Energy Efficient Hospital Patient Room Design: Effect of Room Shape on Windowto-Wall Ratio in a Desert Climate

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1 Energy Efficient Hospital Patient Room Design: Effect of Room Shape on Windowto-Wall Ratio in a Desert Climate Ahmed Sherif Hanan Sabry Rasha Arafa Ayman Wagdy [Department of Construction and Architectural Engineering, The American University, Cairo, Egypt] [Department of Architecture, Faculty of Engineering Ain Shams University, Cairo, Egypt] [Department of Construction and Architectural Engineering, The American University, Cairo, Egypt] [Department of Construction and Architectural Engineering, The American University, Cairo, Egypt] ABSTRACT This paper reports on a research that utilized simulation techniques for identifying the most efficient hospital patient room designs and their associated window-to-wall ratios. Simulation of the energy consumption and daylighting performance of common patient room designs were conducted using a range of Window-to-Wall Ratios (WWRs). The paper focuses on arriving at solutions that balance between the reduction of energy consumption and the achievement of proper daylight distribution in the desert climate of Cairo, Egypt. Simulations were conducted using the Diva-for-Rhino, a plug-in for Rhinoceros modelling software to interface with the Energy Plus, Radiance and Daysim software. Results demonstrated that solar penetration is a critical concern affecting patient room design and window configuration in desert locations. Use of the outboard bathroom patient room design was found to be the least efficient among the tested alternatives. Although it has a smaller external wall size, it failed to provide energy consumption that is lower than that of the other options. Its best energy performance was 20% higher than that of the nested bathroom patient room design. However, the outboard bathroom design allowed for larger WWRs (70%-90%), which might prove useful for external view exposure purposes. The nested and inboard bathroom patient room designs provided better energy performance. However, this was on the expense of window size. The acceptable cases of these designs had smaller WWRs, (30%-40%). The results of this paper demonstrated the need for the careful consideration of the size of windows and openings in relation to different patient room designs. Simulation techniques can prove useful in this regard. INTRODUCTION Hospitals are typically considered one the most energy demanding building types. Patient rooms compose the largest volume of hospital buildings. The external walls of patient rooms represent the most significant part of the external surface area of these buildings. Windows can contribute significantly to the healing process and reduction of pain and length of stay in hospitals through the provision of daylight and allowance of external view (FGI, 2010). However, they can also contribute negatively to the energy consumption of these buildings, especially in desert climates, where the cooling load

2 represents a significant percentage of total energy consumption. Sizing the windows of patient rooms should be carefully considered in relation to patient room shape. Some common patient room designs have a small external wall surface area with a large room depth, while others have larger external room surfaces and a reduced depth of the work area. The windows of patient rooms should minimize solar penetration, reduce overheating; yet at the same time maximize daylighting and patient access to external view. The objective is to reduce the total energy load while maintaining comfort and quality health care. Literature addressed the effect of environmental aspects on healthcare delivery. Ulrich recommended that natural light improvement could help reduce stress and fatigue, while increasing effectiveness in delivering care, patient safety and overall healthcare quality (Ulrich, 1991 and Ulrich et al., 2004). In an attempt to develop patient room designs to create healing environments, the effect of natural daylight on the patients average length of stay in hospitals was investigated. Studied factors were patient s average length of stay as an index of health outcome, and the differences in environment during daylight hours, such as illuminance, luminance ratio, and illuminance variation in the hospitals patient rooms (Choi et al., 2012). In research work more relate to this study, energy efficient building envelope treatments were examined for a generic reference hospital in Thailand. Parametric analysis was conducted. The overall thermal transfer value, glazing material, Window-to-Wall ratio (WWR) and external shading devices were addressed. The annual energy savings due to increasing daylighting reached up to 15.4% and 11.3% for the electrochromic and green tinted glazing respectively (Chungloo et al., 2001). Optimization of window opening in a hospital patient room was addressed in a research that aimed at providing daylighting, external view, while minimizing the energy consumption. An optimization methodology was demonstrated through parametric computer simulations to determine the optimum window design in the form of window width, sill and lintel heights and shading device depth (Shikder et al., 2010). The impact of using various window shading systems and different window glazing types on the energy consumption of a typical hospital Intensive Care Unit room space in Egypt was examined. It was found that energy savings reaching up to 30% could be achieved by the use of externally perforated solar screens and overhangs positioned at a shading angle of 45 (Sherif et al., 2013-a). In another study, daylighting performance was simulated for a typical hospital Intensive Care Unit room space located in Cairo, Egypt. Several window configurations were simulated in the four main orientations, where the effect of adding shading and daylighting systems was examined. Successful window configurations were recommended for different window to wall ratios (Sherif et al., 2013-b). The above review of literature demonstrates that a limited number of publications addressed with the relationship between hospital patient room designs and the associated window configurations. Research work concerned with this relationship in desert environments is almost nonexistent. Configuring the windows of patient rooms for energy efficiency, while providing acceptable daylighting levels, could pave the way for reaching more sustainable hospital designs. OBJECTIVE This paper aimed to compare the energy consumption and daylighting performance of common hospital patient room designs. Investigation focused on the design of windows facing the south orientation under the desert clear-sky of Cairo, Egypt. The larger aim was to arrive at satisfactory patient room designs that minimize energy consumption and maximize the utilization of daylighting, thus help improve the delivery of sustainable healthcare facilities. METHODOLOGY The methodology was divided into two consecutive stages. Stage one investigated the energy performance of the tested patient room design cases along with the alternative window configurations. Stage two concentrated on the analysis of daylighting adequacy for the cases which achieved acceptable performance in stage one. Three of the most common patient room designs were selected for

3 investigation. These were: Design A: the outboard bathroom patient room design; Design B: the nested bathroom patient room design; and Design C: the inboard bathroom patient room design. The tested rooms were assumed to have a similar floor area (22 m²). The layout, dimensions and parameters of the tested rooms are shown in Table 1 and Figure 1. Table 1. Parameters of the Tested Patient Room. Internal Surfaces Materials Walls Reflectance 50% (Medium Colored Internal-walls Off-White) Ceiling Reflectance 80.0% (White Colored Ceiling) Floor Reflectance 20.0% (generic floor) Window Parameters Glazing Double glazing clear (VT=80 %) Sun Breaker Reflectance 35.0% (Outside Facade) Design A: Design B: The Outboard Bathroom The Nested Bathroom Figure 1 The tested patient room designs Design C: The Inboard Bathroom Seventeen window size values, expressed as Window-to-Wall Ratios (WWRs) were analyzed for each patient room design. The values ranged from 10% to 90%, at 5% increments. The shape and location of the tested windows alongside the external wall of the patient room space are illustrated in Figure 2. A horizontal sun breaker was assumed to be positioned on top to the window. Its overhang value provided a sun protection angle of 45, as shown in Figure 3. This angle was based on the results of previous research work (Sherif et al., 2013 b). Figure 2 The shape and position of the tested window on the external wall at different WWRs. Simulations were conducted using the climatic data of the city of Cairo, Egypt (30 6'N, 31 24'E, alt.75 m) that enjoys a year-round desert clear-sky. The city is characterized by a hot-arid desert climate,

4 according to Köppen-Geiger (2006). The tested patient rooms were assumed to be located on the second floor level of a hospital building, where windows were assumed to face no external obstruction. The external ground surface was assumed to have a 20% reflectance value. Grasshopper which is a plugin for Rhinoceros modeling software and a parametric modeling tool was used to automate the energy and daylighting simulation process. By activating this function, the Grasshopper plugin generated a parametric model for each WWR and ran a climate based analysis through DIVA interface. Energy simulation was conducted using the EnergyPlus software. Daylight simulation was conducted using the Radiance and DAYSIM software. The Diva-for-Rhino plugin for the Rhinoceros modeling software was used as an interface. Figure 3 The overhang of the shading device protecting the tested window. Methodology of Stage One: Energy Consumption Analysis The aim of this phase was to investigate the energy consumptions associated with the three tested patient room designs (cases A, B and C). The annual energy consumption resulting from the different WWRs of each patient room design was calculated. The cooling, heating and lighting energy consumption values were accounted for. The WWRs which resulted low energy consumption values falling within 3% from the lowest value for a certain patient room design were considered acceptable cases for such as design. Energy simulation parameters were selected to focus on studying the performance associated with room shape and window configuration. The effect of thermal transmittance through walls and ceiling from the adjacent spaces was neutralized. Thus, the thermal transmittance from all walls and ceiling, except that of the window wall, were set to be adiabatic. The effect of the adjacent rooms was considered to be of no relevance to the thermal performance sought in this comparative study. The building was assumed to be fully air conditioned and minimal thermal transmittance was expected from the other internal spaces that would have identical set conditions. The external wall was defined as a 0.35 m thick double brick insulated cavity wall with a U- value of W/m² k that carried the tested window at its center. The air conditioning system heating and cooling set points were assumed to be 22 C/26 C respectively. The occupancy time of the studied patient room was chosen to be all day, at a rate of 10 m²/ occupant. The hourly lighting schedules that were generated through the annual Daylight Availability analysis by the Radiance and DAYSIM software were used as basis for artificial lighting energy calculations. This artificial lighting was set to be dynamically controlled by sensors according to daylighting adequacy. Methodology of Stage Two: Daylight Availability Analysis The aim of this stage was to evaluate the year-round daylighting performance of the cases that proved successful for each of the three design configurations in stage one. Simulation parameters used in investigations were: ambient bounces = 6; ambient divisions = 0. The occupied time of the patient room was assumed to be from 06:30 AM to 10:30 PM. In this study, the reference plane on which daylighting performance was simulated was the patient bed level plane (0.90 m height). The spacing of the analysis grid was set at 0.7m * 0.7m. Four points were placed on the patient bed. The reference plane contained 46, 54 and 53 measuring points in each of the three tested patient room designs A, B and C respectively, as shown in Figure 1. The illuminance value was assumed to be 300 Lx (IESNA, 2000).

5 Three Daylight Availability evaluation levels were used (Reinhart & Wienold, 2011). First, the daylit areas were those areas that received sufficient daylight at least half of the year-round occupied time. Second, the partially daylit areas were those areas that did not receive sufficient daylight at least half of the year-round occupied time. Third, the over lit areas were those areas that received an oversupply of daylight, where 10 times the target illuminance was reached for at least 5% of the year-round occupied time. Two daylighting acceptance criteria had to be satisfied. First, % of the patient bed surface area should be daylit. Second, at least 50% of the patient room area should be daylit. SIMULATION RESULTS Results of Stage One: Energy Performance The total annual energy consumption values expressed in Kwh/m² were calculated. The results are as shown in Table 2. It summarizes the energy consumption results in the south orientation at different WWRs for the three investigated room designs A, B and C. The cases that achieved the required threshold were highlighted with a light tone in the table. Table 2. Total Annual Energy Consumption for Layout Designs A, B and C WWR% Annual Energy Consumption (Kwh/m2) Design A Design B Design C Use of design B that has a nested bathroom resulted in the lowest energy consumption among all three room design types. The consumption was as low as 147Kwh/m2 in WWRs 30%-40%. Moreover, design C (inboard bathroom design) achieved a very close value of 151 Kwh/m2 in WWR 35%. Use of these designs resulted in a better performance in comparison with Design A (outboard bathroom design) which failed to produce a value lower than Kwh/m2. Furthermore, use of Design A resulted in the highest energy consumption among all alternatives. It reached 192 Kwh/m2 at 15% WWR. On the other hand, its consumption was lower than the other two alternatives at high WWR values. Using a 90% WWR with designs A and B resulted in comparatively larger energy consumption values, reaching up to 183Kwh/m2. On the other hand, the outboard bathroom design configuration (Design A) achieved larger window sizes and larger number of options in comparison with the other two layout configurations. The acceptable WWR range of Design A extended from 40 to 90%. Fewer acceptable WWR choices and smaller window sizes were identified for the nested bathroom configuration (Design B). These ranged from 20% to 45% WWR. A very limited range of WWRs was found acceptable in the inboard bathroom configuration (Design C), where only three WWR cases (30 to 40% WWR) met the required criterion. In design A, the bathroom location on the outboard wall reduced the size of the exposed external wall surface, thus reducing the thermal exposure of the patient's room to the hot desert climate. However, this was overcome by the increased artificial lighting energy load, as explained later. This was not the case in the nested and inboard designs, where the size of the external wall surface was much larger. To explain the behavior described above, the lighting, cooling and heating consumption values were analyzed. As expected for a desert environment, cooling represented the highest values, followed by lighting electricity then heating loads, which were almost negligible as shown in Figures 4, 5 and 6. The performance of design A is shown in Figure 4. The lighting electricity load significantly decreased with the increase of WWR. This could be attributed to the increase of daylighting use, which resulted in a reduction of artificial lighting. However, the nature of the patient room plan type resulted in overall higher levels of artificial lighting, with subsequent high cooling energy. On the other hand, the

6 cooling energy loads slightly increased with the increase of WWR. This allowed the acceptance of larger WWRs, reaching up to 90%. The use of an outboard toilet with the resultant small external wall surface dampened the effect of changing the WWR. This was observed in the gentle curve slope of the cooling energy consumption for WWRs 20%-90% that it is almost flat. Figure 4 Design A annual cooling, heating, lighting and total energy loads for different WWRs. The performance of Design B is shown in Figure 5.The lighting electricity load decreased at a constant rate with the increase of WWR, while the cooling energy loads increased considerably with the increase of window to wall ratio (WWR). This is observed in the considerable increase and the curve slope of the cooling and the total energy use from 40% to 90% WWR. This could be attributed to the design of this patient room type that has a nested toilet that is associated with a larger external wall surface. This increased solar exposure and allowed the window transmitted solar energy. Figure 5 Design B annual cooling, heating, lighting and total energy loads for different WWRs. The energy consumption of patient room Design C is shown in Figure 6. This design was found to produce behavior almost similar to that of Design B. Both share a large exposed external wall. It was noticed, thought that the cooling energy of design C was slightly higher than that of Design B. This could be attributed to the cooling load resulting from the slightly increased lighting electricity.

7 Figure 6 Design C annual cooling, heating, lighting and total energy loads for different WWRs. Results of Stage Two: Daylight Availability Analysis In this stage, the cases that achieved successful energy performance in stage one were evaluated for daylighting adequacy. Results are shown in Table 3. In Design A, acceptable daylight availability was only achieved at large WWRs. Only 5 of the tested cases passed the daylight availability test in this case. On the other hand in Design B, 4 of the 5 tested cases resulted in acceptable daylighting performance. In Design C, all of the three tested cases resulted in an acceptable daylighting performance. Table 3. Percentage of Daylit Area Relative to Patient's Room and Bed Plane Areas WWR % Design A Design B Design C Room Room Room Bed Bed Bed 0 25 For more detailed discussion, eleven cases were analyzed for the outboard bathroom design (Design A). Simulation results revealed that the amount of acceptable daylit areas was directly proportional to the increase of WWRs values. Only large windows achieved adequacy in the case of the outboard bathroom design. For WWRs between 70% and 90%, the daylit area reached 72% of the space area, especially at 85% WWR. The partially daylit areas dominated the patient room, where it reached 50% of the space in average (40% to 65%). However, it decreased gradually until it became unnoticeable at 85% WWR (15% of the space). In contrast, the overlit area was almost constant (13% as an average) in the tested WWRs. On the other hand, when the bathroom was located in-between two adjacent patient rooms (Design B: The nested bathroom), only four cases from five energy efficient ones achieved adequacy (30% to 45% WWRs). The Daylit area reached 80% of the space, at a WWR value of 45%. Although, the daylit area of the patient bed plane achieved adequacy in the 25% WWR case, it was unacceptable in relation to the overall patient room area testing (41% daylit area). The Partially daylit area decreased gradually until it almost disappeared (1%), in the case of 40% WWR. For the inboard bathroom design (Design C), the three energy efficient cases (30%, 35% and 40%WWRs) were acceptable for daylighting performance. The daylit area values for the patient room space were almost similar (60% at an average). For the three design configurations, the "over lit" area percentages did not exceed 15% in average for overall the patient room space in all accepted daylight availability cases.

8 CONCLUSION The energy and daylighting performance of three common patient room designs were simulated. The performance resulting from use of a range of window sizes (expressed as Window-to-Wall Ratios - WWRs) under the clear-sky desert sun of Cairo, Egypt was examined for each of these room designs. Table 4 summarizes the range of WWRs that were recommended for each patient room design for satisfying the energy and daylighting criteria. In addition, the balanced WWRs that satisfy both energy and daylighting criteria at the same time were identified. Results of this study demonstrated that solar penetration is a critical concern affecting patient room design and window configuration in desert locations, like in Cairo, Egypt. Use of the outboard patient room design was found to be the least efficient among alternatives. Although it has a smaller external wall size in comparison with the other alternatives, it failed to provide an energy consumption that was lower than that of other two tested room designs. Its best energy performance was 20% higher than that of the nested bathroom design. This could be attributed to the increase of artificial lighting that resulted from allocating the bathroom along the external façade in the outboard bathroom design. However, the outboard design allowed for larger WWR values. This might prove useful for external view exposure purposes. Although the nested bathroom and inboard bathroom designs provided better energy performance, this was on the expense of window size. The acceptable cases of these designs had smaller WWRs, between 30% and 40%. The results of this paper demonstrated the need for a careful consideration of the size of windows and openings in relation to different patient room designs. Simulation Techniques proved useful in identifying the window configurations that satisfy both the energy and daylighting requirements at the same time. Table 4: Recommended WWRs for Patient Room Designs A, B and C Design A Design B Design C Patient Room Designs Energy 40% - 90% 30% - 45% 30% - 40% Daylighting 70% - 90% 30% - 90% 30% - 90% Balance 70% - 90% 30% - 45% 30% - 40% REFERENCES Choi, J., Beltran, L. and Kim, H Impacts of indoor daylight environments on patient average length of stay (ALOS) in a healthcare facility. Building and Environment, 50: Chungloo, S., Limmeechokchai B., and Chungpaibulpatana S., Parametric analysis of energy efficient building envelope in Thailand. Asian journal of energy environment, 2 (2): FGI Guidelines for Design and Construction of Healthcare Facilities. USA: Facility Guidelines Institute. IESNA, Rea M. S., (ed.) IESNA Lighting Handbook References and Application. 9th ed. Köppen-Geiger, World Map of Köppen-Geiger Climate Classification. Retrieved 22 January 2010.

9 Reinhart, C. F. and Wienold, J The daylighting dashboard simulation-based design analysis for daylit spaces. Building and Environment, 46: Sherif, A., El Zafarany, A., and Arafa, R., 2013-a. Energy simulation as a tool for selecting window and shading configuration in extreme desert environment- Case Study: Intensive Care Unit in Aswan. Proc. of the Sustainable Building Conf. (SB 2013), Cairo, Egypt. Sherif, A., Sabry, H., and Gadelhak, M., 2013-b. Daylighting simulation as means for configuring hospital intensive care unit windows under the desert clear skies. Proc. of the Building Simulation Conf. (BS 2013) August 2013, Chambéry, France. Shikder, S., Mourshed, M. and Price, AD Optimisation of a daylight-window: Hospital patient room as a test case. Proc. of the International Conference on Computing in Civil and Building Engineering, Nottingham, UK, pp Ulrich, R., Effects of healthcare interior design on wellness: Theory and recent scientific research. Journal of Healthcare Interior Design, 3: Ulrich, R. and Zimring, C., The role of the physical environment in the hospital of the 21st century: a once-in-a-lifetime opportunity. The Center for Health Design SM.

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