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Healthcare Facility Commissioning: Ensuring Critical System Performance

Micheal Munson
Author:
Micheal Munson

Working with healthcare facilities has been one of the most rewarding parts of my career, especially as the Head of Customer Success at PingCx. These buildings aren't just complex structures—they're environments where system performance directly impacts patient outcomes, staff effectiveness, and operational costs. Today, I'd like to share some insights on why proper commissioning is absolutely critical in healthcare settings and how we're helping our clients achieve exceptional results.

Why Healthcare Facilities Demand Special Attention

Throughout my career, and especially this last year at PingCx, working with hospital systems across the country, I've seen firsthand how the stakes in healthcare settings are uniquely high. According to a 2022 study by the American Society for Health Care Engineering (ASHE), healthcare facilities use approximately 2.5 times the energy of commercial buildings of similar size, primarily due to their 24/7 operations, specialized equipment, and stringent environmental requirements.

Just last month, I was on a call with the facilities director of a major hospital in Southern California who put it perfectly: "When systems fail in an office building, people are uncomfortable. When systems fail in our hospital, lives are at risk."

This isn't hyperbole. Consider these critical factors:

  • Infection Control: The CDC reports that approximately 1 in 31 hospital patients has at least one healthcare-associated infection on any given day. Proper ventilation and pressurization are essential defense mechanisms.
  • Temperature and Humidity: Research published in the Journal of Advanced Nursing found that surgical site infection rates increased by 1.3% for each degree Fahrenheit above the recommended temperature range in operating rooms.
  • Power Reliability: The Department of Health and Human Services notes that even momentary power interruptions can compromise critical care equipment and patient safety systems.

The Commissioning Gap in Healthcare Facilities

Despite these high stakes, we've observed a concerning trend. According to a 2021 report by the Lawrence Berkeley National Laboratory, while 70% of new healthcare facilities undergo some form of commissioning, only 28% receive comprehensive system verification. This leaves critical gaps in system performance that often aren't discovered until they impact operations.

I recently worked with a 450-bed hospital that had undergone traditional commissioning during construction. When we implemented our autonomous commissioning platform, PingCx, we discovered that 37% of patient rooms had pressure relationships that didn't match design specifications, creating potential cross-contamination risks that had gone undetected for months.

Critical Systems Requiring Thorough Verification

In healthcare settings, several systems demand particular attention during commissioning:

1. Airflow Management and Pressurization

Maintaining proper pressure relationships is crucial for infection control. Research from the American Journal of Infection Control shows that improper pressurization contributes to approximately 17% of healthcare-associated infections.

One of our clients, a 275-bed hospital in New York City, used the PingCx platform to verify pressurization in all 38 of their isolation rooms. Our comprehensive Lifecycle CommissioningTM approach found that 7 rooms had inadequate pressure differentials during certain conditions. Knowing every room is verified gave our client the confidence they simply didn't have before.

2. HVAC Performance and Redundancy

Healthcare facilities require not just proper HVAC operation, but also verified redundancy and failover capabilities. According to ASHRAE's healthcare facility design guidelines, critical care areas should maintain proper temperature and humidity even during primary system failures.

Last year, I worked with a surgical center that thought their backup systems were fully functional—until comprehensive testing revealed that 3 of their ORs would experience humidity excursions during an emergency power transition. 

3. Air Handler Failure Mode Operations

HVAC redundancy in critical healthcare spaces isn't just about having backup equipment—it's about verified sequences that respond appropriately during partial system failures. According to a 2023 survey by the American Society for Health Care Engineering (ASHE), 31% of hospitals discovered incorrect failure mode programming in their air handling systems that standard commissioning processes had missed.

I recently worked with an academic medical center that was confident in their air handler redundancy after passing all traditional commissioning tests. When our platform ran comprehensive failure simulation sequences, we discovered that 2 of their ORs would experience positive pressure during certain air handler failure scenarios—potentially allowing contaminants to enter during procedures. 

The Transformation: From Sampling to Comprehensive Verification

The shift from traditional commissioning to Lifecycle CommissioningTM is perhaps most valuable in healthcare settings. When I explain this to clients, I often reference research from the Building Commissioning Association showing that comprehensive system verification can identify up to 40% more issues than traditional sampling methods.

I often joke that the traditional approach was like checking one patient's vitals and assuming everyone on the floor was fine.

This transformation is yielding impressive results:

  • Reduced Energy Consumption: Healthcare facilities implementing comprehensive commissioning see average energy savings of 12-15%, according to the U.S. Department of Energy's Better Buildings Healthcare Initiative.
  • Fewer Emergency Repairs: One of our hospital clients reported a 62% reduction in emergency maintenance calls in the first year after implementing autonomous commissioning.
  • Improved Regulatory Compliance: Joint Commission data indicates that environment of care issues account for approximately 30% of citations during accreditation surveys. Our clients report significant reductions in these findings after comprehensive system verification.

Case Study: Memorial Regional Hospital Success Story

One of my favorite success stories involves Memorial Regional Hospital (name changed for privacy), a 400-bed facility that was experiencing persistent issues with their isolation rooms despite having undergone traditional retro-commissioning just two years earlier.

Their challenges included:

  • Inconsistent pressure relationships in isolation rooms
  • Temperature fluctuations in operating theaters
  • Unexplained energy consumption patterns
  • Staff complaints about environmental conditions

After implementing our Lifecycle CommissioningTM platform, we discovered:

  • 23% of isolation rooms failed to maintain proper pressure differentials under certain conditions
  • Four operating rooms experienced temperature excursions during peak cooling loads
  • 18 VAV boxes were operating outside their designed parameters
  • Multiple air handling units had suboptimal economizer sequences

The facilities team was able to address these issues systematically, resulting in:

  • 100% compliance with pressure relationship requirements
  • Operating room conditions maintained within ±2°F of setpoint
  • 14.7% reduction in energy costs
  • 58% decrease in environment-related complaints

As their point of contact from the PingCx team, watching this transformation was incredibly rewarding. 

Implementation Lessons for Healthcare Facilities

Based on my experience working with several healthcare clients, I've found some keys to successful commissioning implementation:

  1. Involve Clinical Staff Early: Include infection control, surgical teams, and nursing staff in defining critical parameters. Their insights into operational needs are invaluable.
  2. Document Baseline Performance: Comprehensive baseline documentation is essential for both regulatory compliance and future troubleshooting.
  3. Implement Zone-Based Prioritization: Focus on critical care areas first, then move to less critical zones.
  4. Plan Around Patient Care: Develop testing schedules that minimize disruption to patient care activities.
  5. Verify Emergency Scenarios: Test systems under normal conditions and emergency power/failure scenarios.

A simple reminder: "Patients don't care about commissioning, but commissioning cares about patients." 

Looking Forward: Lifecycle CommissioningTM

The most forward-thinking healthcare facilities are moving beyond point-in-time commissioning to Lifecycle CommissioningTM. According to a recent American Hospital Association survey, hospitals implementing ongoing commissioning report 23% fewer building-related patient incidents and 31% lower maintenance costs.

I'm currently working with three major hospital systems implementing continuous verification programs. Their approach includes:

  • Quarterly automated testing of all critical systems
  • Continuous monitoring of key performance indicators
  • Automated alerts for performance drift
  • Regular verification of emergency systems
  • Documented performance history for regulatory compliance

Conclusion: A Patient-Centered Approach to Commissioning

If there's one thing I've learned working with healthcare facilities, it's that behind every technical specification and performance metric are patients who depend on these systems—often without ever knowing it.

Comprehensive commissioning isn't just a technical requirement or regulatory checkbox. It's a fundamental component of patient care and safety. When implemented properly, it ensures that the complex systems supporting healthcare delivery are performing optimally, reliably, and safely.

As healthcare facilities continue to grow more complex and connected, the importance of thorough commissioning will only increase. Those facilities embracing comprehensive verification approaches are seeing measurable improvements in system performance, regulatory compliance, energy efficiency, and ultimately, patient care.

I consider it a privilege to work with healthcare professionals who understand these stakes and commit to excellence in their built environments. After all, in healthcare facilities, commissioning isn't just about buildings—it's about the people those buildings serve.

As the Head of Customer Success, I've helped several healthcare facilities implement comprehensive commissioning programs. If you're facing challenges with your healthcare facility systems or looking to enhance your commissioning approach, I'd love to discuss your specific needs. Contact us!

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