1.3: Research questions...............................................................................................................5
1.4: Research Objectives.............................................................................................................5
1.5: Research Hypothesis............................................................................................................5
1.6: Relevance/Justification.........................................................................................................5
1.7: Scope and limitations of study.............................................................................................6
1.8: Definition of operational terms............................................................................................6
1.10: Overview of the rest of the chapters..................................................................................7
Chapter 02: Theoretical Framework
vii
...
viii
...
ix
...
x
LIST OF FIGURES
xi
...
xii
...
xiii
LIST OF TABLES
xiv
LIST OF CHARTS AND GRAPHS
xv
xvi
CHAPTER ONE:
INTRODUCTION
1.1: Background
All around the world, countries are in a development and innovation race. Mega-structures are
coming up and energy is being used. On the global front, buildings take up about a third of
the available energy. For instance, of the available global energy in 2018, buildings and the
construction sector consumed 36% (pie chart 01) of the final energy end-use and produced 39%
of energy and process related carbon dioxide (CO2) emissions (NEECS, 2019). The healthcare
buildings taking up a large portion of that use. This being a result of hospitals needing a lot of
energy to function effectively. This is in itself, due to the fact that most of the hospitals in con-
sideration, have to run for 24 hours in a day, 7 days in a week, all year round. And considering
the energy intensive equipment used for imaging and scans, specialized lighting for the oper-
ating rooms, pressure control, space heating, ventilation, artificial lighting, hot water systems,
and a number of other uses; this high, specific energy need is understandable. With energy use,
there are resultant green house gas emissions. And with most of the hospitals in Kenya still us-
ing the grid - whose emission factor is 0.33kg of CO2 per kWh - as the main source of electricity
for lighting, HVAC and running energy intensive equipment; hospitals end up being some of
the biggest contributors to climate change.
Page 2 Energy Efficiency in Hospitals

Even though emissions from years past have made a certain level of global temperature rise in-
evitable, all is not lost. We can still manage the situation and stop the upward trend by reducing
our emissions of Green House Gases (GHGs). One way through which we can do this is, by
making better choices in our energy-use.
It is with this background that this study proposes efficient energy use in hospitals, by seeking
to prove that a net zero hospital is achievable and a prerequisite for better universal health.
1.2: Problem Statement
Owing to their size, capacity and functions, hospitals take up a high share of the global and na-
tional energy use. The use of which results in emissions, especially green-house gas emissions,
that cause the green-house effect and further exacerbate the climate crisis.
This study proposes making hospitals energy efficient as a way of supporting sustainability
goals (SDG 7 (fig 1.4 & 1.5)) and reduce overall running costs of hospitals through a net-zero
energy building (NZEB) approach.
Energy Efficiency in Hospitals Page 3

1.3: Research question
How can the energy efficiency of hospitals be improved through net-zero energy strategies?
1.4: Research Objectives
+ To identify the typical energy demand for a hospital in Kenya.

+ To identify their typical energy sources and corresponding end-uses
+ To identify and propose energy efficiency and net-zero strategies for the hospitals.
1.5: Research Hypothesis
A hospital that is net-zero can reduce running costs for the owners, improve the bottom-line
for them, save the environment and improve patient and staff well being.
1.6: Relevance/Justification
By making hospitals energy efficient, we will not only be in support of actions combating
climate change and promoting environmental sustainability; we will also be promoting good
health by cutting back on their running costs and channeling the funds towards actual health-
care.

1.7: Scope and limitations of study
The research was focussed on energy efficiency in a general hospital, specialized hospitals might have
differing energy demands and require a different approach. The geographical scope of the research was
Nairobi, Kenya: as a benchmark for energy efficient hospitals in tropical upland regions.
The limitations for the study were:
a. Limited access to the hospitals and their operations
b. Financial constraints
c. Time constraints
1.8: Definition of operational terms
Clean energy: energy produced from a source which produces no kind of pollution which causes cli-
mate change.
Climate change: long term natural and or human caused shifts in temperature and weather patterns.
Energy efficiency: the process of reducing the amount of energy required to provide products and ser-
vices.
GHG: Greenhouse gas, a gas that absorbs and emits radiant energy within the infrared range, causing
the greenhouse effect, such as carbon dioxide.
IPCC: Intergovernmental Panel on Climate Change
Hospital: an institution providing medical and surgical treatment and nursing care for sick and or in-
jured people.
Net Zero Energy Building (NZEB): a building that produces enough renewable energy, on or off site,
to meet its own annual energy demands.
Renewable energy: energy produced from a source that is not depleted when used.
Sustainability: the avoidance of the depletion of natural resources in order to maintain an ecological
balance.
UHC: Universal Health Coverage
WHO: World Health Organization

1.9: Overview of the rest of the chapters
Chapter 1: Introduction
This chapter contextualized the research. It includes: the abstract, the background, the problem state-
ment, the research questions, objectives and hypothesis, the relevance/ justification, the scope and
limitations, and the definition of terms, of the study.
Chapter 2: Theoretical framework

This chapter formed be the grounds on which the research questions would be answered. Literature
that was reviewed included: the role of hospitals in society, energy efficiency standards and ratings for
buildings (hospitals), annual energy consumption in hospitals (local and international), available tech-
niques and technologies for energy efficiency in buildings.
Chapter 3: Methodology and Chapter 4: Data collection

This chapters were focused on the collection of qualitative and quantitative data for the research. The
aforementioned methods of data collection were utilized to collect the raw data for critique and
analysis.
Chapter 5: Data analysis

This chapter was focused on the analysis of the data obtained from work done in chapter 4. This analy-
sis was to either prove or disprove the research hypothesis and guide the content of the conclusions to
be drawn and recommendations to be made.
Chapter 6: Conclusions and recommendations

This final chapter provides a report on the findings of the research. It gives a conclusive answer to the
research question and on the research objectives. Areas of the topic needing further research are also
recommended.

Page 8
CHAPTER TWO:
THEORETICAL FRAMEWORK
2.1: Hospitals - an overview
2.1.1: Definition
By definition, a hospital is an institution that is built, staffed and equipped for the diagnosis of
disease; for the treatment, both medical and surgical, of the sick and injured; and their housing
during this process (britannica, 2022).
2.1.2: History
As early as 400 BC, religions identified certain of their deities with healing. Such as the Brah-
manic hospitals - Sri Lanka, 431 BCE,and the Valetudinaria - Romans, 100 BCE - for treatment
of their sick and injured soldiers. In331 CE, the idea that we associate with a modern hospital
was conceptualized by Roman Emperor, Constantine I (Constantine the Great). This he did by
emphasizing the close relationship between the patients care and the role of the community as
the care provider. Throughout the middle ages, religion continued to be the dominant influence
in the establishment of healthcare facilities. Near the end of the 15th century, many of the cities
and towns in Europe had some kind of institutional health care.
In Kenya, most of the communities traditionally depended on medicine-men, diviners, herb-

alists and older women (midwives), for the resolution of health related issues. The medicine
involved herbalism, and African spirituality. They used their knowledge of herbs and animal
products in specific combinations to bring about healing. The modern medicine and health sys-
tems that we know off and mainly use today were brought by the Europeans. The first hospital
to be built being the Kenyatta National Hospital, set up in 1901, under the name the Native
Civil Hospital.
2.1.3: Types
Hospitals can be classified according to their size, function and or ownership. By size, the hos-
pital can be small, medium or large; depending on the number of beds available. By function,
it can be academic/ teaching, acute, community, general, long-term or a specialty hospital.Then
by ownership, it can be public, private or a charitable hospital.

2.1.4: Departments
The functions in a hospital can be placed under one of 5 departments. These are: clinical,
nursing, supportive, technical and administrative departments. Each of this has sub-depart-
ments to better run the multitude of functions effectively and on time. Most of them running
24/7/365. A factor that leads to the intensive energy and resource use.
The clinical department is in charge of the consultation, diagnosis and treatment of the pa-
tients. Under this we can have: casualty/emergency department, intensive care unit (ICU),
general surgery, gynaecology department, operating theatres/ rooms (OT/ OR), haematology
department, oncology department, pediatrics department, orthopaedic department, urology
department, anasthesiology department, cardiology department, ENT department, geriatric
department, gastroenterology department,opthalmology department, psychiatry department
and in and out-patient departments.

2.2: Healthcare infrastructure in Kenya
Healthcare infrastructure refers to all the physical infrastructure, inpatient beds, transport, and
technology required for effective delivery of services at the National and County Government
Levels.
The healthcare infrastructure in Kenya is made up of a network of about 14,000 facilities coun-
trywide. These are under the Kenya Essential Package for Health (KEPH) system. Under this
system, the facilities are divided into 2 sectors: the public sector and the private sector (fig 2.4).
The public sector comprises of the MOH and parastatal organizations. The private sector com-
prises of private for profit facilities, Community Based Organizations (CBO) and Faith Based
Organizations (FBO) facilities.
46%
54%
The public sector accounts for about 54% of the hospital beds in Kenya, while the private sector
accounts for about 46% of the hospital beds in Kenya (pie chart 02). Hospital density stands
at 2.2 - 2.3 per 10,000 population and the infrastructure distribution is; level 2 - 77%, level 3 -
17% and level 4 - 6% (Table 02). The Ministry of Health (MOH), is in charge of the supervision
and monitoring of the health facilities in Kenya. It sets the standards and protocols to guide
Public: MOH & parastatals
the players in the health sector., and is itself guide by the National Health Sector Strategic Plan
Private: PFPs, NGOs, CBOs & FBOs (NHSSP).
Under schedule 4 of the Kenyan Constitution, 2010, and Executive Order number 1 of June
2018; the healthcare system is decentralized between The National and County Governments.
The Health Sector is one of the 14 devolved functions managed by the county governments.
The healthcare facilities are then organized into 6 levels, under the KEPH system, as in (fig
2.5).
At the apex are the tertiary -Level 6- hospitals. They are the national referral hospitals and
large private teaching/mission hospitals. The 5 national referral hospitals are: Kenyatta Nation-
al Hospital (KNH), Mathare Hospital, the National Spinal injury Hospital, Kenyatta University
Teaching Referral and Research Hospital (KUTRRH) and Moi teaching and Referral Hospital
(MTRH). They are managed by the national government.

Right below these are the secondary hospitals. Commonly known as From the MOH report ‘Pathways to optimal health infrastructure in
level 5 hospitals such as the Machakos Level 5 and Kisii Level 5 hos- Kenya’ (Pepela, Njuguna, Bartilu, Okoro, 2016). Most of the actual
pitals.These are the county referral hospitals and some large private/ buildings are dilapidated and in need of renovation. The nations bed
faith-based hospitals. The Level 4 hospitals -primary hospitals- are capacity is still low at 14 beds per 10,000 population - compared to
sub-county hospitals and medium-sized faith-based hospitals. Level 3 the global average of 27 beds per 10,000 population. This number is
hospitals are health centres, that is, small hospitals with minimal fa- however, still above the average for Africa, which is at 10 beds per
cilities. At Level 2 we have dispensaries. These are like the Level 3 10,000 population. There are no established call centers for control
facilitiesbut without in-patient services. At Level 1 are the community and co-ordination in times of emergency. The available equipment are
facilities. These offer treatment for minor ailments and screening for either inadequate and or aged, and lack the human resources to oper-
diseases -mostly communicable ones. In this system, one can move up ate, manage and repair.
the chain, from one level to another, by using referral letters.

2.3: The energy demand by hospitals in Kenya
Hospitals in Kenya, and internationally, use a mix of energy supply sources to meet their
energy needs. Focusing on the actual hospital grounds, this mix is majorly grid supplied
electricity backed up by natural gas. Each to supply different end uses in the hospitals. An
average US hospital uses about 27.5 kWh/ft2 (275kWh/m2) of electricity. In India, this figure
is between 200 and 225 kWh/m2. The major end uses being: lighting, ventilation, heating and
cooling, refrigeration and powering the medical and general electrical equipment. Taking the
Aga Khan University Hospital, Nairobi (AKUH-N), as a typical case study of energy use in a
Kenyan hospital, the typical annual energy consumption is calculated to be 200 kWh/m2, that
is, 10,000,000kWh divided over a 50,000m2 total floor area.
For context, AKUH-N is a private tertiary care hospital that also offers speciality services in
oncology. It is located in the Parklands area, in Nairobi, kenya, and is built on a 9 acre (36,
421m2) piece of land with a total floor area of 50,000 square meters. The hospital has a 209 bed
capacity and 9 operating theatres. The peak working hours, and consequently the peak energy
consumption hours, are between 8am and 6pm. Most of this being spent on plant rooms, fol-
lowed by big medical equipment, then small electrical equipment, and finally lighting; in that
order.

The typical energy supply and use distribution is: grid (electricity) = 95%, Diesel =
4%, LPG = 1%. Solar is not currently installed but they have plans in place for the
same. The end uses for each source are: electricity - ventilation, space heating, lighting
(general and specialised), refrigeration, water heating and running equipment, diesel -
boilers and backup-generator, liquid petroleum gas (LPG) - cooking.
The energy efficiency strategies that were considered during the design phase and are
in place at the moment are: passive ventilation and proper building-on-site orientation,
these are to mostly reduce the ventilation, heating and cooling loads needed for ther-
mal comfort. Other strategies that have been adopted and utilised are: energy efficient
lighting fixtures in the form of LEDs, motion sensors in the halls and corridors, invest-
ing in energy efficient equipment, proper running and maintenance of equipment and
carrying out energy audits periodically.

Electricity use at AKUH
4% 6%
18%
42%
30%
Lighting HVAC Equipment Refrigeration Others
Diesel use at AKUH
30%
70%
Boilers Back-up generators

2.4: Net Zero Energy Building
A net zero energy building is defined as, a building that produces enough renewable energy
to meet its own annual energy consumption. A term commonly confused and sometimes
used interchangeably with net zero energy building is nearly zero energy building. This is, by
definition, a building with a high energy performance such that its energy demand is low, and
- the low energy required - is covered to a large extent by renewable energy sources on-site or
off-site nearby.
NZEB is a part of ‘Green Design’, a building design and construction approach that aims to
minimize and or reduce the harmful effects of the building and construction sector on human
health and the environment. Green design does this by focusing on 5 broad areas: sustain-
able building, safeguarding water and water efficiency, energy efficiency and renewable en-
ergy, conservation of materials and resources and finally indoor environmental quality (IEQ).
NZEBs fall under energy efficiency and renewable energy.
A NZEB can be measured in 4 ways (fig 2.10), dependent on the; site energy, source energy,
energy cost and carbon emissions.
a. Net zero site energy building. This is a building that produces as much energy as is con-
sumed by it in a year, via on site renewable energy generation strategies.
b. Net zero source energy building. This metric that produces as much energy as it consumes
on an annual basis, via off site renewable energy generation strategies.
c. Net zero energy cost building. This building produces and sells at least as much renewable
energy to offset the cost it pays in utility bills for its annual energy consumption.
d. Net zero energy emission building. This building produces at least as much emissions free
renewable energy as the energy it uses from emissions producing energy sources.

As a rule of thumb, an effective approach to making a building net-zero is, incorporating
renewable energy strategies as a sort of complementary measure. That is, providing energy
for an entire building through renewable energy generation will be very expensive and not
practical for a hospital, which is essentially a business with workers to pay and a bottom-line
to consider. As such, reducing the energy demand should be carefully and thoroughly con-
sidered, afterwards, renewable energy measures can be implemented to provide the - now
reduced - energy need.
Three key principles are typically used to make a building net zero. These are:
a) Building envelope measures
b) Energy efficiency measures
c) Renewable energy measures
NZEBs have been advocated for from as early as the late 90’s. Their adoption has, however,
been slow due to a number of factors. The barriers to the adoption of NZEBs can be economic,
financial, legal, social or architectural. These are classified as either technical or non-technical
and as either barriers or conditioning-factors. The economic and legal factors are considered
to be the main barriers. Social, environmental, technical, functional and design aspects are
considered conditioning factors in that they greatly influence the choice of technologies to be
implemented and the way they are performed.

2.5: The climate of Kenya
Kenya,though classified as having a tropical upland climate, has a number of climatic condi-
tions being experienced in different regions. These are dependent on the temperature, rainfall
and humidity: and these are affected by the altitude. The 7 major climatic zones are: hot and
wet, very hot and very dry, hot and dry, warm and wet, cool and wet, cold and wet. These allow
for the production of renewable energy through the adoption of multiple sourcing strategies in
the different zones.
2.6: The state of energy in Kenya
Kenya’s energy is a mix of mainly green energy sources with geothermal, hydro, wind and
solar accounting for about 81% of the total generation. However,most of the energy in use
today is from heavy fuel oil (HFO) plants. It is expected that by 2030, energy production will
reach 5,000 MW, with most of it being from renewable sources. Geothermal being the most
significant with an estimated potential of 10,000 MW which, compared to the current 863 MW
installed capacity, remains relatively unexploited. Wind energy is estimated to have a 3,000
MW potential. Kenya is home to the single largest wind power generation plant in Africa,
the Lake Turkana Wind power plant, which supplies 310 MW to the grid. Being in a tropical
upland climate, Kenya receives high irradiation levels - about 6.5 hours of sunlight per day -
throughout the year, which means that she also has a high potential for solar power, especially
as an off-grid solution. In 2021, Kenya added 120MW from solar power to the grid,for a total
of 172 MW.
Furthermore, Kenya is in talks and partnership agreements with China, South Korea, Russia,
Slovakia and the USA on Nuclear Power generation. These will enable her to obtain expertise
and technical support in the area, in preparation of becoming a nuclear power producer by 2035
(United States Official Website of the International Trade Administration, 2021).

The public- institutions involved in the management and regulation of electricity in Kenya
are: the Ministry of Energy (MoE), the Energy and Petroleum Regulatory Authority (EPRA),
Kenya Electricity Generation Company (KenGen), Kenya Electricity Transmission Company
(KETRACO), the Rural Electrification and Renewable Energy Corporation (REREC), and the
sole distributor Kenya Power and Lighting Company (KPLC).
2.7: Energy Efficiency and Conservation in Kenya (Energy-Act-2019)
The Constitution of Kenya, Article 69 (1) states that, the government shall ensure sustainable
exploitation, utilization, management and conservation of the environment and natural resourc-
es (KNEECS, 2020).
The Kenyan government, in cooperation with several development partners, is seeking to pro-
mote energy efficiency improvements in a number of ways, including through enacting energy
regulations and implementing programmes and projects at institutional level. Among these is
the Energy Act 2019, the Energy (Energy Management) Regulations 2012, the Energy (Appli-
ances Energy Performance and Labeling) Regulations 2016, Vision 2030 and the Sustainable
Energy for All (SE4ALL) Initiative. While these approaches have been useful, they have adopt-
ed a rather disparate approach, with no integration point for all the energy-consuming sectors.
There was thus an urgent need to come up with a strategy to harmonize efforts on improving
energy efficiency.
As per the National Energy Efficiency and Conservation Strategy (NEECS) road map, 5 key
sectors are to be prioritised. These are – households, buildings, industry and agriculture, trans-
port and power utilities. This is in line to realize the goal of sustainably transforming Kenya to
an industrialized middle-income nation by the year 2030, as envisioned in Kenya Vision 2030
(NEECS, 2020). Hospitals fall in the buildings category.

There are six targets to be met in the Building Sector. First, there should be 10% share of newly
built floor area compliant with energy efficiency requirements in the total building stock from the
current baseline of zero. Second, two per cent of the buildings should have adopted American So-
ciety of Heating, Refrigerating and Air Conditioning Engineers (ASHRAE) Standards for energy
efficiency of buildings, or equivalent. Third, energy loads due to lighting in public buildings will
be reduced by 50 per cent. Fourth and fifth, 20 per cent of public buildings and 25 per cent of the
affordable houses the government is planning to build should be green, respectively. Lastly, the
sector should develop Minimum Energy Performance Standards (MEPS) for buildings.
Implementation of the NEECS will adopt a multi-sectoral approach, which will include state and
non-state actors. The Ministry of Energy will play a central role in coordinating the programs,
while EPRA will play the regulatory roles, as envisaged in the Energy Act 2019.

2.8: Energy Efficiency Standards for Hospitals
On the global front, buildings take up about a third (36% in final end-use) of the available ener-
gy, whose main sources are finite. This use produces 39% of energy and process related carbon
dioxide (CO2) emissions. The healthcare buildings taking up a large portion of that use - about
10%. This being a result of hospitals needing a lot of energy to function effectively. This is in
itself, due to the fact that most of the hospitals in consideration, have to run for 24 hours in a
day, 7 days in a week all year round. And considering the energy intensive equipment used for
imaging and scans, specialized lighting for the operating rooms, pressure control, space heat-
ing, ventilation, precision lighting, hot water systems, and a number of other uses; this high,
specific energy need is understandable.
To combat this energy use and reduce the carbon emissions, a number of standards have been
created. This standards are meant to reduce the energy demand in buildings and improve their
energy efficiency. Among these, some have been created specifically for health-care buildings.
Among these are: WELL, ASHRAE 170, LEED BD+C and IGBC Green Healthcare Facilities.
2.8.1: WELL
Pioneered by Delos and administered by the International WELL Building Institute™ (IWBI™
), WELL is the first standard of its kind to focus solely on the health and wellness of building
occupants. It focusses on how the built environment can be improved to support human health,
well-being and comfort. WELL is third-party certified through IWBI’s collaboration with Green
Business Certification Inc. (GBCI) – the certification body for the LEED Green Building Rating
System. As such it is designed to work well with the LEED Green Building Rating System and
other leading global green building standards (www.wellcertified.com).
First launched in October 2014 (WELL v1.0), the WELL Building Standard has a predominant-
ly perfomance based rating. But overall, it is designed in a way that comprehensively covers the
individual needs of building occupants while simultaneously building a common foundation for
measuring wellness in the built environment.

The WELL Building Standard is organized into 10 categories of wellness
called Concepts(WELL v2). These are: Air, Water, Nourishment, Light,
Movement, Thermal Comfort, Sound, materials, Community and Mind.
Under the 10 concepts are 102 features, each intended to address specific
aspects of occupant health, comfort or knowledge. Features can be:
+ Performance-based standards that allow flexibility in how a project
meets acceptable quantified thresholds. (Preconditions)
+ Prescriptive standards that require specific technologies, design strate-
gies or protocols to be implemented. (Optimizations)

Projects that want to get the WELL Certification need to be registered with IWBI through
WELL Online. Projects become certified once a sufficient number of features are satisfied. The
projects must be re-certified a minimum of every three years, to maintain the WELL certifica-
tion, because building conditions can deteriorate over time to the point of adversely affecting
the health and wellness of occupants.
If all Preconditions are satisfied, higher levels of certification award are possible. In evaluat-
ing award levels, all Optimization features are treated equally. Concept scores and the over-
all WELL score are calculated as follows for the number of WELL features applicable to a
specific typology:
In making these calculations, Innovation Features are not included among the total optimizations (TO), though
achieving them will increase Optimizations Achieved (OA). Lower scores (0 – 4) comprise the compulsory Pre-
condition features; a score less than 5 would denote failure to meet the Preconditions in that Concept and thus
failure for overall certification or compliance. Silver scores (5 – 6) mean that all compulsory Precondition features
have been met in the Concept. Gold scores (7 – 8) and Platinum scores (9 – 10) comprise the non-compulsory
Optimizations.
Healthcare: Healthcare facilities care for the most vulnerable. WELL features that apply to
hospitals, clinics, medical offices and nursing homes must address the needs of the ill and re-
covering, creating conditions that are conducive to healing by alleviating stress, mitigating the
spread of disease, providing nutritious food and improving occupant comfort.

2.8.2: ASHRAE:
170 (2017) - Ventilation of Healthcare Facilities
Founded in 1894, the American Society for Heating Refrigeration and Air conditioning Engi-
neers (ASHRAE) is a global society advancing human well-being through sustainable tech-
nology for the built environment. It focuses on buiding systems, energy efficiency, indoor air
quality, refrigeration and sustainability. ASHRAE 170 provides guidelines for safe design and
construction practices in healthcare facilities with a focus on ventilation.

2.8.3: LEED v4 for BD+C: Healthcare
The Leadership in Energy and Environmental Design (LEED) is one of
the most popular global green building rating standards. Like the oth-
ers, it is voluntary and focusses on 5 key areas of sustainable design.
These are: site, water, energy, materials and indoor environmental qual-
ity (IEQ).
LEED for health-care (LEED-HC) follows their criteria for New Con-
structions (LEED-NC) rating system but with additional elements spe-
cific for sustainable hospital design, these are:
a. Environmental site assessment
b. Minimal potable water use for medical equipment
c. Source reduction strategies for mercury reduction
d. Integrated planning and design
e. Connection to the natural world
f. Water use reduction
g. Contaminant prevention - airborne releases
h. Contaminant reduction releases
i. Furnishing and medical furnishing
j. Flexible design (future adaptation)
k. Acoustic perfomance (background noise)
l. Low emittance materials

2.8.4: IGBC Green Healthcare Facilities
The Indian Green Building Council (IGBC) was established in 2001 to
encourage the adoption of building green in India hence contribute to
their National Goals on Sustainability. To address national issues of in-
fection, epidemics, resource efficiency and promote patient health and
well-being; IGBC introduced the Green Healthcare rating system® . A
rating program tool that designers can use to apply measurable green
building concepts in their designs to reduce environmental-impacts. The
rating system addresses this under 7 categories: IEQ, sanitization and
hygiene, energy efficiency, site selection and planning, innovation and
development, water conservation and building materials and resources.
Each has detailed guideline standards to enable the design and construc-
tion of health-care facilities of different types and sizes in diverse climatic
zones. From this, different levels of certification, based on total credits
earned, can be awarded.
From the 2016 draft, the concepts would reduce energy use in health-
care facilities by between 20 - 30% by focusing majorly on; the building
envelope, lighting, heating, ventilation and air-conditioning. The Energy
Efficiency rating looks at:
a. Ozone Depleting Substances. These are the measures to minimize
ozone depletion by encouraging the use of eco-friendly refrigerants and
halons.
b. Minimum Energy Efficiency. Measures to reduce energy use through
optimizations in the building envelope,lighting and HVAC systems.
c. Commissioning Plan for Building Equipment and Systems. Verify and
ensure that the building’s equipments and systems are commissioned to
achieve perfomance envisaged in the design phase.
d. Eco-friendly Refrigerants.
e. Enhanced Energy Efficiency.

f. On-site Renewable Energy. Minimize negative enevironmental impacts
by reducing reliance on fossil fuel energy and using on-site renewable
energy technologies.
g. Off-site Renewable Energy. Encourage the adoption of off-site renew-
able energy sources.
h. Commissioning Post-installation of Equipment and Systems.
i. Energy Metering and Management. The use of sub-metering as a means
of monitoring to identify opportunities to improve the building energy
perfomance.

2.9: Factors affecting energy use in hospitals
Energy consumption in hospitals is typically high globally. This is affected from hospital to
hospital and region to region, due to a number of factors.These are: size, function - general
hospitals differ from speciality hospitals mainly due to the equipment in use, occupancy and
peak use hours, room size and height, local climate, building orientation and perfomance of
the building envelope. These factors have a big effect on the lighting, heating, cooling and
humidification demands of the hospital. They can either raise or lower the overall energy use
within the hospital and as such, controlling the energy spent in these areas will effectively
improve the energy efficiency in the facility.
2.9.1: Ventilation
The high energy use intensity (EUI) in hospitals can be attributed, mostly, to the HVAC
systems. The systems regulate the pathogen loads and occupant comfort by controlling the
ventilation rate (ACH) and humidity. Of concern to health specialists is that allowing in
non-filtered air may contaminate the interior air quality.
2.9.2: Humidity
For thermal comfort, ASHRAE 170 recommends maintaining the relative humidity of a space
at between 30% and 60%. Keeping the relative humidity levels below 40% could potential-
ly reduce the necessary design ventilation rate that inhibits virus transmission and therefore
reduce energy use (Taylor and Arch, 2016).
2.9.3: Daylighting
Lighting is another area in which hospitals spend a lot of energy. Sufficient quality lighting is
required for illumination, wayfinding, safety, enhancing the ambience (biophilia) and a num-
ber of other uses. As such, having ways to maximize on daylighting will reduce the overall
energy demand.

2.10: Bio-climatic architecture for energy efficiency
Bio-climatic architecture is a way of designing buildings that are inspired by the local climate
with the aim of: improving resource efficiency, minimizing the building’s environmental im-
pact, and boosting occupant comfort. It comprises of taking cues from the local environment
and climatic conditions and using these to come up with design solutions that are specific to the
area. Some of these are:
2.10.1: Building orientation

This refers to the placement of the building on-site in relation to the 4 cardinal points of the
compass. Orientation determines what elevations of the building will be exposed to sunlight
and for what periods of time. It also determines from what angles the sun will penetrate the
interior of the building. As a consequence,it influences solar gains and subsequently the energy
spent on indoor environmental quality control.
In tropical climates, minimizing the wall surface area directly facing the East and West sides
will reduce the overall building-sunlight exposure hence lowering the solar gains.
2.10.2: Building shape, colour and form

The building shape and form determine the air-flow and speed around and within the building.
Fast flowing air around a building will increase heat loss through the envelope by lowering the
surface temperature of the exposed surfaces. This forces the now warmer interior air to flow
towards the cooler low pressure zones. This knowledge can be utilized for air-flow control and
thermal control.
The colour of the surfaces determines their reflectance, absorbance and emmitance capabilities.
White (lighter coloured) and shiny surfaces being more reflective and darker coloured surfaces
being better absorbers and emitters of radiant heat.

2.10.3: High performance building envelope
The building envelope comprises of the roof, floors, walls, doors and windows. The envelope
is the part of the building directly exposed to the natural environment and determines its trans-
mittance (U-value). A high performance, low U-value, building has a lower energy demand.
2.10.4: Passive design strategies

These are design strategies that use the natural environment to ensure user comfort without the
need for mechanical interventions. They include: daylighting, natural ventilation and utilizing
solar gains.
Daylighting refers to the use of sunlight to provide sufficient light for the functions of a build-
ing. It helps save on energy by reducing the need for artificial lighting. The strategies and ele-
ments that can be utilized are: side-lighting (windows and clerestories) and top-lighting (sky-
lights, atriums and light-pipes).
Natural ventilation refers to the use of airflow through and around the building to regulate the
indoor environmental quality without the use of mechanical means. It is controlled through the
openings of the building by utilizing natural temperature and pressure differences. Wind catch-
ers and solar chimneys can be used.
Solar gains refers to the increase in temperature in a space, object or structure due to the natural
heat from the sun. Buildings absorb the incident solar radiation and that increases their thermal
energy, when they reradiate the energy into the space, it raises the ambient temperature. Solar
gain can be used with thermal massing to reduce heating energy demand at night.This can be
done by storing solar gains accumulated during the daytime and then releasing them slowly
during the night. Unwanted gains can be controlled by the strategies stated above.

2.11: Renewable energy measures as alternative energy sources
Renewable energy is energy obtained from sources that are not depleted when used. Such as the
energy obtained from wind-farms and photovoltaic farms. No discussions on energy efficiency
can be held without the mention of renewable energy strategies. Some of the renewable energy
sources are: wind, solar, geothermal, hydro and biomass. Of these, wind, hydro and solar are
further classified as clean renewable energy sources because they produce no carbon emissions
in their energy production. By using these, buildings can reduce, and in the case of clean re-
newable energy, fully stop their carbon emissions and play a part in reducing global warming.
2.11.1: Solar and wind for electricity

Of the RE sources, solar is the most applicable as an off-grid solution to produce electricity.
This is due to the availability of the sun and the manageable size of solar panels. The simple
functioning of photovoltaics is, light photons from the sun excite electrons into higher energy
states in semi-conductor materials such as silicon and causes electron diffusion, generating
electricity. Solar panels can be used on the roof of the building to generate electric energy -net
zero site energy building. This can then be used directly (during the day), or saved in batteries
to be used later (during the night).
In facilities with a large piece of land off-site, wind generated electricity can be used as an en-
ergy source. The electricity can be used to power the hospital -net zero source energy building;
or to offset their emissions from typical energy use -net zero energy emission building.
2.11.2: Geothermal heat pumps for heating and cooling

GHPs use thermodynamics to exchange heat between two zones. Heat flows from the zone at a
high temperature (heat pump) to the zone at a low temperature (heat sink). There are two types
of heat pump systems, closed loop systems and open loop systems. The heat source can either
be air, ground or water.

The typical process is: a refrigerant (non-freeze fluid) in the system absorbs heat from the
source, is vaporized, then releases that heat when condensed. Taking a ground source heat
pump (GSHP) as an example for heating, the fluid is passed through the coil (evaporator) where
it absorbs ground heat and is vaporized. This vapor is then fed to the compressor where it is
superheated under high pressure and temperature. The superheated vapor travels through the
condenser transferring the heat to the space (heat sink) as it is condensed. From the condenser
it is passed through the expansion valve, turned further into a liquid and fed into the evaporator
coils to repeat the process.
The GSHP depend on the fact that ground temperatures at depths of about 2 metres are fairly
constant at between 50 and 300c. The coils for the heat exchange are placed at these depths to
use the soil temperature as the heat pump for the refrigerant for heating, and as the heat sink for
cooling. Depending on the space available, the loops can either be in a horizontal position, or
a vertical position.
2.11.3: Biomass for power generation and space heating

Biomass refers to animal waste and plant residue that can be burned to produce bio energy.
Compared to fossil energy, bio-energy is eco-friendly, sustainable and renewable. The biomass
can be used to produce electricity by burning it in a furnace, this heats up a liquid in a boiler
turning it into steam, the steam is then used to turn a turbine that operates a generator to produce
electricity.

2.11.4: Combined heat and power systems
CHP systems are systems that simultaneously produce electricity and thermal energy from a
single fuel same source. They boost efficiency by reducing waste, in the form of heat, by using
it such as for space heating. An example would be the biomass electricity generation stated
above, rather than letting the resultant heat from the boiler just dissipate,it can be modified to
work as a heat pump and used for space heating.
2.12: Building Energy Management Systems (BEMS)
With the high energy use in hospitals, regular energy audits are a necessity. These help the man-
agement know exactly on what areas energy is being spent, at what times and at what rate. This
information can then be used to implement energy efficiency strategies as required. Having ICT
systems in place to automate and monitor the energy use will simplify the auditing process, en-
suring efficiency in not just the energy use, but with all other resources. BEMS can be used in:
a.Zone IEQ control c.Lighting sequencing by zones
b.CO2 and pathogen loads monitoring d.Boiler and chiller sequencing

Page 38
CHAPTER THREE:
METHODOLOGY
3.1: Introduction
This chapter was focused on the methods that would be employed to gather data to realize the
objectives of the study. A multi-method approach would be utilized to gather as much data as is
possible within the short time frame allocated.
3.2: Research purpose
The objectives of the study were, in summary, to identify the typical energy demand, supply
and use in a hospital in Nairobi, Kenya; and to propose ways to reduce this together with net
zero strategies that can be employed to curb their carbon emissions.
3.3: Research design
A case study hospital was selected to provide quantitative data on energy use.The hospital was
Komarock Modern Hospital, Utawala. It was selected due to a number of factors that would
play a very big part in the realization of the study objectives. These were: ease of accessibility
due to its location, its size, its type, the services offered and the period in which it had been in
use.
3.4: Data collection
During the case study -fieldwork- the following methods were used to source for information.
Questionnaires and interviews, observation, photographs and sketches, field measurements,
and model buildings simulation.

3.4.1: Questionnaires and interviews
These were used to obtain information from the users and managers of the hospital. Of utmost
concern were the: energy demand, energy sources, energy end uses, cost of sourcing the energy,
net zero alternatives for them. The focus questions included:
1.What is the size of the hospital? Sq-ft/ sq-m/ built-up area/ bed capacity/ staff
2.What is the hospital’s typical energy demand? Day/ week/ month/ year
3.When is the most energy spent in the hospital and on what?
4.Which are your energy sources? Main vs supplementary
5.What areas of the hospital consume the most energy? End use vs Source
6.Are there any energy efficiency strategies in place and or planned? Which ones and on what
areas?
7.What architectural/ design factors were considered in the design of the hospital to reduce
energy demand and use? Building shape and orientation/ high performance envelope/ glazing
area/ window to wall ratio/ lighting (day-lighting)
8.What technological strategies have been considered in the hospital to increase the energy
efficiency? Renewable energy integration/ efficient HVAC system/ BMS & EMS
3.4.2: Observation, sketches and photographs

These were used to mainly record the infrastructure and functioning of the facility. The relation-
ship between spaces and how people interact within and with them. The architectural, mechan-
ical and technological strategies focused on energy use.
3.4.3: Field measurements

Physical (tape measure) and digital measuring tools (measure) were used to take real life mea-
surements of the spaces(widths and heights) to aid in the subsequent modelling and simulation
of the facilities.

3.4.4: Model building for simulation
Using data obtained from the facilities, the author made a digital model of
the facility using CAD software -Rhino + Ladybug tools. This model was
used to simulate different conditions that affect energy use. As-built con-
ditions were simulated, then bioclimatic energy efficiency strategies were
added onto the model and this simulated, then the results were noted and
compared to each other and to the green building standards for hospitals
stated in chapter 2.
3.5: Software Validation
About Rhino + Ladybug tools

Rhino is CAD software that can be used in multiple design fields. It is
an easy to use software that can create simple early-design stage models
to complex final-design stage models. Its compatibility with grasshopper
allows a number of plug-in tools to be used in conjunction increasing its
usability. Of these plug-in tools, the Ladybug tools allow for energy mod-
elling and simulation through Honeybee - which uses Energyplus to run
the simulations.
3.6: Data analysis and presentation
After the collection of data, the results were analyzed and presented in a
number of ways, including but not limited to: comparative line and bar
graphs, comparative pie charts, CAD drawings and models, energy per-
formance simulations and written explanatory prose.

Page 43
CHAPTER FOUR:
PRECEDENT AND CASE STUDY
4.1: THE PRECEDENT STUDY - ST. ANTHONY HOSPITAL

St. Anthony Hospital is a 112 bed, full medical services hospital located
in Gig Harbor, Washington, USA. It was designed by ZGF Architects and
covers 25,000 square meters of built-up area. The design is meant to em-
phasize the connection between nature, health and well-being.

4.2: Energy Efficiency Strategies
4.2.1: Bio-climatic strategies

a.The design uses aluminium curtain walling to maximize on natural day-
lighting and reduce lighting energy loads.
b.Polished concrete floors and wood and stone clad walls enhance the
thermal performance of the building to reduce heating and cooling loads.
c.Wide corridors, atriums and double volume public areas are used to
enhance the free flow of air and minimize on energy use for ventilation.
d.The building is oriented to minimize solar gains by placing the majori-
tyof the windows on the North - South direction.
e.The use of vegetation to reduce wind speeds and create a slow breeze
while at the same time reducing overheating by the reduction of high
thermal emittance surfaces.

4.2.2: Technological strategies
a.The hospital is designed to LEED and Green Guide for Healthcare
guidelines so as to achieve a high performance healing environment.
b.The equipment used at the hospital is cutting edge energy efficient med-
ical and electrical equipments.
c.The use of energy efficient LED lights technology.

4.3: THE CASE STUDY - KOMAROCK MODERN HOSPITAL UTAWALA

4.3.1: Introduction
Komarock Modern Hospital (KMH) was started in 2006 as an outpa-
tient clinic. Since then, it has grown into a large hospital with currently 4
branches and growing. The branches are:
+Komarock branch: this was the first branch and is a 24 bed, level 3 hos-
pital.
+Utawala branch: opened in August, 2016, KMH:Utawala is a 150 bed,
level 5 hospital.
+Kathwana branch: this was opened in November, 2018. It is a 180 bed,
level 4 hospital.
+Chuka branch: this was opened in December, 2020.
The hospital offers all general medical services and minor surgical condi-
tions but with a speciality in obstetrics and gynaecology.
4.3.2: Reasons for Selection of the Case Study

The researcher selected Komarock Modern Hospital for the reasons stat-
ed below:
(a)Ease of access. The branch located in Utawala was easy for the re-
searcher to get to location wise, this allowed for the possibility of multiple
trips, whenever required. As an added bonus, the researcher was familiar
with the climatic conditions of the area.
(b)Its size and type. The branch is a reasonably large level 5 hospital, with
a 150 bed capacity, this meant that a good understanding of the function-
ing of a hospital and subsequent energy use could be correctly inferred.
(c)Operation period. The hospital had been in operation for slightly over
6 years by the time of the study, this allowed for the analysis of energy
trends over a number of years.
(d)Available facilities and operations. The hospital offers not only general
medical services but also minor surgical services, and boasts of multiple
facilities such as: an operating theatre(OT), a maternity and new born unit
(NBU), an oxygen plant, among others.

KMH Utawala is a private level 5 hospital located in Utawala, Embakasi East, in Nai-
robi, Kenya. It is easily accessible via the Eastern Bypass - a 3 minute drive (7 minute
walk) from the exit point. It is situated in a predominantly residential area -Ndege View
Estate- and is bordered by a number of high rise apartment buildings. As one of the larg-
est hospitals in its locality, and owing to its facilities, and running times (it runs 24/7),
it is the busiest hospital in the area.

The climate of the area is semi-humid to semi-arid, which is the climate of the larger
Machakos county, as the hospital is located close to the border of Machakos county.
This means that it receives a lot of incident radiation which is good for solar power
generation.

4.4: Energy Use at KMH:Utawala
The average cost of meeting the total energy needs of the hospital in a
Main energy supply
month is Ksh 1,200,000. This approximates to a total electric energy use
of 66,362 KWh from the grid. 8% 2%
90%
Electricity Solar LPG
BACKUP ELECTRICITY
SUPPLY
Diesel Solar
20%
80%

4.5: Energy Efficiency Strategies Implemented at KMH:Utawala
4.5.1: Bio-climatic strategies

+Form and building orientation
The form of the buildings are polygonal, tending towards rectangular shapes. These are oriented
in the South-East to North-West direction. This design and placement reduces solar gains, but
at the same time reduces the amount of natural light that gets into the interior spaces creating
some dark corridors.

+Window to wall ratios
The majority of the windows are on the South-East facing facades to al-
low in daylight with reduced heat gains. On these walls, the window to
wall ratio is 35% (0.35:1). On the East and West facades, this ratio reduc-
es to 5% on the main building and 15% on the maternity building.
+Building envelope
The structure is made of masonry walls and reinforced concrete columns,
beams and slabs. The walls are 200mm thick plastered and painted on the
insides, the outsides are plastered and painted on some areas, keyed on
some areas and finished with mazeras on some areas.

4.5.2: Technological/ mechanical strategies
+Lighting schedule
There is a lighting schedule in place. This, however, is utilised on the exterior lights only. Most
of the interior lights are run constantly for the entire day, especially, on the corridors which lack
sufficient natural light penetration as a result of the compact design of the buildings.
+Energy efficient lighting

The hospital uses energy efficient lighting fixtures, that is LEDs,which consume less power
compared to regular light bulbs.
+Solar power generation and use

The facility has 60 solar panels - with a 275 W capacity each - in total atop its roof. 33of the
panels are on the main building, and the remaining 27 are on top of the maternity building. The
entire hot water supply for the maternity building is also supplied by solar water heaters located
atop the roof.

Page 58
CHAPTER FIVE:
DATA ANALYSIS
5.1: Introduction
The Komarock Modern Hospital has multiple energy types and their sources in use. This leads
to high costs and high carbon emissions, necessitating net zero interventions in multiple areas.
This chapter will be focussed on the quantitative analysis of net zero strategies to enhance
energy efficiency at the hospital.

5.2: Demand and cost of energy at the hospital
The most energy intensive systems at KMH are the HVAC, the lighting systems, heavy medical
equipment, the elevators on the private wing and light electrical equipment.
The average electricity consumption in a month at the facility is 66,362.2 KWh. The cost for
this being around 1.2 million kenya shillings in a month. Whenever there is a blackout and they
have to use the back-up generator, it consumes (25 - 30)L of diesel per hour. The cost for this
being dependent on how many hours the blackouts last for in a month multiplied by the cost
per litre of diesel (164.212 kes at time of writing this), and how many litres it consumes in an
hour. The kitchen uses 2, 500kg capacity LPG gas tanks in a month. That is 1000 kgs, equal to
about 260,000 ksh/ month.

5.3: Energy Use Analysis
5.3.1: Design
The design of the form and the building envelope help to reduce some of the energy demands
of the hospital, especially within the main building. Its SE - NW orientation ensures that while
there is daylight penetration, solar gains are low.

5.3.2: Natural Ventilation
Openings on all elevations of the building help in the reduction of cooling loads by al-
lowing easy cross ventilation by utilising the natural wind flow patterns to circulate air
within the building.. Conventional currents suck cool air in from the sides and expell
warm air through the top.

5.3.3: Daylighting
The roof of the building receives 10 - 12 hours of direct sunlight, this was only utilised
in the ramp area, which is clad in glass, to provide natural lighting. The walls, depend-
ing on their location, receive between 4 - 8 hours of direct sunlight in a day.
Oversights in the design were: in the provision of solar shading for the windows and
insufficient lighting for some of the corridors. As the climate of the area is semi-arid,
it can get quite hot, with external temperatures going to as high as 25.9 0c. The lack of
solar shading on the solar exposed windows necessitates the use of curtains to block out
the sun’s rays and reduce solar gains.
The light within some of the dark corridors could be as low as 40 lux, whereas the rec-
ommended lighting for in-patient spaces is at 100 lux.

The simulation software mapped out 52 focus points on the Sun hours on March 21st
study geometry. It then did the simulation of the resultant sun- 14
hours received on each of the points.
)s 12
r
h
( 10
On March 21st, the equinox date: some points of the geome- sr
u 8
try -such as 0, 8 and 24- receive no sunlight. These points are o
h
heavily shaded and as such can not be utilised for daylighting. n
u
s 6
However, most of the points (exposed walls) receive about 6 f
o
. 4
sun hours in a day, and some points (on the roof) receive double o
N
that amount at 12 sun hours. 2
0
Running the simulation for the entire year produces a graph that 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
is almost similar to the single day simulation. The points on the Points on the simulated geometry
roof receiving almost 4,500 total annual sun hours. This calcu-
lates to 12.33 sun hours in a day, confirming the first simulation
as the location receives high amounts of sunlight.
Total annual sun hours
Locating the windows on the areas receiving more than 6 hours 5000
of sunlight in a day would maximize on daylight to light the 4500
interior. Circulation spaces can utilise open or curtain wall sides )s 4000
r
and skylights to naturally light the spaces for up to half of the h
( 3500
sr
day. These strategies would reduce the energy used in lighting. u 3000
o
h 2500
n
u
s 2000
f
o
. 1500
o
N1000
500
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Points on the simulated geometry

5.3.4: Renewable energy alternatives
Owing to the climate of the area, the renewable energy source that has been most
exploited is solar energy. The 60 solar panels, as stated in the previous chapter, can
produce a total power output of 16.5 KWh. From the simulation of the building model,
the building receives 10 - 12 hours of direct sunlight atop the roof, with an incident
radiation of 4.44 KWh/m2.

Two renewable energy sources are unexploited, these are, wind and biomass. The area does not
have tall buildings nor tall vegetation, subsequently, there is a lot of wind that can be harnessed
for electric power. Carbon based materials waste from the hospital can be used to produce bio-
gas as a replacement to the LPG used in the kitchen.
Combining these sources in a combined heat and power loop can also further enhance the effi-
ciency of the hospital such as by reusing the released heat from the kitchen in for space heating
during the cold times.

Incident radiation on March 21st Simulations were also done on the incident radiation received
5 by the 52 points on the geometry. As expected, the points that
)
m4.5
q
received low sun-hours also received low incident-radiation
s/ 4
h levels, and the inverse is true as well. The areas that received the
W3.5 highest sun-hours also received the highest incident radiation
K
( 3
n levels. The same trend is witnessed when the annual simulation
io
ta 2.5
i for incident radiation is done.
d 2
ra 1.5
t
n
e 1 These simulations show that PV panels are a viable option as an
d
ic alternative energy source. Locating these on the roof areas that
I 0.5
n
0 receive upto 12 sun hours in a day with an incident radiation
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 level of close to 4KWh/m2, would be able to produce sufficient
Points on the simulated geometry electric energy and solar water heating for the hospital.
This would reduce their energy bill by at least half or even com-
Total annual incident radiation pletely, if sufficient inverters and batteries are used. The strategy
)
m would also have the side effect of reducing their carbon emis-
q
s/ 2000
h 1800
sion levels by utilising a clean and renewable energy source.
W
K
( 1600
n 1400
o
it
ai 1200
d
ar 1000
t
n 800
e
d
ic 600
n
i 400
d
ev 200
i
ec 0
e
R 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Points on the simulated geometry

5.4: Compliance with the NEECS recommendations
As stated in chapter 2 of this study, the NEECS recommends six targets to be met in the build-
ing sector. Among these are:
a.10% of newly built floor areas should be compliant with the energy efficiency requirements.
- Compliant, the maternity building uses solar for the production of its hot water supply.
b.At-least 2% of the building should have adopted ASHRAE energy efficiency standards or
an equivalent standard. - Compliant, the lights in both the main and the maternity building are
LEDs
c.Reduce lighting energy loads in buildings by 50%. - Not yet compliant
d.20% of public buildings should be green. - Compliant, there is a trial to utilise solely LEDs
for lighting and solar for power generation.
5.5: Failures in Energy Efficiency at the Hospital
a.The lack of solar shading on any windows. With the highly exposed walls of the hospital
receiving up to 8 hours of direct sun in a day, the lack of solar shading means that the demand
for cooling is high. While this is mitigated in some spaces by cross ventilation and thermal
massing, the exposed windows, more-so on the front elevation force the users to have their
curtains drawn shut.
b.The daylighting potential is under-utilised. Had skylights and atriums been incorporated into
the design, the dark corridors would not have been an issue. And this would reduce the lighting
demand.
c.The biggest failure in energy management at the hospital would be in the lack of a BEMS.
Artificial lighting and air-conditioning is left to the discretion of the users within their spaces.
The lack of a system to regulate lighting and HVAC schedules leads to very high energy con-
sumption by the two systems. Furthermore, the lack of sub-metering means that the energy
demand of different systems and equipments cannot be measured.

5.6: Remedies for the Failures
a.Utilizing bio-climatic design approaches to reduce ventilation and lighting loads. Though the
winds are predominantly North-Easterlies, the geometry receives wind flow from all directions.
Cross ventilation can be used to reduce air conditioning running costs.
A combination of solar shading devices and high perfomance glass on the windows would re-
duce unwanted solar gains during the hot afternoons without severely impacting natural light-
ing. This would in turn minimize energy use on space cooling and air conditioning.
b.Using a combined heat and power system to heat the spaces in the night, when it can get quite
chilly. Having spent a couple of hours at the cafeteria at night, temperatures can go as low as
100c, space heating becomes imperative. Using a CHP system that can store the excess heat
from the kitchen and incinerator when in use, and then utilise this to heat the spaces in the night
would save on space heating costs.
c. Utilizing the solar power. The building is located in an area with a lot of sun-hours and subse-
quent incident radiation in a year. The utilization of this can be increased to provide even 100%
of the hospitals hot-water needs, as in the maternity wing.
d.Having BEMS in place to help in the scheduling of energy use and taking energy audits. A
BEMS would not only help in the scheduling of different equipment to increase the energy
efficiency but also in the general running and maintenance of energy intensive equipment and
area. Helping to understand the energy use and improve as necessary.
e.Fine tuning the existing medical and electrical equipment. As a follow up to the energy audits
made possible by an installed BEMS system, existing equipment can be easily managed and
fine tuned.
f.Purchasing energy efficient equipment. Purchasing medical and electrical equipment that are
rated as needing little power to run effectively.

Page 71
CHAPTER SIX:
CONCLUSION AND RECOMMENDATIONS
6.1: Conclusion
Hospitals are some of the biggest energy consuming buildings globally. This also makes them
one of the largest contributors to climate change as a result of the sources having high carbon
emission factors. This research was conducted with the aim of understanding energy use in hos-
pitals with the goal of increasing energy efficiency through a net-zero approach.
The theoretical framework chapter set-up the baseline for understanding energy use, ways to
reduce energy use and net zero approaches for reduced carbon emissions. After that, a case
study, Komarock Modern Hospital, was selected and its energy use analysed. The demand, cost
of supply and areas of concern on energy use were analysed; and applicable improvements for
energy efficiency and alternative renewable energies were recommended.
From the study, it is evident that the biggest contributors to the high EUI of hospitals are the
running of the medical equipment, lighting loads and heating and cooling loads. To reduce their
carbon footprint and overall running costs, energy efficiency in hospitals is necessary and long
overdue. By focussing on these larger energy consumers and and employing some BEMS cou-
pled with good housekeeping strategies, the energy and general resource efficiency of hospitals
will be improved, and we will be on the path to achieving a Net Zero Hospital.
As a basis, the approach to achieving energy efficiency in hospitals through a Net Zero Energy
Building Approach is: (a) Reduce the energy demand. This can be done by keeping in mind and
applying bioclimatic strategies in the design of new hospitals. (b) Using green energy to supply
the unavoidable energy needs of the hospital. That is, ensuring that the energy used within the
hospital is from not only renewable, but also cleanenergy sources. (c) Making conscious en-
ergy decisions in the day to day running of the hospitals. These include the use of technology
to regulate different energy loads within the different zones of the facility to ensure maximum
efficiency.

6.2: Recommendations to Increase the Energy Efficiency
To increase the energy efficiency of hospitals, this study proposes the below strategies. They
are further breakdowns of the three net zero building principles:
- Building envelope measures
- Energy efficiency measures
- Renewable energy measures
6.2.1: Building envelope measures

a. Carrying out sufficient studies in the design stage through CAD simulations and models be-
fore proposing design solutions.
b. Design with the environment. That is, orienting the building to maximize on daylighting and
natural ventilation, while keeping solar heat gains at a minimum.
c. Use a high performance building envelope, informed by the studies in ‘a’ above during con-
struction. This will reduce the heating and cooling demand during the operational period of the
building.
6.2.2: Energy efficiency measures

d. Building to the recommended standards. Although the standards for healthcare buildings
are few, they are there and they can play a large part in the design and construction of energy
efficient hospitals.
e. Using energy efficient equipment. Purchasing and using energy efficient equipment is an
obvious but normally overlooked energy efficiency strategy.
f. Fine-tuning existing equipment to ensure that they are running smoothly and efficiently. This
can be effectively done by carrying out energy audits on existing equipment to ensure they are
running optimally.
g. Setting up BEMS. Having schedules to control the lighting and HVAC systems and heavy
equipment use, will aid in the management and control of energy consumption.

6.2.3: Renewable energy measures
h. Utilize renewable energy sources for power generation. Whenever applicable, renewable en-
ergy sources should be used to reduce carbon emissions. Such as using the organic waste from
the kitchen to produce biogas.
i. Set up a loop - co-generation system - for the energy use to maximize on a combined heat and
power system. Such as using the resultant heat from incinerators for medical waste and from
the kitchen to heat spaces.
6.3:Areas for Further Research
Hospitals are complex buildings with an energy demand that is unique to the type and overall
size of hospital. This study was limited in that it focussed on a medium sized general hospital.
The NZEB metrics focussed on were 2 out of the aforementioned 4, these are:
a. Net Zero Site Energy Building
b. Net Zero Energy Cost Building
As such, the following areas need further research.

a. Achieving energy efficiency in a speciality hospital via a NZEB approach
b. Energy efficiency in hospitals via an emissions analysis
c. Net Zero Source Energy Building as an approach to energy efficiency in hospitals

Page 79
References

...

Appendix:
The Authors Introduction Letter

Case Study Checklist

Page 85
The Technical University of Kenya
Faculty of Engineering and the Built Environment
School of Architecture and Spatial Planning
Department of Architecture and Environmental Design
Sarota Clement Onyiego

©2022

Energy Efficiency in Hospitals

Uploaded by

Copyright:

Available Formats

Energy Efficiency in Hospitals

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Energy Efficiency in Hospitals

Uploaded by

Copyright:

Available Formats

ENERGY EFFICIENCY

SAROTA CLEMENT ONYIEGO

The Technical University of Kenya

EAAQ/ 00636/ 2015

I dedicate this thesis to God, my family,

My family, who have always oﬀered me unwavering support, encouragement and

And last, but certainly not least, myself,

Chapter 02: Theoretical Framework

Page 2 Energy Eﬃciency in Hospitals

1.2: Problem Statement

Energy Eﬃciency in Hospitals Page 3

1.4: Research Objectives

+ To identify the typical energy demand for a hospital in Kenya.

1.5: Research Hypothesis

Energy Eﬃciency in Hospitals Page 5

1.8: Deﬁnition of operational terms

Page 6 Energy Eﬃciency in Hospitals

Chapter 2: Theoretical framework

Chapter 3: Methodology and Chapter 4: Data collection

Chapter 5: Data analysis

Chapter 6: Conclusions and recommendations

Energy Eﬃciency in Hospitals Page 7

In Kenya, most of the communities traditionally depended on medicine-men, diviners, herb-

Page 10 Energy Eﬃciency in Hospitals

Energy Eﬃciency in Hospitals Page 11

Page 12 Energy Eﬃciency in Hospitals

Energy Eﬃciency in Hospitals Page 13

Page 14 Energy Eﬃciency in Hospitals

Energy Eﬃciency in Hospitals Page 15

Lighting HVAC Equipment Refrigeration Others

Diesel use at AKUH

Boilers Back-up generators

Energy Eﬃciency in Hospitals Page 17

Page 18 Energy Eﬃciency in Hospitals

Energy Eﬃciency in Hospitals Page 19

2.6: The state of energy in Kenya

Page 20 Energy Eﬃciency in Hospitals

2.7: Energy Eﬃciency and Conservation in Kenya (Energy-Act-2019)

Energy Eﬃciency in Hospitals Page 21

Page 22 Energy Eﬃciency in Hospitals

Page 24 Energy Eﬃciency in Hospitals

Energy Eﬃciency in Hospitals Page 25

Page 26 Energy Eﬃciency in Hospitals

Energy Eﬃciency in Hospitals Page 27

Page 28 Energy Eﬃciency in Hospitals

Energy Eﬃciency in Hospitals Page 29

Page 30 Energy Eﬃciency in Hospitals

Energy Eﬃciency in Hospitals Page 31

2.10.1: Building orientation

2.10.2: Building shape, colour and form

Energy Eﬃciency in Hospitals Page 33

2.10.4: Passive design strategies

Page 34 Energy Eﬃciency in Hospitals

2.11.1: Solar and wind for electricity

2.11.2: Geothermal heat pumps for heating and cooling

Energy Eﬃciency in Hospitals Page 35

2.11.3: Biomass for power generation and space heating

Page 36 Energy Eﬃciency in Hospitals

2.12: Building Energy Management Systems (BEMS)

Energy Eﬃciency in Hospitals Page 37