The audit in the Energy Axis consisted in the systematic inspection and analysis of the global use and consumption of energy in HURH, aimed to identify energy flows, establishing a baseline of consumption and developing the potential for improvement of its energy efficiency.

In 2014, the electricity consumption in HURH facilities that were optimized in the framework of the Project was 1,785,242 kWh.

In 2014, the thermal energy consumption in the 4 boilers installed in HURH that were optimized in the framework of the Project was 20,900,912 kWh.

This audit consisted of determining the previous scenario of the HURH relative to the consumption of water and polluting load of its discharges. In 2014, the total water consumption was 443 m³ / d, of which 227 m³ / d came from the water network and 216 m³/d from a well located in the industrial zone of HURH and whose use was authorized by the Confederation Hydrographic of the Duero at the end of 2012.

Regarding the K factor, an indirect measure of the pollutant load of the discharges, the value of the year 2014 was 0.97 in 2014.

In the first place, a thorough analysis of the applicable legislation on sanitary waste has been carried out. Subsequently, a methodology and specific questionnaires have been developed to carry out this audit. Specifically, two types of questionnaires were defined: general questionnaire (general level of the hospital) and questionnaire units (unit level). In turn, both questionnaires have been divided into two blocks of questions. The waste management block includes questions directly related to the handling of different types of waste. For its part, the procedure block focuses on questions related to the hospital’s policies on waste management.

The result of the audit shows that the HURH has obtained a partial score of 138 points with respect to a maximum score of 257 points. Therefore, the total score obtained initially has been 54%.

In addition, the potential actions to be implemented have been identified. These are both waste management improvements of Group I, II, III and IV at unit level, intermediate warehouse and final warehouse, as well as procedural improvements in the following fields: waste management policy and management commitment; measurement and monitoring; training; waste management plan; legal requirements; incidents, corrective and preventive actions; evaluation and control of suppliers; communications; prevention.

In total, 59 potential improvement actions were identified in the area of the waste management, as well as another 31 actions related to waste management procedures.

The actions that have been deployed in the Energy Axis are the following:

Implementation of lighting control and LED lighting.

1,212 conventional lamps have been replaced by LED lighting in high consumption locations: emergency and delivery room, outpatient corridors, hospitalization blocks, outpatient clinics and locking rooms. In addition, a smart system of lighting control has been installed together with the LED luminaires, which takes into account the external luminosity, presence of users, lighting demand schedules and selection of light intensity, so the use of the luminaires can be optimized at each point. This action has generated energy savings of up to 63%.

DALI control lighting

Optimization of ventilation in operating rooms.

The air-conditioning of 18 operating rooms in HURH has been optimized (16 rooms, 1 burned unit and 1 high-risk ward) to maintain adequate temperature and humidity conditions, preserve air quality and maintain an overpressure that provides biological safety for immunosuppressive patients. This measure has generated electric savings of 61% and thermal savings of more than 660,000 kWh/year.

Ventilation control in operating rooms

Improvement of combustion in boiler burners.

A digital control of the combustion has been introduced in the 4 boilers of the HURH. This action has generated savings of 51% in the electric power consumed by the air fans and of 0,41% in the efficiency of gas consumption.

Boilers of HURH

Optimization of ventilation and air conditioning in common areas.

The 54 Air Treatment Units of HURH have been intervened to adapt the air conditioning of the common areas (corridors and crossing areas) by modifying the ventilation conditions according to the demand. In addition, the operation of the air conditioning engines has been optimized, as were initially oversized, setting transmission ratios and use conditions to demanded powers. This measure has generated an estimated electric saving of 28%.

Air Treatment Units of HURH

Best practices in energy management.

Energy is a key resource of any hospital’s daily activity. The management of lighting, air conditioning, ventilation and the operation of common facilities are crucial to ensure its proper operation.

Training activities involving the HURH staff have been carried out, aimed at the promotion of best practices. Moreover, informative posters have been placed in common areas, corridors and elevators, to raise awareness among users and workers about the responsible use of energy.

Results assessment

In the framework of LIFE SMART Hospital Project, in 2017 these actions have reduced the consumption of electricity by 756,116 kWh / year, which means a global saving of 42% compared to the initial scenario.

In 2017 the consumption of thermal energy for heat (heating and domestic hot water) has been reduced by 736,553 kWh / year, which represents a saving of 4% compared to the initial scenario.

The actions that have been deployed in the Water Axis are the following:

Recovery of the rejections from the haemodialysis unit.

HURH haemodialysis unit is equipped with a water treatment plant to produce dialysis fluid. This plant consists of several pretreatments (filtration, decalcification and dechlorination), followed by two serial stages of reverse osmosis, and provides excellent water quality. Within the framework of the Project, the rejection water from the first reverse osmosis module has been recycled to the general cistern of the hospital for its further use as water for human consumption, providing water savings of 15-18 m³ per day.

Water treatment plant in the haemodialysis unit

Recovery of the rejections from the evaporative panels.

The HURH has 4 chillers that work in the summer months, with an approximate consumption of 10 m³ / h. The evaporative panels of these chillers worked before the Project under a “lost water” mode, so large amounts of water were poured into the drain. Within the framework of the Project, the rejection water has been recycled to the general cistern of the hospital for its use in the flushing network.

Deposit for the recovery of the water rejection from the evaporative panels

Installation of water meters to determine consumption patterns.

In order to account for specific water uses and define consumption patterns, meters have been installed in the irrigation system and in the extraction of the well.

Best practices in water management.

Training activities involving the HURH staff have been carried out, aimed at the promotion of best practices. Moreover, informative posters have been placed in all the changing rooms, bathrooms and toilets of the hospital, to raise awareness among users and workers about water conservation and promote its responsible use.

Results assessment

After the implementation of these actions, the annual water consumption in the HURH has been 321 m³/day, which represents a 28% saving compared to the initial scenario.

The actions that have been deployed in the Waste Axis are the following:

Improvement of waste classification, segregation and collection

By conducting an initial audit, it has been possible to identify specific improvement measures related to the waste management in terms of segregation. These measures have allowed increasing from 22 to 35 the number of different fractions that are segregated in the HURH:

• Group I: Solid urban assimilable: Up to 19 types of waste.
• Group II: Non-specific sanitary: 1 type of waste.
• Group III: Specific sanitary: Biosanitary and sharps. 2 types of waste.
• Group IV: Classified in Special Regulations. Up to 13 types of waste.

Implementation of a traceability system

The new traceability system has been implemented at 3 different levels of management:

• Unit level: labelling of all the Group III and Group IV containers, reporting on the specific type of waste and the origin unit.
• Intermediate warehouse level: labelling of Group I and II containers, reporting on the specific type of waste and intermediate warehouse of origin which, in turn, has a series of units associated.
• Final warehouse level: weighing containers from intermediate units and warehouses, as well as other fractions that have not passed through them.

The improvement of waste traceability allows a computerized and automatic recording, in real time, of quantities and qualities of different fractions of waste generated in each area of the hospital. This improvement minimizes the cost of the management and facilitates the adaptation to possible changes in the generation of waste. All this information is reported on the Waste Plan of HURH.

Training and awareness campaigns

Training and awareness of the hospital staff is the main pillar to set an adequate system of waste management. Within the framework of the LIFE Smart Hospital Project, customized specific training has been carried out, involving the 2,500 employees of the HURH.

Results assessment

After the start-up of the 3 actions, a final audit of the waste axis was carried out both at the general level of the hospital (general questionnaire) and in each of the units (questionnaire units).

The HURH obtained a partial score of 214.5 points with respect to a maximum score of 263 points. Therefore, the total score obtained has been 85.8% (compared to 54% obtained in the initial audit).

A Best Practices Book on adaptation plans for the mitigation of Climate Change in hospitals has been prepared. The Manual includes 30 good practices (10 for each axis) identified in the framework of the LIFE SMART Hospital Project, some of which have been deployed in the HURH demonstrator, and which have been selected taking into account criteria of replicability, economic return and ease of implementation:

This Manual is aimed at all actors involved in the health sector, hospital managers, medical and nursing staff, maintenance technicians, occupational risk prevention, cleaning personnel, kitchens, etc.

On the other hand, e-Learning is an on-line tool available through the Project website, structured with a self-assessment questionnaire and based on the 30 good practices identified in the 3 axes of action. This tool will provide an evaluation of environmental sustainability of a hospital, helping to identify possibilities for improvement and defining future management strategies:

This action was carried out using the Life Cycle Assessment tool (ISO 14040&14044) and aimed to assess the improvements achieved by the technical actions deployed in the HURH compared to the baseline scenario.

In this action, the environmental indicators selected in the Project have been determined:

• Inventory of greenhouse gases.
• Water footprint.
• Quantity of waste managed.
• Percentage of waste reduction incorrectly segregated.

The results of the final environmental characterization have determined that the measures implemented in the 3 axes have been effective since all the selected indicators have improved with respect to the baseline scenario:

• Decrease of 17% in the environmental indicator of carbon footprint.
• Decrease of 29 % in the shortage of blue water.
• Reduction of 38.6% of waste to be managed. Finally, the final result of the audit of the waste axis was 6% higher than the score obtained in the initial scenario.

This action aimed to quantify and monitor the social and economic benefits of the Project through the following indicators: discomfort, labor security, education and operating costs.

Considering the geographic, temporal and demographic aspects, this action provides the methodology to measure the indicators to evaluate the socio-economic impact of the Project in the surroundings of the demonstrator of the HURH.

Through environmental performance surveys carried out on all the groups of people related to the hospital centers (working personnel, users, patients, neighbors), the positive social and economic impact that the Project has provided, and how it has affected in the environment performance of each person surveyed.

By means of the replicated study of this impact in two other Spanish hospitals, such as the Hospital Universitario de La Paz (HULP), in Madrid, and the Hospital Clínico Universitario of Valencia (HCUV). Quantitative and qualitative values have been obtained to represent the social and economic benefits of the LIFE SMART Hospital Project.

The Dissemination Plan was designed to achieve the following objectives:

• Increase the value and impact of the Project and the results achieved in the demonstration phase.
• Organize the public dissemination of the Project activity and results to interested stakeholders.
• Broadly disseminate the results related to the main activity of the Project at European level.
• Contribute to the elaboration of a “post-LIFE” plan to continue with the dissemination and communication after the Project.

Dissemination tasks have been structured through 5 communication channels:

• Promotional material (brochures, roll-ups, posters, pen drives, folders and anti-stress dolls, etc.).
• Project website.
• Social networks (Twitter and YouTube channel).
• Attendance at events.
• Media appearances.

This action has been developed throughout the project with the aim of establishing an active network for the exchange of information and knowledge, mainly between LIFE projects implemented both in Spain and in other European countries. The following LIFE projects have been contacted:

• LIFE + BOHEALTH (LIFE12 ENV/ES/000124).
• LIFE OPERE (LIFE12 ENV/ES/001173.
• LIFE MED (LIFE13 ENV/IT000620).