1. Aim and energy technology objectives
This project will demonstrate how to renovate totally an old and inefficient hospital by means of new and for the region almost revolutionary ideas and designs of the latest innovative methods and by use of experiences from previous projects including for instance cost-effective solar hot water heating systems. The solar technique will be extended to all areas of the hospital both in intercepting the energy and in distributing and exploiting the solar energy.

The key objectives of the project are:

• To save the hospital from closing down due to lack of heating.
• To create state of the art efficiency in the zones of the building where climatisation is needed.
• To create new buildings with most modern low-cost methods
• To implement active and passive solar building integrated energy devices.
• To implement new and efficient energy technologies.
• To make new environments for cleaning and sanitary work.
• To educate the national and international clinic authorities.

The most important innovative energy saving measures to be studied and combined are:

• Design of double skin facades for natural ventilation systems.
• Maximum use of insulation in the existing construction with effective fire-proof material.
• Installing ventilation techniques with heat recovery for providing as well heating in wintertime as cooling in summertime by exchanger devices.
• Use of natural ventilation with new wallintegrated techniques.
• Replacing the old inefficient and polluting coal based boiler system with a condensing gas boiler..
• Using flat plate solar collectors for hot water and space heating.
• Installation of photo voltaic systems for production of electricity for running pumps for the solar collectors and for household electricity
• Establishing long time storage of hot water, with more than 2 weeks self supply of hot water as reserve for periodically insufficient solar gain periods
• Installing computer based Building Management Systems.
• Installing wastewater separators for preventing infection spread.
• Installing wastewater and water treatment system.
• Isolating the various bed areas for preventing infection spread (important for ventilation strategies)

Combinations of these elements will be studied and optimised and the most attractive combination will be implemented In the final design of the hospital.

It is expected that a combination of the above suggested innovative initiatives and new technologies will create a new hospital building with a close to zero consumption of gas and other liquid and solid fuels by using minimal electricity supply (for instance from a wind-mill).

2. Description of the project

Background
The Public Medical and Sanitary Institution “Clinical Hospital of Infectious diseases Toma Ciorba” was started already in the 1890’es by the famous medical researcher Toma Ciorba of Chisinau and has been a leading hospital in infectious diseased of all kind and in the latter years including the HIV/AIDS.

The existing hospital is more than one hundred years old and was designed and created for long term use and in a classic building style that was typical for that time – notable a prestige project. However, experiences reveals that such an institution, due to development of new standards and new techniques, is not fit for more than half a century and it is not practicable to reconstruct the installations without radical interference in the actual building parts. The building has also been selected as a historical building worthy of preservation.

It is the only hospital in Moldova of this kind but due to age and lack of maintenance it is about to be closed down and stop treating patients although there is definitely a great need for the expertise existing at Toma Ciorba.

The present area of the hospital is about 30.000 m² land in the best part of the capital and is laid out as a recreational park-like garden that is considered of high national pride. It is a part of the intention to keep and restore this.

The building complex consists of many classic brickwork constructions with decorative patterns and friezes from the original construction and with a total area of about 5.000 m² floor area. Since the mid 20th century however a total of at least another 5.000 m² were added with a number of barracks for storage, waste, garages, boiler-room and fuel storage and gardeners depots. It is agreed that these low class temporary buildings should all be demolished and the areas used for the intended new modern buildings in an up to date architectural style that fits the area, town and purposes.

The existing heating system (boilers and radiators) was installed at the beginning of the 20th century and runs on poor quality waste coal from Ukraine and is therefore heavily polluting the area.

The age of the buildings also makes installing necessary ventilation, good insulation and effective water and waste water systems quite problematic.

The existing classic buildings are intended to be converted into administrative, secondary or supplementary premises for emergency, reception, ambulatory or other feasible uses such as kitchens facilities, laundries, etc. The total area of new buildings will contain about 300 beds and an area of at least 15.000 m² including service areas for patients treatment. The new building is intended to consist of a high 4 to 5 story building for beds and a lower two or three story building for medical treatments and smaller surgery.

The infectious hospital includes today a children’s department in another location in the city which is not a practical solution and it is intended to be transferred to this new central hospital for a rational enterprise.

The hospital treats many different infectious diseases of which patients with HIV/Aids is a growing part. Also whooping cough, diphtheria, asthma, malaria and other diseases are treated and for this reason the new hospital will have different isolated departments for respectively “air infectious” and “touch infectious” patients which means that the most modern and recent experience must be taken into consideration.

3. Aim
The new building constructions are intended to be of a modern energy saving design and energy efficient lay-out. The new buildings will be planned in a cost saving design and will as such be made in a fast-to build light weight building system that still has an elegant and attractive appearance with extensive use of an insulating high performance glass facade.

The key goals of the project are:

• To design, construct and erect a new type of energy conscious health care buildings for bedding and treatment of the patients and at the same time to transform some old but preserved buildings for reception and administration so as to keep the total cost of reconstruction at a low expense but high utilisation.
• As Moldova is indeed a poor country and as such a low cost area, building costs are expected to be quite modest compared to the average European level. This means that it is the aim to keep the total construction cost of the new high quality building below 500,- Euro pr m²
• And in addition to keep the installation costs at an even lower level.

Innovative initiatives
The construction of a modern type steel-structure building gives the possibility to design and install a totally new concept of low-energy solar heating, wall-ventilation and water systems with hot water, steam and cold water supply for rinsing, cleaning, washing, sanitary clean distillation with separate outlets. The design will include a number of innovative elements which will be optimised through an integrated energy design process based on valuable contribution from WP2 – Facilitation of Integrated Energy Design and Design Reviews. This means that the final design will consist of the most attractive combination of the following innovative energy elements which have been selected for the final design optimisation:

• Design of double skin facades for natural ventilation systems.
• Maximum use of insulation with effective fire-proof material.
• Installing ventilation techniques with heat recovery for providing as well heating in wintertime as cooling in summertime by exchanger devices.
• Use of natural ventilation with new build-in-walls techniques.
• Replacing the old inefficient and polluting coal based boiler system with a condensing gas boiler.
• Using flat plate solar collectors for hot water and space heating.
• Installation of photo voltaic systems for production of electricity for running pumps for the solar collectors and for household electricity
• Establishing long time storage of hot water as reserve for periodically insufficient solar gain periods
• Installing computer based Building Management Systems.
• Installing wastewater separators for preventing infection spread.
• Installing wastewater and water treatment system.
• Isolating the various bed areas for preventing infection spread (important for ventilation strategies)

The expected result will give a low cost running hospital with low CO2 waste discharge. The new design will furthermore make the treating, cleaning and maintenance work of patients and bed areas considerable easier and in-expensive and improve hygiene and indoor air quality.

Monitoring
A thorough monitoring program, which will evaluate the specific and the global energy and environmental qualities of the Toma Ciorba hospital will be carried out. Thus, monitoring protocols and strategies will be defined and designed in order to achieve the necessary information. The monitored data will be compared with the expected performance defined during the design phase. This will focus on performance of the innovative energy measures that are implemented and on the thermal and visual indoor climate and on the indoor air quality which is of particular importance in hospitals compared to other building types (especially in hospitals within the field of infectious diseases like Toma Ciorba).
Another important element of the evaluation will be the carrying out of a user survey including the patients and the employees in order to evaluate the level of thermal comfort and indoor environment quality achieved in Toma Ciorba.
The identification of the monitoring plan will be carried out in close cooperation with the common Work Package “WP4 – Monitoring – advice, coordination and lessons learned”
The monitoring system will be combined with the new computerised Building Management System (BMS). For this purpose additional heating volume meters and electricity meters will be installed.
The monitoring campaign will have a duration of one year. The data obtained will be analysed and evaluated in order to identify the efficiency of the implemented energy saving strategies and technologies. This will also be a valuable result with respect to other old and inefficient hospitals which are in great need of renovation.
Parts of the monitoring activities will be subcontracted to experts within the field of monitoring.

Dissemination:
The results of the retrofitting and the implementation of the innovative elements will be disseminated to all areas where new hospitals are built or old hospitals are being retrofitted. Dissemination will happen on a national as well as an international level. For Toma Ciorba, international dissemination will especially focus on countries being in the same situation as Moldova. This means in particular countries in the East European area including new member states as well as expected future member states, in which almost all of them many health care buildings are in a very poor condition due to lack of maintenance and repairs.

All important results achieved will be reported in public available reports and will be uploaded to the BUILD HEALTH web site. As described in WP6 – Dissemination, also a project specific brochure about the design and the results achieved will be produced.

Dissemination will happen through seminars, workshops etc. and through the existing health care network of Toma Ciorba which reaches many countries throughout Europe.

Dissemination activities will be coordinated by the common work package WP6 – Dissemination.

Energy balance
As described in the description of the project, the buildings of the hospital dates back to the beginning of the 20th century and are therefore very energy inefficient. Below the energy consumption for heating for the proposed project is compared to the present situation.

The total energy demand for heating will be reduced from 11,774 MWh/year to 9,939 MWh/year, corresponding to a reduction of 15.6 %. Since the hospital in the present situation has 10,000 m2 and is enlarged to 20,000 m2 in the project proposal, the energy demand for heating per m2 will be reduced from 1,18 MWh/m2 per year to 0,5 MWh/m2 per year, corresponding to a reduction of 57,8 %.

The reduction in the heating consumption derives from replacement of the inefficient coal based boiler system with a condensing natural gas boiler, maximum use of insulation, use of flat plate solar collectors for hot water and space heating and installation of natural ventilation with new build-in-wall techniques with heat recovery. Furthermore, establishment of long time storage of hot water as reserve in periods with insufficient solar gain contribute to the reduction in the heating consumption.

In the present situation the annual electricity consumption is 526 MWh, which probably will be the same or slightly larger in the project proposal. The electricity consumption will be kept down even though the hospital will be modernized by use of energy efficient equipment, optimized use of daylight, daylight control on the lighting system, installation of photo voltaic systems for production of electricity for running pumps for the solar collectors and for household electricity. On top of this, the Building Management System will ensure an accurate control of all energy consuming installations.

4. Drawings, photos
Attached please find photos of the present state and situation of the buildings and the area as well as interior vision of the workplace and the ramshackle conditions that the hospital work with and which speaks for itself.