WATER, WATER, EVERYWHERE:

41th 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, 18-24 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 TowersBoilers/ChillersFood Services (Kitchen)Operating Room Sterile Processing (Autoclaves) Radiology (Film Proc) Analytical LabsPure Water Systems (RO/Stills)Medical Air/VacuumIrrigation

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 & SystemsNon-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

• H2O 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 39th 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 H2O 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

Benchmarking Data - Water Usage Analysis- H 2 O Applied TechnologiesActual Data - On-site Engineering Evaluations Revised : April 29, 2002Major Teaching General Hospitals

Facility AV AW AX AY AZBED SORT AVERAGE

City / State Nashville, TN Burlington, VT Ft. Worth, TX Hartford, CT Phoenix, AZ

Number of Beds 510 510 508 504 475 501

Staff FTEs 2,962 3,784 3,009 2,567 3,500 3,164

Outpatient Visits 321,460 397,613 209,341 260,454 285,000 294,774

Medical Research x

Water Usage (Gals/yr) 100,000,000 105,000,000 140,000,000 115,750,000 130,000,000 118,150,000

Year-round Cooling x x x x

Seasonal Cooling x

Number of Sterilizers 15 14 13 13 22 15

Water - Cooled Vac/Air #skids 4 4 4 4 0 3

Potential Audit Savings Gals/yr 18,400,000 42,000,000 18,800,000

Percent of Potential Audit Savings 18% 30% 14%

Best Practice Achieved Savings Gals/yr 19,100,000 28,333,240

Percent of Achieved Savings 18% 24%

Water Usage - Gals. Per Bed/yr. 196,078 205,882 275,591 229,663 273,684 236,180

*percents rounded to the nearest whole

Benchmarking Data - Water Usage Analysis- H 2 O Applied TechnologiesActual Data - On-site Engineering Evaluations Revised : April 29, 2002Major Teaching General Hospitals

Facility BF BG BH BI BJBED SORT AVERAGE

City / State Bay Pines, FL Crozer, PA New Brunswick, NJ Portland, ME Pittsburgh, PA

Number of Beds 453 450 445 435 420 441

Staff FTEs 2,130 2,345 2,918 3,200 4,780 3,075


Medical Research


Year-round Cooling x

Seasonal Cooling x x x x



Potential Audit Savings Gals/yr 21,000,000 8,700,000

Percent of Potential Audit Savings 22% 15%

Best Practice Achieved Savings Gals/yr 19,100,000 14,790,000 22,000,000

Percent of Achieved Savings 14% 18% 29%



Benchmarking Data - Water Usage Analysis- H 2 O Applied TechnologiesActual Data - On-site Engineering Evaluations Revised : April 29, 2002GENERAL HOSPITALS COMMUNITY BASED

Facility FP FQ FR FS FTBED SORT AVERAGE

City / State Stamford, CT Lakewood, NJ Pittsburgh, PA Atlanta, GA St. Petersburg, FL

Number of Beds 300 293 292 291 288 293

Staff FTEs 1,416 1,106 1,280 1,888 986 1,335


Medical Research


Year-round Cooling x x

Seasonal Cooling x x










Facility GY GZ HA HB HCBED SORT AVERAGE

City / State Cleveland, OH Providence, RI Hyannis, MA Cape Coral, FL Kittanning, PA

Number of Beds 219 216 214 212 210 214

Staff FTEs 987 1,271 1,339 1,057 793 1,089


Medical Research













Facility IK IL IM IN IOBED SORT AVERAGE

City / State Everett, MA Atlanta, GA Middlesex, CT Melrose, MA Laurel, MD

Number of Beds 145 140 136 135 133 138

Staff FTEs 856 283 1,362 1,011 606 824


Medical Research






Potential Audit Savings Gals/yr 3,750,000 6,000,000

Percent of Potential Audit Savings 15% 18%

Best Practice Achieved Savings Gals/yr 5,800,000 6,300,000 6,100,000

Percent of Achieved Savings 20% 23% 21%



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 oroperating 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, 617-574-1192

E-mail [email protected]

Benchmarking Study on “Water Usage”

available upon request

WATER, WATER, EVERYWHERE:

Documents

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