41 th Annual Conference and Technology Exhibition July 25-29, 2004

Presented By: Tom Muratore, Executive Vice President, H2O Applied Technologies Bob Loranger, Director, Facilities, TUFTS-New England Medical Center

Water, Water, Everywhere Source Assessment Treatment Distribution Conservation – Reduce Requirements

Source Assessment Clean – know where your supply comes from Quality – know the chemistry of the water Reliable – city based - non-potable well

Treatment Potable: Chlorine, Chlorine Dioxide, Softener Plant –Boiler –Cooling Tower Hi-Purity – DI/Reverse Osmosis - Central Sterile, OR, Research, Dialysis

Distribution Emergency – Are Plans in Place? Disaster Preparation – Alternate supply, domestic support, hr backup Mitigation Recovery – know how systems will react when water supply comes back

Water Conservation Facility Type Assessment Benchmark Facility Mass Balance Conservation Plan

Water Balance: Hospitals & Research Facilities Sinks Showers Toilets/Urinals Typical Water Saving Opportunity = A 25% Reduction Cooling Towers Boilers/Chillers Food Services (Kitchen) Operating Room Sterile Processing (Autoclaves) Radiology (Film Proc) Analytical Labs Pure Water Systems (RO/Stills) Medical Air/Vacuum Irrigation Domestic: 25% (10 million gals/yr) Non-Domestic: 75% (30 million gals/yr)

Why Water Conservation? Wide range of water-using equipment in hospitals Relatively easy to improve equipment efficiency Excellent savings

What Water Conservation Is NOT “Black Box” Off-the-shelf solution Limited to bathrooms

What Is Water Conservation? Reduce, Reuse, Recycle, Replace –Reduce flow or frequency –Replace with water-efficient models –Reuse once-through water Proven method to reduce operating expenses –Most solutions based on: Simple engineering principles Existing equipment specs/plumbing code Off-the-shelf retrofits

Engineered Products & Systems Non-Domestic Water Reduction Central Sterile Equipment Vacuum Pumps/Air Compressors Radiology Equipment Radiation Oncology Operating Room Equipment Ambulatory Surgery Food Service Area Refrigeration Equipment Bio Reactors Analytical/Lab Equipment Instrument Washers Cage/Cart Washers Laundry Boiler Blowdown Water Reuse Reverse Osmosis Units Stills Water for Injection Air Handling Unit Condensate Domestic Water Reduction Toilets/Urinals Sinks Showers Water Supply/System Use Analysis Cooling Towers Condenser Water Chilled Water Non-Potable Supply Irrigation Steam System

Ways to Reduce Water Usage Reduce Reuse Recycle Replace

Benchmarking H 2 O Applied Technologies has conducted engineering audits at hundreds of Healthcare facilities, resulting in a comprehensive Benchmarking study The study with data from over 250 hospitals was presented at the 39 th Annual ASHE Conference & Technology Exhibition, July 2002 This standard is used to show facilities where their water use should be, based on size and shape, and what opportunities exists to bring them in line with ‘best practices’ in water conservation. This study is available upon request from H 2 O Applied Technologies

Water Use Profile Impact on Best Practice Factors Type of Facility ( Specialty) - Major Teaching with Research - Major Teaching Hospital - City Based General Hospital - Community Based General Regional Weather Impact Local Steam, Chilled Water Demographics

Conservation Opportunities  Domestic –Replace 3.5 gpf with 1.6 gpf in HT Areas –Reduce sink flow –Repair leaky fixtures –Waterless Urinals –Replace old shower heads  Process Equipment –Replace water cooled equipment –Use alternate source of water for cooling –Recover waste water and reuse –Make water using equipment more efficient

Conservation Opportunities  Plant Operations –Install non-potable well –Reuse CT/Boiler Blowdown –Zero Landscaping –Recover condensate and reuse –Eliminate water-cooled equipment  Reduce Consumption by 30% –Benchmark –Set Goal –Develop WCM Plan –Implement Plan

Why Water Conservation? Wide range of water-using equipment in hospitals Relatively easy to improve equipment efficiency Excellent savings

Facility Manager’s Perspective Motivation -- what is our incentive? Understanding -- where is water used? Who cares? Who has the time? Where do we get the funds to implement?

Facility Manager’s Perspective: Motivation A painless way to reduce usage and costs -- no staff reductions -- no reduction in material/service Sustainable Savings Third party can do the work – Facility Manager can take the credit No need to divert staff from more important things

Facility Manager’s Perspective: Understanding: Where is the Opportunity?  The “no brainers” showers, toilets, faucets - been there, done that  Toilets, etc don’t excite the CFO  Process equipment Who controls the equipment? How can we effect change? No matter what your location, water rates are increasing and supplies becoming an issue

Facility Manager’s Perspective: Who Cares? Answer: No one. New Question: How do we get the CFO to care? New Answer: 40% ROI or operating expense reduction without a capital investment

Facility Manager’s Perspective: Who has the Time? My staff is too busy complying with the new Environment of Care standards and continuing operations. Exactly. Let someone else do the work (corollary: it’s ok to let other people make money if your facility benefits, too)

Facility Manager’s Perspective: Where Do We Get the Funds? Capital Dollars are scarce and must compete against program Operating budgets are getting cut Off-balance sheet financing (i.e. pay back installed conservation measures from savings)

Creative NEW Funding Approach  Utility Expense Reduction Program  Requires NO Capital  Treated as an Operating Expense  5-Year Program  Savings Fund Program  M&V Every Year

Questions and Answers  Call Tom Muratore,   Benchmarking Study on “Water Usage” available upon request