Until recently, health care facilities were often left behind as the green revolution in design and construction began to reshape the standard approach to building design. The reasons for the lag were many, including the unique nature of hospitals as 24/7 operations subject to strict regulations regarding safety and infection control. Initial guidelines for sustainable design, typically written with corporate office buildings in mind, were not an ideal fit for the unique needs of health care.

In addition to its many green features, Jefferson County Health Center is designed
to create a welcoming, soothing environment for patients and families.

In 2003, however, a national group of health care leaders recognized the need to tailor design, construction and operations guidelines to health care facilities. Based on input from numerous industry stakeholders, the Green Guide for Health Care™ was finalized in 2007. The guide is a voluntary, selfcertifying metric toolkit that assists designers, owners and operators in creating energy-efficient, high-performance health care buildings. The approaches and findings of the GGHC also promise to inform the long-awaited LEED for health care guidelines to be released by the USGBC.

The Jefferson County Health Center in Fairfield, Iowa, designed by HGA Architects and Engineers became one of Green Guide’s 115 national pilot projects in 2006, during the early phases of project planning. The 115,000- square-foot hospital and clinic, which replaced an existing hospital, opened in early 2009.

The new Jefferson County Health Center achieves many of the sustainable benchmarks outlined in the Green Guide for Health Care, from minimizing pollution and runoff during construction, to ensuring the cost- and energy-efficient operation of a facility with clean indoor air, natural daylighting and built-in future flexibility. As such, the hospital administration and design team ensured that the facility celebrates the relationship between the built environment, staff and patient wellbeing, and ecological health.

Site and Sensitivity
The hospital occupies a very unique and picturesque site; a cluster of historic barns occupies the adjacent property to the south. Taking advantage of the site’s rural character, hardy native grasses were used for the majority of the landscaping. This approach helps minimize irrigation requirements, and in the case of Jefferson County Health Center, no irrigation was provided, saving significant construction dollars. The native grasses, which require minimal maintenance, are also ideal for controlling soil erosion and even help encourage the development of local ecosystems. During construction, soil erosion and site damage were controlled by planting a fast-growing cover crop.

To minimize storm runoff, the site design features a large retention pond that collects water and naturally filters out contaminants. In addition, a number of smaller rain gardens are located within the parking lots to collect storm runoff and break up the paving of the parking areas.

A central garden planted with trees, shrubs and perennials connects with walking trails incorporated into the site. The garden and greater landscape are visible through large windows strategically placed throughout the hospital and are accessible from the facility’s primary public corridors. These links between inside and outside are key to creating a healing and restorative environment for patients.

Key Features of Energy and Water Efficiency
Energy use was a central consideration from the beginning, helping to shape the overall building massing and orientation on the site. The building’s unusual shape is intended to minimize the east and west facades, where heat gain from windows is especially difficult to control.

To further reduce hospital cooling loads, a white TPO membrane roofing system was specified; the light-colored roof mitigates heat build-up inside the hospital and reduces the potential for “heat island effect” (the unnatural warming of air near buildings and paved areas) outside.

Artificial lighting demands a significant amount of energy in health care facilities, both to power the fixtures themselves and to dissipate their heat through HVAC systems. To minimize the energy required by artificial lighting, extensive daylighting was incorporated through the facility, coupled with sunshades and high- performance glass to control the potential for glare and internal heat gain. In addition to reducing energy use, daylighting has been shown to boost staff productivity and enhance patients’ sense of well-being. Daylight streams into the building through twostory- high windows along the public corridors, and clerestory windows in the interior spaces, such as the surgery recovery rooms and meditation space, borrow light from those daylit corridors.

The building’s massing – a series of smaller components with relatively narrow floor plates – also supports access to natural light. Large windows in hospital patient rooms and the facility’s outpatient rehabilitation center frame vistas of the site’s ponds and natural landscaping. Glass-enclosed family areas located at the ends of corridors in the patient-care unit provide views to the outdoors. The cafeteria looks across a public corridor to the central garden.

To reduce the potential for nighttime light pollution and light trespass onto adjacent properties, dark-sky- compliant exterior site lighting fixtures were specified. Within the building, lights were placed to intersect opaque building surfaces (rather than windows) to reduce the amount of light that spills onto the site, and automatic controls were used where possible to minimize after-hours energy use.

To decrease water waste, the hospital’s plumbing fixtures are equipped with water-regulating sensors. Low-flow fixtures and controls conserve water in lavatories, showers, urinals and toilets.

Because health care facilities frequently undergo renovation and remodeling to accommodate changing technologies and regulatory requirements, Jefferson County Health Center has been designed with flexibility for future growth. The hospital design includes “soft” space— such as administration and storage next to clinical departments—that can be easily modified during future expansion. Plans also include possibilities for horizontal expansion with minimal demolition to fixtures and walls to reduce disruption and dust during construction.

Preserving Indoor-Air Quality
To bolster employee productivity and ensure the health of staff and patients, a number of strategies were incorporated to preserve high-quality indoor air. The hospital includes a ventilation monitoring system that verifies the recommended outdoor-airflow rate and monitors CO2 levels. Entryways connected to the outdoors are at least 16’ long to capture dirt and keep particulates from entering the building.

Pressurized entryway vestibules also keep contaminants (such as vehicular exhaust, pesticides, herbicides, helipad exhaust, and generator fumes) from entering the building. Similarly, pressurized exhaust systems help prevent air movement from one room to another in areas where hazardous gases or chemicals may be used (such as soiled utility rooms, sterilization and disinfection areas, and housekeeping areas). Each space includes self-closing doors and floor-to-deck partitions to prevent chemical fumes from leaking out of one space and into another.

Low-VOC interior finishes and paints were also selected, reducing the potential for toxic fumes from these products to contaminate indoor air. Interior finishes such as carpeting and acoustical ceiling tile include high levels of recycled content. To reduce waste and control costs, hospital administrators also elected to reuse much of the furniture and medical equipment from the original building.

Through these and other measures, Jefferson County Health Center has proven to be early adopters of the Green Guide for Health Care.

In addition to its many green features, the building is designed to create a welcoming, soothing environment for patients and families. The building’s exterior of brick and rough-cut stone opens to an entry lobby featuring broad expanses of glass framing views to the outside. A sunlit corridor accented with rough-cut stone columns connects the entry lobby to the nursing unit along the south side of the building. Throughout the hospital, patient areas emphasize privacy, convenience and confidentiality, while providing plentiful opportunities for healing views to the outdoors. Not only does the new green hospital provide a healthy, safe and energy-efficient environment for patients and health care providers, the facility complements the beauty of its natural setting.

Amy Douma served as the Project Designer for Jefferson County Health Center and is an associate vice president in the Minneapolis office of the HGA Architects and Engineers.