From power plants to surgical services, hospitals update their infrastructure
For five years, a crew from Hatzel & Buehler Inc. advanced the massive but meticulous renovation of the Johns Hopkins Hospital North Plant – a power distribution center that supports roughly half of the multi-million-square-foot hospital campus.
The critical work at Johns Hopkins meant the renovation had to be designed to include the minimum number of outages and never do anything that could compromise life safety. Existing power equipment would have to remain in place and operational until new systems were powered up. The plant, however, had virtually no free space to accommodate installations.
“We had to be really creative with the manufacturer to obtain equipment,” said James Sauter, Project Manager.
The project team carefully selected and customized equipment so that a piece could be delivered, installed and powered up. Then, the equipment it replaced would be removed.
“We had to work in phases and replace one piece at a time in order to keep the customer’s service on. We worked really hard to reduce the duration of outages,” Sauter said. That effort produced “a really, really nice product at the end of the day. It’s very clean, it’s code compliant and they ended up with more space due to sizing of equipment, so the plant is more usable.”
The Baltimore-Washington corridor enjoys an abundance of outstanding healthcare institutions. That legacy, however, comes with a huge and challenging building stock, including historic buildings, repeatedly renovated facilities, state-of-the-art centers and an abundance of buildings that need to keep evolving to support modern medical technologies and new standards of care.
Delivering those capabilities requires contractors to execute demanding, specialized and innovative renovations while supporting ongoing operations. After a lull in contracting during the pandemic, healthcare facilities are moving forward with numerous renovations, including improved patient care areas, updated laboratories, installation of new technologies and updates on facilities ranging from cafeterias to pediatric wings to morgues.
At MacKenzie Contracting Company, healthcare projects account for 50-60 percent of annual revenues. Recent projects have included several breast cancer centers, laboratories, pharmacy renovations, more attractive patient rooms and public areas, and one Covid-inspired design change.
“One trend we have repeatedly seen is ‘back of the house circulation’ for medical staff,” said Marty Copsey, President and Chief Operating Officer. Whereas previous medical facilities would have healthcare providers and patients walking the same hallways, “the new layouts we are seeing have a front-of-house corridor for patient uses and a back-of-house corridor for staff… This has been driven by Covid to limit exposure of staff to patients.”
Some renovations involve highly specialized systems.
Inside the Greater Baltimore Medical Center (GBMC), Plano-Coudon Construction has been working since September 2021 to renovate the central sterile processing facility. Surrounded by operating rooms, the facility continuously collects, cleans, sterilizes and repackages surgical instruments.
The renovation, understandably, required stringent Infection Control Risk Assessment (ICRA) measures, negative air machines, tight barriers and other initiatives to prevent any contamination of the hospital space. The Plano-Coudon team had to coordinate with hospital staff to avoid impacting medical work, gain access to infrastructure that served the sterilization facility and ensure that new installations would not clash with existing systems. But the construction crew also had to enable 24/7 sterilization to continue.
“Because this is specialized sterilizing equipment, it couldn’t just be moved and operated elsewhere,” said Merissa Detwiler, Senior Project Manager. Consequently, “the hospital rented two sterilizer trailers and set them outside to keep the process going… It was a unique challenge to work with that vendor, make sure all the correct utilities were run to the trailers, and build a separate corridor that creates a clean, conditioned environment between the hospital and the trailer setup.”
At the same time, hospitals are embarking on a string of infrastructure improvements. At Johns Hopkins Hospital campus, infrastructure work is sufficiently ample that both Hatzel & Buehler and Denver-Elek have permanently posted employees to the site.
Like the North Plant project, most infrastructure upgrades present contractors with major space constraints. On top of the requirement that new systems be installed before old equipment is removed, available space for electrical and mechanical gear is typically smaller than the space in modern buildings and the corridors leading to that space are often tight.
“Where we would bring in one large piece of equipment in normal conditions, we might have it manufactured in nine separate pieces, assemble it onsite and have a manufacturer’s representative come out to recertify it,” Sauter said.
“It takes a lot of thought and planning by the foremen and supervisors to come up with a workable plan for an installation,” said Stephen Karminski, Project Manager at Denver-Elek. “For projects in some of the older buildings, we have taken graph paper and cut out pieces of equipment to scale then walked around the building to see if we could get those pieces down the corridors and around the corners.”
Those tight spaces also complicate contractors’ prefabrication plans.
“On the one hand, we are trying to prefabricate as much as possible to reduce our time and our storage needs onsite. On the other, we are cutting things down to make them fit,” Karminski said. “It takes a lot to figure out what kind of magic will work in each space.”
Project teams working in older healthcare buildings often encounter unexpected infrastructure issues – equipment that is malfunctioning or nearing its end of life, piping installations that differ from as-built drawings and electrical or mechanical systems that service unexpected areas. Those discoveries prompt changes in project plans. They have also prompted some contractors, including Denver-Elek and Hatzel & Buehler, to offer a proactive service, namely alerting clients to upcoming maintenance or equipment-replacement needs.
“We will evaluate areas that we work in and provide clients with reports of our findings and recommendations,” Sauter said. “Certain types of equipment may have a manufacturing lead time of 54 weeks which isn’t out of the ordinary right now. If we see equipment that should be replaced within that duration or shortly afterward, we will recommend the client start thinking about replacing it now. It could function fine for the next year and a half, but if it fails, you could be without service for more than a year. We want to get in front of that issue.”
Some healthcare clients are also creating provisions within existing projects to address neglected or looming infrastructure issues.
“As we complete demolition in an area, hospital facilities staff will survey the space to identify old piping or piping that is no longer in use,” Detwiler said. “While we have everything opened up, they will decide what they want removed or replaced, and that is covered under an allowance in the contract.”