Guided by Green

When planners sat down to design the new Jefferson County Health Center in Fairfield, Iowa, they started with a unique repertoire of tools and direction.

The 115,000 square-foot, $25 million replacement 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.

In the inpatient areas, nursing pods located outside of every other room contain linens, supplies, medication and a computer. Two observation rooms that sit next to each other are acuity-adaptable to better serve patient needs.

From a caregiver’s perspective, the placement of the nursing 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 interplays 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 fixtures 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.”

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.

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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 popular cool roof material – was used to reduce the heat-island effect and air conditioning expenses. No doubt they contacted a company specializing in commercial roofing projects like Nelson Roofing, who would also be able to take care of any repairs to the TPO that they may need in the future.

In order to make sure that every feature complemented the overall space, one of the contractors they decided to hire, from somewhere like Calvac Paving decided to choose a light-colored paving solution to reduce the heat island effect.

For the interior, JCHC reused much of the furniture and medical equipment from the existing building. A total replacement 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 primary factor in driving the decision to reuse, but some other logistical factors also played a part,” Lind says. “Most of the fixed equipment was purchased as new so that it could be installed without significant downtime.”

HGA’s mechanical engineers also designed a ventilation monitoring system that ensures the recommended outdoor airflow rate is being achieved at all times. The building features low-VOC interior finishes and paints designed to reduce indoor air pollutants, which benefits people who have allergies and chemical sensitivities. Many interior finishes, such as carpeting and acoustical ceiling tile, were manufactured with recycled content.

Pressurized entryway vestibules minimize the entry of contaminants like vehicular exhaust, pesticides, herbicides, helipad exhaust and diesel generator fumes.

Moving Forward

As is the case with many replacement hospitals under construction today, JCHC’s former facility was constructed in the 1940s and is located in a land-locked residential area, where limited parking and constricted space hampered opportunities for growth.

With service and waste trucks making their way through the vicinity, it was difficult for the hospital to be a good neighbor. Inside the hospital, semi-private rooms made patient privacy and family involvement difficult to achieve. There was no way to adjust the old space to accommodate new, state-of-the-art amenities. The infrastructure could not support new technology.

Now, the new hospital sits just off of a new exit ramp from a nearby highway, improving wayfinding for drivers. A tower is the tallest element on the site and serves as a focal point for visitors. Once inside, the layout is simple and patient rooms are now private.

“This is really a no-nonsense building with no frills,” says Dan Rectenwald, principal at HGA. “There is room for growth and expansion, and the facility allows citizens to get state-of-the-art care here. They can stay closer to home and closer to their families who will be involved in their care.”


Green Guide for Health Care