Hospitals, being resource-intensive establishments, consume vast amounts of natural resources including electricity, water, food and construction materials to provide high-quality healthcare while ensuring hygiene. However, by deploying simple, smart and sustainable measures hospital can greatly reduce their carbon footprint. We call this concept Green Hospitals. The article talks about the various measures, challenges, and solutions to make greener and sustainable hospitals for the betterment of humanity.
The deteriorating health of our planet is an issue of international concern and has a direct impact on human health. Healthcare industry uses modern medications, equipment and sophisticated technologies for the treatment, but through resourceintensive processes.
Healthcare sector consumes a large number of resources, energy-intensive equipment and generates an array of wastes which has a direct impact on human health. In India, it is estimated that the commercial sector, which includes the healthcare sector, consumes 7.58 per cent of the total electricity and generates approximately 1.48 million tons of healthcare waste per year according to the Central Pollution Control Board (CPCB) of India.
According to an American journal,"The health sector is one of the most trusted and respected sections of society, and it is also one of the largest employers and consumers of energy. This presents both: a duty and a window of opportunity to achieve climate-neutrality, efficiency and cost reduction all at the same time".
This vision can be achieved by improving the hospital design, minimising the waste and its disposal, using natural light and ventilation as much as possible, using inverter-based air conditioners and ventilation system (HVAC).
The United States Environmental Protection Agency defines a green building as, "the practice of creating structures and using processes that are environmentally responsible and resource-efficient throughout a building's life-cycle from siting to design, construction, operation, maintenance, renovation, and deconstruction. This practice expands and complements the classical building design concerns of economy, utility, durability, and comfort. Green building is also known as a sustainable or highperformance building"
According to the Indian Green Building Council, a green hospital building can be defined as one which enhances patient well being, aids the curative process, while utilising natural resources in an efficient, environmentfriendly manner.
In India, we have a BEE (Bureau of Energy Efficiency) which works towards saving natural energy resources. The Confederation of Indian Industry (CII) established the Indian Green Building Council (IGBC) in the year 2001 to promote the concept of sustainable green buildings.
The role of IGBC includes developing new rating systems, certifications, conducting training programs. IGBC is licensed by US Green Building Council to provide LEED Certifications in India (Leadership in Energy and Environment Design)
Similar to LEED, there are other building rating systems which have been developed globally and are followed in different countries
• LEED- Leadership in Energy and Environmental Design (United States, Canada, China, and India), BREEAM-Building Research Establishment Environmental Assessment Methods (UK and Netherlands)
• Green Star (Australia, New Zealand, and South Africa),
• CASBEE -ComprehensiveAssessment System for Building Environmental Efficiency (Japan)
• Green Mark Scheme (Singapore)
Talking about the one followed in India, Leadership in Energy and Environment Design or LEED ratings are classified into four categories: LEED-certified, Silver, Gold, and Platinum.
Platinum is the highest rating and some of the factors behind this classifications are sustainable site development, water savings, energy efficiency, material selection, and indoor environment quality.
In the Indian context, Kohinoor Hospital in Mumbai is the first hospital in Asia and second in the world to achieve LEED platinum certification under Indian Green Building Council.
Since Hospitals are required to run all the time, some of the factors are studied which pose complexities to change it to Green Hospitals like:
• All-time back up required for emergencies
• All hours are operational hours with no shutdown
• Protocols to control infections counters sustainability.
• High Air Changes per hours to prevent contamination
• High requirement of Energy & water as compared to other buildings
• High waste generated per bed
• Constant renovations inside the building to upgrade machinery.
Since a hospital operates 365 days-ayear, 24/7, it needs heating, ventilation, and air conditioning (HVAC) systems to maintain the standards of care. This consumes 40 to 60 per cent of the total energy. Also, significant energy is used for heating water, temperature and humidity controls for indoor air, lighting, ventilation and numerous medical processes which have greenhouse gas emissions. Without any compromise on the quality of care.
Small steps such as switching to compact fluorescent and lightemitting diode (LED) light bulbs, using optimum temperature for the HVAC system, using energy-efficient products, reducing the stand-by time of the medical equipment, and certain retrofit measures as suggested by Energy Consultants can bring in positive change. Also, we all have observed slogans, posters on the walls which can also lead to a big impact. An energy audit can also help in saving millions by detecting leakages in HVAC Systems and checking the efficiency of motors and compressors of electrical equipment.
Greener source for creating energy
In India, most of the electricity is generated from coal, which has a direct impact on increasing carbon footprints, and the same goes for hospitals due to their heavy electricity requirement. Furnace oil, or liquified petroleum gas (LPG) is used to generate steam for processes such catering, and laundry. For backup, diesel-powered generators are used to get an uninterrupted supply of power.
This can be resolved by using natural and renewable sources of such as solar, wind, and geo-thermal. Since it requires engineering, high construction and operating costs but in case of small sections, work can be done by solar energy like to sterilize medical equipment, sanitize the hospital's laundry, heat water for baths.
Reduce waste management
In India, most of the clinics, hospitals, and healthcare facilities do not have the infrastructure for waste management, and most of waste goes directly to the open, and then into ground water. This becomes even more critical as 10 to 15 per cent of the waste is toxic and harmful for all the handlers and environment. Releasing this waste openly in the environment allows transmission diseases to flourish which impacts the health of human beings.
This can be resolved by minimising waste through composting, recycling, and disposing of it the right way. Here, we all need a behavioural change in better purchasing (minimising packaging, using reusable rather than disposable products, and buying recycled products).
Also, plastic which is the main source of pollution, must be disinfected first before the landfill. A hospital in Asia has done wonderfully well by developing a compost system which will naturally create bio-methane and change it to bio-natural gas which is then used to power the hospital and water purification systems.
Since hospitals run throughout the year, green hospitals work towards bringing the electricity load down. This is possible by using light sensors in the passage or washrooms and other areas which can detect occupancy and installing low-energy LED lights. Also, the architecture should work to bring in maximum natural daylight to reduce the load.
Since hospitals have a huge water requirement, they must have a rain harvesting system in place and sewage treatment to recycle water for non-drinking use. The recycled water can be used for irrigation, cleaning activities, etc. In India, lots of healthcare facilities are using these approaches but we need to build at scale.
This is one of the most vital components of any green building. Cities are suffering from poor quality air due to rising pollution, meaning a green hospital must have provision for better indoor air. This can be achieved by indoor plants, natural air purifiers, etc. Since the hospital area is exposed to so many pathogens and bacteria, it becomes vital to have a ventilation system and a well-designed cleanroom to continuously provide fresh and filtered air.
Research has proved that a welldesigned green building can accelerate the healing process. Hence, consultants consultants and designers are working in the direction to employ green strategies to have a positive impact on patients. Due to this, a green hospital has various attributes such as better indoor air quality, 20-40 per cent energy saving, 35-40 per cent water saving, good day lightning, no sick building symptoms, comfortable temperature and humidity control for faster recovery.