Civista Medical Center

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2006-2007 Thesis Presentation

• Civista Medical Center
• La Plata, MD

Thad Maugle Construction Management
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Presentation Outline

• Project Overview
• Infection Control Risk Assessment
• Technical Analyses
• Mechanical Steam Turbine vs. PRV
• Electrical Aluminum vs. Copper Conductors
• Acknowledgement
• Questions / Comments

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Project Overview

• Location La Plata, MD
• Building Occupant Civista Health, Inc.
• Scope
• Addition 122,864 SF
• Renovations 36,303 SF
• Occupancy Function
• Institutional I-2
• Medical Care
• Size 159,167 SF of total construction
• Number of stories above grade / total levels 4
  / 4
• Dates of Construction 12/1/04 - 8/1/07 (33
  months)
• Total Project Cost 43,941,344
• Project Delivery Method CM _at_ Risk w/ GMP

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Project Overview (contd)

• Existing Site Conditions
• Foundation
• Augered CIP Concrete piles
• Structure
• Elevated CIP Concrete
• Building Envelope
• Precast Stone Masonry Units w/ Modular Face Brick

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Project Overview (contd)

• Mechanical System
• Electrical System
• 480/277V Lighting, Major Mech. Equip., Building
  Equip.
• 208/120V Lighting, Small Mech. Equip., Small
  Building Equip.
• Building Service 15 kV service

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Infection Control Risk Assessment

• Problem
• Civista requires an ICRA plan that is properly
  sequenced.
• Goal
• Formulate an ICRA plan unique to Civista
• Sequence an area of renovations
• Analysis Techniques
• Overview of ICRA
• Formulate ICRA plan for Civista renovation

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Background

• Infection Control Risk Assessment (ICRA)
• A strategic plan intended to identify and
  alleviate potential risks associated with the air
  quality environment during the construction phase
  of a project
• Interim Life Safety Measures (ILSM)
• A series of actions required to be taken to
  temporarily compensate for hazards posed by
  existing Life Safety Code deficiencies or
  construction activities, allowing for safe
  execution of the ICRA.
• American Institute of Architects (AIA) Guidelines
  for Design and Construction of Healthcare
  Facilities
• Introduced ICRA in 2001
• Joint Commission for Accreditation of Health Care
  Organizations (JCAHO)
• Mandated ICRA in 2001

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Implications of ICRA

• Owner
• Responsible for budget and ICRA completion prior
  to the commencement of work
• Construction Management Team
• Preconstruction planning and implementation of
  the infection control measures
• Monitoring, documentation, and quality control
• Trade Contractors
• Abide by the provided infection control measures
• Monetary penalties may result otherwise

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ICRA Analysis

• Step 1
• Identify Type of Construction Project Activity
  (Type A-D)
• Step 2
• Identify the Patient Risk Group

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ICRA Analysis

• Step 3
• Match the Patient Risk Group with the planned
  Construction Project Type to find the Class of
  Precautions or level of infection control
  activities required.

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Suggested Infection Control Actions

• Dust proof plastic barrier with door and frame to
  be installed. Contains demo debris and dust, and
  protects patients
• Air vents inside the work area will be sealed
  with plastic sheeting
• Dust mats to be placed at entrances and exits of
  work areas
• Negative air pressure to be maintained within
  work area utilizing HEPA equipped air filtration
  units
• Construction debris to be transported in tightly
  covered containers
• Inside work area to be completely cleaned prior
  to removal of plastic barrier
• After removal of plastic barrier, area to be
  cleaned again with disinfectant
• All staff in the area to be briefed prior to the
  commencement of work

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Suggested Interim Life Safety Measures

• Forms submitted and approved.
• Fire door exits to be maintained for clear access
  at all times.
• Hospitals existing life safety systems not to be
  interrupted.
• Additional fire fighting equipment to be
  available.
• Staff to be briefed prior to the commencement of
  work.
• Install dust proof plastic barriers to contain
  demo debris and protect occupants
• Properly cover loads of debris
• Clean interior area enclosed by barriers
• Remove temporary barriers upon completion
• Clean and disinfect entire area upon removal of
  temporary barriers

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Additional ICRA Provisions Unique to Civista
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Decision Tree

• Invasive Work
• Layout work plan
• Use containment
• Shield patients visitors
• Use dust mats
• Signage as needed
• Cover trash during removal
• Type of Containment
• 1-14 days Plastic Wall
• Affecting existing utilities?
• Plan outages

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Wall Mount Configuration

• Minimizes number of wall penetrations by running
  cable and wiring down from the ceilings instead
  of through the walls

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Outage Request Forms

• Existing utilities and systems will be affected
• (Ex.) Sheaves and belts on Air Handling Unit
  (AHU) 7 need replaced and upgraded
• Affects occupied space being renovated
• Requires schedule and approved system outage
• Isolate areas - ventilation temporarily out of
  service
• Highly sensitive at-risk patients may need to be
  moved to a more stable environment for the time
  being.

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2nd Floor East Wing Sequencing

• Risk Type
• C work generates moderate to high levels of
  dust
• Patient Type
• Highest Risk
• Description
• Additional Plumbing and sprinkler piping required
  above ceilings in patient rooms of the 2nd floor
• Sequencing will involve two rooms at a time

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2nd Floor East Wing Sequencing - (1)

• Sequence 1, 2, 3, 6, 7, 8
• General Trades
• Remove furniture
• Construct plastic dust barrier
• Install floor protection
• Install HEPA filters in both rooms
• Cut drywall for tie-ins
• Lay out piping on ceilings
• Cut drywall ceiling for piping
• Cut drywall ceiling in toilet room for
  sprinkler piping and head
• Remove drywall debris
• Plumbing Contractor
• Lay out piping on ceilings
• Core drill roof
• Install hangers and piping
• Perform pipe testing
• Sprinkler Contractor
• Install hangers and piping

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2nd Floor East Wing Sequencing (2)

• Sequence 1, 2, 3, 6, 7, 8
• General Trades
• Remove furniture
• Construct plastic dust barrier
• Install floor protection
• Install HEPA filters in both rooms
• Cut drywall for tie-ins
• Lay out piping on ceilings
• Cut drywall ceiling for piping
• Cut drywall ceiling in toilet room for
  sprinkler piping and head
• Remove drywall debris
• Plumbing Contractor
• Lay out piping on ceilings
• Core drill roof
• Install hangers and piping
• Perform pipe testing
• Sprinkler Contractor
• Install hangers and piping

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2nd Floor East Wing Sequencing (3)

• Sequence 1, 2, 3, 6, 7, 8
• General Trades
• Remove furniture
• Construct plastic dust barrier
• Install floor protection
• Install HEPA filters in both rooms
• Cut drywall for tie-ins
• Lay out piping on ceilings
• Cut drywall ceiling for piping
• Cut drywall ceiling in toilet room for
  sprinkler piping and head
• Remove drywall debris
• Plumbing Contractor
• Lay out piping on ceilings
• Core drill roof
• Install hangers and piping
• Perform pipe testing
• Sprinkler Contractor
• Install hangers and piping

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2nd Floor East Wing Sequencing (4)

• Sequence 4 5
• Can be accomplished after normal hours
  without disturbance to staff
• General Trades
• Remove supplies from the supply room
• Construct plastic dust barrier
• Install floor protection
• Install HEPA filters in both rooms
• Demo drywall ceiling in the supply room
• Remove drywall debris
• Install plastic covering on the walls and
  floors in rooms to be worked that night
• Remove ceiling tiles as required
• Plumbing Contractor
• Lay out piping on ceilings
• Core drill roof
• Install hangers and piping
• Perform pipe testing
• Sprinkler Contractor
• Install hangers and piping
• Install sprinkler heads

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2nd Floor East Wing Sequencing (5)

• Sequence 4 5
• Can be accomplished after normal hours
  without disturbance to staff
• General Trades
• Remove supplies from the supply room
• Construct plastic dust barrier
• Install floor protection
• Install HEPA filters in both rooms
• Demo drywall ceiling in the supply room
• Remove drywall debris
• Install plastic covering on the walls and
  floors in rooms to be worked that night
• Remove ceiling tiles as required
• Plumbing Contractor
• Lay out piping on ceilings
• Core drill roof
• Install hangers and piping
• Perform pipe testing
• Sprinkler Contractor
• Install hangers and piping
• Install sprinkler heads

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2nd Floor East Wing Sequencing (6)

• Sequence 1, 2, 3, 6, 7, 8
• General Trades
• Remove furniture
• Construct plastic dust barrier
• Install floor protection
• Install HEPA filters in both rooms
• Cut drywall for tie-ins
• Lay out piping on ceilings
• Cut drywall ceiling for piping
• Cut drywall ceiling in toilet room for
  sprinkler piping and head
• Remove drywall debris
• Plumbing Contractor
• Lay out piping on ceilings
• Core drill roof
• Install hangers and piping
• Perform pipe testing
• Sprinkler Contractor
• Install hangers and piping

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2nd Floor East Wing Sequencing (7)

• Sequence 1, 2, 3, 6, 7, 8
• General Trades
• Remove furniture
• Construct plastic dust barrier
• Install floor protection
• Install HEPA filters in both rooms
• Cut drywall for tie-ins
• Lay out piping on ceilings
• Cut drywall ceiling for piping
• Cut drywall ceiling in toilet room for
  sprinkler piping and head
• Remove drywall debris
• Plumbing Contractor
• Lay out piping on ceilings
• Core drill roof
• Install hangers and piping
• Perform pipe testing
• Sprinkler Contractor
• Install hangers and piping

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2nd Floor East Wing Sequencing (8)

• Sequence 1, 2, 3, 6, 7, 8
• General Trades
• Remove furniture
• Construct plastic dust barrier
• Install floor protection
• Install HEPA filters in both rooms
• Cut drywall for tie-ins
• Lay out piping on ceilings
• Cut drywall ceiling for piping
• Cut drywall ceiling in toilet room for
  sprinkler piping and head
• Remove drywall debris
• Plumbing Contractor
• Lay out piping on ceilings
• Core drill roof
• Install hangers and piping
• Perform pipe testing
• Sprinkler Contractor
• Install hangers and piping

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Steam Turbine vs. PRV

• Problem
• Pressure Reducing Valve (PRV) used to reduce
  steam pressure.
• Goal
• Redesign pressure reducing equipment from PVR to
  non-condensing backpressure steam turbine.
• Analysis Techniques
• Overview of steam turbine system
• Size equipment
• Conduct energy analysis
• Conduct cost analysis

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Non-Condensing Backpressure Steam Turbine

• Non-condensing (backpressure)
• Operates above or in excess
• of atmospheric pressure
• Used where low steam loads are required
• Steam passes over turbine blades, spins turbine
  blade shaft which directly connected to an
  electrical generator, generates electricity
• Low efficiencies (15-35)

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Sizing the Steam Turbine

• Given Variables
• Inlet Pressure (Pi) 60 psig 14.7 atm pressure
  74.7
• Outlet Pressure (Po) 10 psig 14.7 atm
  pressure 24.7
• Total Capacity (m) 3590 lb/hr
• Temperature of Steam (T1) est. 300oF (227oF to
  307oF)
• Efficiency Rate (n) est. 20 (15 to 35)
• Find Power Rate
• Q m h

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Sizing the Steam Turbine (contd)

• Find Enthalpy Using Steam Tables
• hi 269.8 BTU/lb
• ho 1190 BTU/lb
• h ho hi 920.5 BTU/lb
• Q m h 3,635,975 BTU/hr
• Factor in Efficiency
• Q x n 3,635,975 BTU/hr x 0.20 727,197 BTU/hr
• Convert to kW
• 727,197 BTU/hr x (1 kW) / (3412 BTU)
  213.13 kW
• Equipment can now be sized according to kW
  output

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Cost and Energy Analysis

• Impractical to operate at full capacity
• Assumed
• 40 max capacity during Summer months (Jun
  Oct) 85.25 kW
• 60 max capacity during Winter
• months (Nov May) 127.88 kW
• Chart would be most useful in the presence of
  steam charts

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Cost and Energy Comparison
w/ Pressure Reducing Valve
w/ Steam Turbine

• 5,044,064 kWh consumed
• 491,575.76

• 5,759,158 kWh consumed
• 508,907.24

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Cost and Energy Comparison

• Steam Turbine estimated performance over 9 month
  period
• Saves over 17,000
• Saves over 715,000 kWh
• Cycle produces no emissions
• Could be greater savings based on actual
  efficiency of equipment and actual capacity used.

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Aluminum vs. Copper Conductors

• Problem
• Civista wired with copper.
• Reliable but expensive.
• Goal
• Redesign copper feeders with Aluminum Alloy
  (AA-8000 series) alternative.
• Analysis Techniques
• Compare material properties
• Resize feeders and conduit
• Conduct cost analysis
• Conduct schedule comparison

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Background

• Copper shortage 1965
• Aluminum was a cheaper alternative
• Steel receptacle screws replaced brass
• Aluminum to steel connection far more sensitive
  than copper to brass
• Thermal expansion and creep
• Oxidation Resistance - hot
• Corrosion
• Faulty connections, even fires resulted
• No contractor wants to take the risk

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Material Composition

• Previous Aluminum Classifications
• AA-1350
• EC (Electrical Conductor) aluminum
• 99.5 pure aluminum
• Current Aluminum Alloy Classification
• AA-8000 series
• 0.001 to 0.3 zinc
• 0.001 to 0.03 titanium
• 0.001 to 0.5 manganese
• 0.03 to 0.4 silicon
• Combination yields excellent strength
  resistance to corrosion

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Problems / Solutions

• Improper Installation
• Use appropriate tools (i.e. stripping wire)
• Wrap wire in a clockwise manner (i.e. tightens
  while being screwed in placed)
• Sufficiently tightened (i.e. adequate contact
  area at the connection)
• Oxidation / Corrosion
• AA-8000 series - thermal expansion and creep
  similar to copper
• Proper tightening
• Oxide inhibitor

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Cost and Schedule Comparison

• Saves over 8,000 in conductor and conduit costs
  of feeders
• Saves 4 days in construction time
• Savings would be greater when including branch
  circuits

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Acknowledgements

• AE Faculty
• Dr. Michael Horman
• Dr. James D. Freihaut
• Professor Richard Mistrick
• Professor Kevin Parfitt
• Industry Contacts
• Ben Alexander - Gilbane Building Co.
• Greg Dunkle - Gilbane Building Co.
• Mike DuLaney - Gilbane Building Co.
• Melanie Townsend - Gilbane Building Co.
• Dan Kerr - McClure Company
• Gary Hall - Civista Health, Inc.
• Fellow AE Students
• Alexis Kreft
• David Potchek
• Andrew Rhodes

...and most importantly, family and friends
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Questions ???