Adoption of cogeneration in hospitals as an option for fulfilling the stability Law. An application for the Nomentana Hospital in Fonte Nuova (RM)

Tesi di Laurea Magistrale in Ingegneria Meccanica - Università di Roma La Sapienza - Paolo Petroni A.A. 2012/13 
 
chapter 1 
INTRODUCTION 
 
 
 
Individuation of new possibilities for saving energy is a creative activity, a 
branch of engineering for which fundamentals can be sketched only at large. It is 
a common knowledge that universal recipes do not exist. Each case is 
independent from the other, i.e. only a deep knowledge of all the technical 
installations involved in a specific structure, a right understanding of their 
operation and, of course, a solid basic preparation and experience can help define 
the best feasible interventions for that specific case.  
Management of energy is the result of the combinations of several elements, as 
technology, experience, knowledge, operative efficiency and investments. The 
goal is herein a reduction in cost via right allocation of the resources. For an 
increase in the cost of all energy forms and a variation of the availability of the 
majority of them is predictable, it is necessary to accomplish any reasonable 
effort with the aim of reducing energy consumption in hospitals (one of the top 
energy consumer in our country, but not only there), without compromising the 
quality of the healthcare services provided.      
Dealing with hospitals holds back several peculiarities. Primary goal of a 
healthcare structure is to provide requested medical cures with the best quality, 
the highest velocity in the best environmental conditions available. Operating 24 
hours a day and 365 days a year, without interruptions. Adhering to this primary 
goal, at least until recent years, by nature nobody cared about energy costs, 
indeed it was a common idea that the adoption of measures to cut these costs 
could cause a reduction of the general medical services standard [33]. The goal of 
an Energy Manager is indeed to prove that it is possible to accomplish certain 
interventions, both during planning or operating phase, in order to put all the 
technical installations in operation with an appropriate efficiency and to reduce 
energy consumption, without compromising the high standards, instead, 
improving it.  Sure enough, it has to be clear that each euro saved following an 
efficiency improvement or a reduction in wastage, can be profitably spent for new 
devices, instruments, employment.  
The final energy consumption for domestic and other civil uses (hospitals are 
in the latter category) represents in Italy about 1/3 of the total energy 
consumption and, thanks to the advent of new technologies, the trend is 
permanently growing. Energetic crisis, that had happened recently at a global 
level and have been periodically engaged during periods of energy request peak, 
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Tesi di Laurea Magistrale in Ingegneria Meccanica - Università di Roma La Sapienza - Paolo Petroni A.A. 2012/13 
 
have demonstrated how it is essential for modern industrial, domestic and 
tertiary systems to ensure the availability of great quantity of energy, in all its 
forms, and how these systems are vulnerable. Therefore, a general energetic 
problem exists, heavily conditioning each user and in particular healthcare users; 
which need significant and continuous provisions to meet their needs.  
Recent years have shown that in the light of a low incidence of the energetic 
costs on the overall economy of a healthcare company (on average, in the balance 
sheets of the National Healthcare System supply of fuel and electrical energy 
affect for about 2%), the same company could not have a propensity for 
improving interventions in this sense. That is, energetic expense is relatively low, 
but certainly high for the Nation in absolute, for it corresponds to almost 2 billion 
euro each year. The general trend towards energy efficiency has however changed 
in the last period. Above all, in the light of what is expected according to the new 
Stability Law of the Monti government, approved in last December 2012. The 
most interesting point here is the one stating that hospital must cut their costs 
for purchasing goods and services of 10%, regardless of the level of efficiency or 
virtuosity that a particular hospital could have reached before the approval of the 
same law. In this context it is clear that energy efficiency can and has to give its 
contribution for meeting this percentage, through adoption of interventions, the 
aim of which is wastage reduction and, thus, technical installations efficiency 
improvement, without compromising the hospital’s performance.  
 The numerous installations, indispensable for the operation of a modern 
hospital, entails the consumption of a significant amount of energy, both 
electrical and thermal. Measurements done in the past and reported in literature, 
pointed out that a considerable amount of energy is wasted, for many reasons: 
obsolescence of buildings and installations, inadequate choice or design, 
management lacks, etc. In order to provide an idea of the situation, ENEA [33] 
estimates an average savings of 10-20%, obtainable without excessive efforts and 
changes: it is right and proper to try to obtain such an important result.  
With regards to the context in which operations will take place, considering 
the sole thermal installations (which, as it will be shown, are the main sources of 
energy consumption and wastage in hospitals), it must be kept in mind that each 
room or area of a healthcare structure normally needs the presence and the right 
operation of so-called “well-being” installations which can assume the form of 
heating, conditioning, ventilating systems, or combination of these depending on 
individual cases. These systems must work in order to guarantee the maintenance 
of well-being conditions, established on the occasion of design. In order to 
provide an idea on the system’s complexity, it must be taken into consideration 
that hospitals’ land use have been categorized into 4 main different areas, with 
relation to users’ characteristics of the rooms involved in these areas:   
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Tesi di Laurea Magistrale in Ingegneria Meccanica - Università di Roma La Sapienza - Paolo Petroni A.A. 2012/13 
 
 areas without patients which are only occupied during working hours 
(laundry, kitchen, sterilization, workshop, shops, canteen, laboratories). 
In these zones during nighttime installations can be put out of service 
and the distribution priority is low;  
 areas with patients during daytime, but not in intensive therapy 
(physiotherapy, pool, radiology, clinics). An attenuation of installations 
can be proposed during nighttime and the distribution priority is 
medium;  
 areas with continuous presence of patients, not in intensive therapy 
(bedrooms, services). Same considerations as above matter; 
 areas with patients in intensive therapy (intensive cares, surgery, 
delivery room, nursery). Here maximum comfort must be assured 24 
hours a day, throughout the year and the distribution priority is 
evidently high.  
 
All these demonstrates how the management of technical installation 
operation can be a complicated issue and how difficult it can be to evaluate the 
interventions for increasing energy efficiency inside such a diverse and articulate 
context.   
 
Having said that, this thesis truly deals with energy efficiency in hospitals, a 
topic no longer young and nearly endless, as asserted by many authors 
mentioned in the references at the end of this treatise. But, as already run over, 
the context in which everything takes place is decisively current: the Stability Law 
of the Monti government. The present treatise, among innumerable energy 
efficiency interventions admissible for a healthcare structure, considers perhaps 
the most drastic: the direct intervention over the methodology of electrical and 
thermal energy production, i.e. the installation of a cogeneration plant.  
The justification is easier said: detailed knowledge of all the technical 
installations operating of a hospital and of their modus operandi would require 
years of work and studies, an unacceptable period in the field of a master degree 
thesis. Therefore, on the strength of a real energy consumption of a real 
healthcare structure, it will be evaluated one of the most forceful intervention, as 
already said, and the benefits obtainable in the context of the stability law will 
also be computed. 
The healthcare structure under consideration is the Nomentana Hospital, 
located in Fonte Nuova (RM). This preference has been dictated, besides 
immediate logistical convenience, by the fact that nobody has ever done this kind 
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Tesi di Laurea Magistrale in Ingegneria Meccanica - Università di Roma La Sapienza - Paolo Petroni A.A. 2012/13 
 
of analysis for this structure (which, as it will be shown in the 5th chapter, is 
characterized by a remarkable annual energetic expense) before.  
 
This is, briefly, the content of the following chapters:  
 
 chapter 2, Reference norm. A brief overview on the main references 
concerning the healthcare sector and the cogeneration will be offered, 
with particular emphasis on the incentives provided for high efficiency 
cogeneration plants;  
 chapter 3, Energetic situation of hospitals. On the strength of statistical 
data, main consumption centers inside a hospital and the respective 
percentage, energy forms enlivened and reference amounts referred to 
unit of beds, surface and volume, will be pointed out;  
 chapter 4, Cogeneration. General definitions and application fields of 
cogeneration are provided, together with brief historical hints, main 
energy balances and motivations about the importance of using 
cogeneration in hospitals;  
 chapter 5, Feasibility study of a cogeneration plant at the Nomentana 
Hospital. This makes up the bulk and the most important part of this 
treatise. Different installation hypothesis for 2 cogeneration plants for the 
Nomentana Hospital will be provided, presented as a feasibility study 
including detailed consumptions accompanied by the relative costs 
evaluation for each month of the hypothetical year in which the proposed 
installation is put into operation. Together with relative discounted cash 
flows and obtainable White Certificate computation, a deepened study of 
the electrical energy bill will close the chapter;  
 chapter 6, The context: the stability law 2013. As already outlined, this law 
calls for clear restrictions for national healthcare structures, concerning, in 
particular, a huge cut to purchasing costs of goods and services. It will be 
computed that the contribution given by the energy saving achieved on 
the strength of the previous feasibility study in the light of this context.  
 
 
 
 
 
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