1. Water Audits and Best Management Practice Life Cycle Cost Analyses for Army Medical and Health Care Facilities Presented By: Lisa Raysby Hardcastle, P.E. and CPT Katherine Kinder Tuesday, 02 June 2009

2. Agenda Regulatory Drivers Background Conduct Water Audit Identify Best Management Practices (BMPs) Life Cycle Cost Analyses (LCCAs) Leadership in Energy and Environmental Design (LEED) Credit Lessons Learned Potential Road Blocks and Opportunities

3. Regulatory Drivers Executive Order (EO) 13423: “Strengthening Federal Environmental, Energy, and Transportation Management” – Beginning in FY 2008, reduce water consumption intensity, relative to the baseline of FY 2007 through life cycle cost- effective measures by 2 percent annually through the end of FY 2015 or by 16 percent by the end of FY 2015 Energy Independence and Security Act (EISA) – EISA requires the completion of a comprehensive energy and water evaluation (including re-retrocommissioning) of 25% of covered facilities each year so that an evaluation of each such facility is completed at least once every four years.

4. Background US Army MEDCOM wanted protocol developed for water conservation at hospitals – MEDCOM sustainability (“green health”) initiatives Why? – Hospital are generally large water consumers CHPPM-West took the initiative to develop the protocol and the first Water Management Program (WMP) plan for an Army hospital Madigan Army Medical Center chosen as the model facility

5. Conduct Water Audit Data collection Conduct on-site assessment Evaluate Best Management Practices (BMPs) Conduct Life-Cycle Cost Analysis (LCCA) Identify water conservation opportunities Develop Water Management Program (WMP) Plan

6. Data Collection Conducted during the preparatory and on- site assessment portion Most time consuming portion of the water audit Obtained from multiple sources Some gathered information was conflicting or erroneous and had to be verified and recorded during on-site assessment

7. Conduct On-Site Assessment Verify all data Gather equipment use (“operational”) data Review equipment specs or O&M manuals, if available Record fixture and plumbing types Review state plumbing codes Identify possible opportunities to implement BMPs

8. Best Management Practices (BMPs) 1 - WMP 2 - Information and Education 3 - Distribution 4 - Landscaping 5 - Irrigation 6 - Toilets and Urinals 7 - Faucets and Showers 8 - Boiler/Steam (and Humidifier) Systems 9 - Single-Pass Cooling Equipment 10 - Cooling Towers and Evaporative Coolers 11 - Commercial Kitchens and Restaurant Equipment 12 - Laboratory/Medical Equipment (including Photography and X-Ray) 13 - Other Water Use – Housekeeping – Laundry and Dry Cleaning – Maintenance 14 - Alternative Water Use

9. Generic Hospital Water Use Characteristics

10. Hospital Specific Equipment/Processes Sterilizers Autoclaves Ultrasonic Cleaners X-Ray developers Silver Recovery Units Compressors Laboratory Hood Scrubbers Water Softeners Casting Processes Dental Mold Process Laboratory Commercial Dishwashers Cart Washers Vacuum Waste Systems [New equipment and measures must not degrade the quality of medical care]

11. Life Cycle Cost Analysis (LCCA) Defined: “the sum of present values of investment costs, capital costs, installation costs, energy costs, operating costs, maintenance costs, and disposal costs over the life of the project, product or measure” or “evaluates the total operation and maintenance (O&M) costs of water efficiency options over the life time of the project, not just the initial equipment capital costs”

12. Continued, LCCA Consideration for purchasing new equipment, fixtures, technology should include: – Cost of water and wastewater – Energy cost – Cost of new equipment – Labor costs – Other costs associated with installation – Maintenance costs

13. Continued, LCCA Calculate costs to replace immediately or at “End of Useful Life” Options to simplify analysis at “End of Useful Life” – Look at incremental higher cost – Look at only capital cost if construction is the same Implement BMPs immediately with less than a 10 year payback Consider non-monetary values – EMS sustainability goals – Role model – Community relations *See Handout

14. Easy Wins and Big Ticket Items Easy wins: – Upgrade toilets, urinals, faucets and showers (plumbing) BMPs #6 & 7 – Water efficient landscaping BMP #4 – Leak detection and repair BMP #3 – Information and Education Programs BMP# 2 Big ticket: – Medical Equipment (esp. X-ray to Digital) BMP #12 – Cooling and Heating BMPs #8, 9, & 10 – Alternative water use BMP #14

15. Leadership in Energy and Environmental Design (LEED) Offers up to five LEED water efficiency credits: – Two (2) for reducing potable water use for irrigation – One (1) for reducing potable water use for sewage conveyance – Two (2) for reducing potable water use inside a building

16. Lessons Learned Need leadership to be onboard with water audits and collection of data Medical equipment specifications may not readily provide information on water use Water use may need to be estimated – No meter at facility – No sub-metering of large uses Leave comprehensive LCCA to final product selection and large acquisition projects

17. Potential Road Blocks May have already implemented projects with significant water conservations savings Largest potential water savings may be outside control BMP may not comply with safety and public health standards Existing building construction (space limitations) Funding

18. Potential Opportunities Improved technologies Take into account energy and environmental cost associated with BMPs Coordination with local water utility (or installation for military) Coordination with local energy provider Existing Environmental Management System (EMS)/Sustainability program goals

19. Questions?