Guided by

Green
Small, Rural Hospital Uses
LEED Alternative for Sustainable
Design Guidelines

BY STEPHANIE THUM
P R O J E C T D ATA
Facility Name: Jefferson County Health Center
Number of patient rooms: 25
Building Area: 115,000 square feet
Land Area: 35.5 acres
Construction Costs: $24.7 million
General Contractor: Carl A. Nelson & Co.

8 H E A LT H C A R E C O N S T R U C T I O N & O P E R AT I O N S — J U LY / A U G U S T 2 0 0 9
 FACILITY OF THE MONTH

planners sat down to design the new Jefferson

When County Health Center in Fairfield, Iowa, they

started with a unique repertoire of tools and
direction.
The 115,000 square-foot, $25 million replace-
ment facility for the existing 25-bed acute care hospital needed to make
the most of its rural attributes while ascribing to the Green Guide for
Health Care — a best practices guide for healthy and sustainable building
design, construction and operations.

The Rural Angle

One of first challenges for project architect HGA Inc., of Minneapolis,
was to remain mindful of the size of the facility and the range of conditions
that bring patients to the hospital. As a critical access facility, JCHC pools
its resources with nine other rural facilities in Iowa to create efficiencies
and cost savings. Flexibility in the design was critical.
“The finest asset of the new hospital is its functionality,”
says Deb Cardin, CEO of JCHC.
PROJECT TEAM In the inpatient areas, nursing pods located outside of every
Chief Administrator: Deb Cardin other room contain linens, supplies, medication and a comput-
Architect: HGA Inc. er. Two observation rooms that sit next to each other are acu-
Construction Manager: Carl A. Nelson & Co. ity-adaptable to better serve patient needs.
General Contractor: Carl A. Nelson & Co.
From a caregiver’s perspective, the placement of the nurs-
ing pods in close proximity to patient rooms means nurses can
stay closer to the patient’s bedside, Cardin says. There is also a
lift system in every room and a patient call light system eliminates the
need for an audible paging system.
Lighting and landscaping also factored into the design, which inter-
plays with the qualities of the hospital’s rural locale. Because the Green
Guide encourages designers to steer away from up-lighting to avoid light
pollution, particularly in rural areas, architects selected and placed fix-
tures that would not affect the surrounding environment.
“The more rural the hospital, the more stringent the criteria for light
pollution,” says Amy Douma, associate vice president of HGA. “This is
one location where you actually can see night sky.”

“The finest asset of the new

hospital is its functionality.”

When it came time to select landscaping plants, hospital executives

chose fast-growing, native prairie grasses that require no irrigation, which
helped the facility earn Green Guide points. Landscapers planted the
grasses at the beginning of construction to reduce soil erosion and water
run-off while the facility was built.
In a nod to the rural locale, designers positioned windows so visitors
and patients could enjoy views of nearby farms, barns and bicycle paths
as they move through the facility.
HGA, local civil engineering firm French-Reneker Associates Inc. and
the county government collaborated on best ways to protect the natural
landscape and prevent disturbance to natural resources, wetlands and
endangered species during construction.

Following the Green Guide

In addition to embracing the hospital’s rural surroundings, architects
focused on the energy-efficiency principles of the Green Guide.
Designers oriented the building and selected high-performance glass
for the windows to help control heat gain. Rather than having only one
large water retention area, French-Reneker integrated numerous small
retention ponds and rain gardens in parking lot islands to control storm-
water runoff and filter pollutants.
Firestone’s white TPO (thermoplastic polyolefin) membrane — a pop-
ular cool roof material — was used to reduce the heat-island effect and air
conditioning expenses. Designers also chose light colored paving to
reduce the heat island effect.
For the interior, JCHC reused much of the furniture and medical

H E A LT H C A R E C O N S T R U C T I O N & O P E R AT I O N S — J U LY / A U G U S T 2 0 0 9 9
FACILITY OF THE MONTH

LEED Certification vs.

equipment from the existing building. A total replace-
ment would have cost nearly $3 million, says Matt
Lind of Korbel Associates, an equipment consultant
who worked with HGA on the project
“The limitation of the equipment budget was the
primar y factor in driving the decision to reuse, but
some other logistical factors also played a part,”
Lind says. “Most of the fixed equipment was pur-
chased as new so that it could be installed without
significant downtime.”
HGA’s mechanical engineers USGBC
www.usgbc.org
also designed a ventilation monitor-
ing system that ensures the recom- Green Guide for Health Care
mended outdoor airflow rate is www.gghc.org
being achieved at all times. The
building features low-VOC interior HGA
finishes and paints designed to www.hga.com
reduce indoor air pollutants, which
benefits people who have allergies
and chemical sensitivities. Many interior finishes, such way to adjust the old space to accommodate new, state-of-
as carpeting and acoustical ceiling tile, were manufac-
tured with recycled content.
Pressurized entryway vestibules minimize the entry
Green Guide for Health Care
HGA designers worked with hospital executives
early in the planning process to determine if the new
facility should follow the USGBC’s LEED certification
program or the Green Guide for Health Care. The
guides are similar and each has pros and cons.
LEED certification is based on energy and water
usage, among other design techniques, but it
does not specifically address healthcare environ-
ments. It also requires paperwork and a third-
party review to verify compliance, which could
add costs to a project.
The Green Guide integrates healthcare-specific
circumstances and breaks down certification crite-
ria by department. For example, the Green Guide
gives more points than LEED for integrating places
of respite and views of the outside because of the
healing nature of those design elements.
Additionally, the Green Guide is a self-certifying
tool with minimal paperwork. It does not require
program participants to provide documentation
demonstrating that a project has complied with
the program’s requirements.
Hospitals can track their own ongoing perform-
ance using Green Guide criteria. However, because
the Green Guide it is a self-certifying and self-moni-
of contaminants like vehicular exhaust, pesticides, herbi-
toring program, it can become very easy to cut cor-
cides, helipad exhaust and diesel generator fumes.
ners or follow the guide in an imprecise manner.
The Green Guide goes beyond basic LEED in that
Moving Forward
it has a large section on operations, how to handle
As is the case with many replacement hospitals the materials and how to maintain the facility, says
under construction today, JCHC’s former facility was Amy Douma, associate vice president at HGA.
constructed in the 1940s and is located in a land-locked A LEED guidebook for healthcare organizations
residential area, where limited parking and constricted that borrows tenets of the Green Guide is in
space hampered opportunities for growth. development. Douma believes as those guidelines
With service and transform, more clients will be encouraged to pur-
waste trucks making their sue LEED for healthcare organizations because
they will have a guideline tailored to their needs.
way through the vicinity, it
was difficult for the hospi-
tal to be a good neighbor. ramp from a nearby highway, improving wayfinding for
Inside the hospital, semi- drivers. A tower is the tallest element on the site and
private rooms made serves as a focal point for visitors. Once inside, the lay-
patient privacy and family out is simple and patient rooms are now private.
involvement difficult to “This is really a no-nonsense building with no frills,”
achieve. There was no says Dan Rectenwald, principal at HGA. “There is room
for growth and expansion, and the facility allows citi-
the-art amenities. The infrastructure could not support zens to get state-of-the-art care here. They can stay
new technology. closer to home and closer to their families who will be
Now, the new hospital sits just off of a new exit involved in their care.” I

Cafeteria & Kitchen
Custom Stainless Equipment: Servco
Hot food wells: APW Wyott
Hot/cold pans: Delfield
Combi oven: Rational
Accelerated oven: Turbo Chef
Reach-in refrigerator: Victory
Merchandising refrigerator: True
Refrigerated prep table: Randell
Walk-in refrigeration system: RDT
Exhaust hood: Captive Aire
Fire protection: Ansul
Walk-In Coolers/Freezers: American
Panel
Wire/polypropylene shelving: Metro
Hand sink: Krowne
Disposer: Salvajor
Utility cart: Lakeside
Patient tray cart: FEW
Soiled tray cart: Piper/Servolift
Ice maker/dispenser: Hoshizaki
Food mixer: Hobart
Food processor: Robot Coupe
Protector shelf: Brass Smith
P R O D U C T D ATA
Carpet and Flooring
Carpet: Shaw Contract Group
Ceramic Tile: Veranda, Daltile
Sheet Vinyl: Armstrong
Vinyl Composition Tile: Mannington
Commercial, Armstrong
Resilient Rubber Flooring: Johnsonite
Construction Materials
Acoustical Ceilings: Armstrong
Brick/Masonry: Briarwood by Glen-
Gary, Owens Corning Cultured Stone
Cabinets: Siewert Cabinet & Fixture
Manufacturing, Techline
Metal Panels: Firestone Una-Clad
Door Hardware: ACSI, Burns, Hager,
Ilco, H.B. Ives, Norton, Pemko,
Rockwood, Rixson, Securitron, Sentrol,
Trimco, Yale
Metal doors: Ceco, EFCO
Wood doors: Eggers Industries
Glass/Glazing: Guardian SunGuard
Insulation: Owens Corning
Laminate Millwork: Nevamar
Solid Surfacing Millwork: Silestone,
Northstar Surfaces, Corian
Paint: Pittsburgh Paints, PPG
Operable Partitions (Operable):
Modern Fold
Plumbing: Watts/Woodford
Roofing: Firestone
Vinyl Wall Covering: Maharam,
JM Lynne
Security & Safety
Alarms: GE/EST
Fire/Life Safety Systems: GE/EST
Intercom/Paging: Atlas, Bogen, Dukane,
Toa
Nurse Call Systems: Ideacom
Security Systems: GE, American Time &
Signal
Signage: GSI Building Signage Systems
HVAC/Controls
HVAC Control Devices: Johnson
Controls
HVAC Units: York
Lighting
Indoor Lighting: Eureka, Winona, H.E.
Williams, Infinity, Gotham, Windirect,
Lithonia, Agion, Lightolier, Erco
Emergency Lighting: Lithonia
Washroom Equipment/Supplies
Drinking Fountains: Elka
Showers/Shower Equipment: Powers
Toilets/Sinks: Kohler/Sloan/Bemis,
Kohler/Chicago/DB
Washroom Accessories: American
Specialties, Koala, EPCO
Washroom Partitions: Accurate
Partitions Corp.
Miscellaneous
Draperies/Blinds: Mecho Shades
Lockers: Republic Storage Systems

10 H E A LT H C A R E C O N S T R U C T I O N & O P E R AT I O N S — J U LY / A U G U S T 2 0 0 9 w w w. H C O n e w s . c o m