Performance-based Reliability Centered Maintenance Planning for Hospital Facilities

Mohamed Salah1, Hesham Osman2, and Ossama Hosny3

Abstract

The deteriorating state of the built environment has affected numerous sectors, and hospitals
are no exception. Hospitals are relatively unique compared to other facilities due to the
complexity of their systems and criticality with respect to the communities they serve. Faced
with limited budgets and pressures to comply with increasing performance requirements,
hospital facility managers are required to strike a delicate balance between hospital
maintenance costs and level of service requirements. As such, this paper proposes a
reliability-centered maintenance (RCM) approach that is combined with evolutionary
optimization to develop optimal maintenance plans for hospital facilities. The scope of the
developed model covers four mission-critical systems in hospitals namely medical gases,
primary Heating Ventilation and Air Conditioning (HVAC), secondary HVAC and elevators.
Failure Mode Effect Analysis (FMEA) is used to determine the optimal maintenance strategy
for various components within these systems. The model considers how each system
contributes to the continuity of services in four areas within hospitals; namely intensive care
units, emergency rooms, operating rooms and regular patient rooms. In order to demonstrate
the capabilities of the developed model a case study of a 5,200m2 hospital is considered.
Results demonstrate that by using the RCM and optimization approach, savings ranging from
6 to 16% in maintenance costs can be realized in comparison to traditional preventative
maintenance approaches undertaken by existing maintenance contracts. The developed model
is thus capable of providing hospital facility managers with an effective tool to better
understand how their maintenance expenditures directly contribute to overall system
availability and impact on health care services delivered to patents.

1
M.Sc Candidate, Department of Construction Engineering, American University in Cairo, Cairo, Egypt.
msahmed@aucegypt.edu
2
Associate Professor, Department of Structural Engineering, Cairo University, Egypt.
hesham.osman@gmail.com
3
Professor, Department of Construction Engineering, American University in Cairo, Cairo, Egypt.

ohosny@aucegypt.edu

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Introduction
Hospitals play a vital role in delivering health care services to communities. Hospitals are

unique facilities that rely on numerous specialized and sometime complex systems to

deliver health care services to patients (Lavy and Shohet, 2009). In addition to medical

equipment, hospitals include mission-critical building systems like medical gases, primary

and secondary HVAC systems, elevators, etc… These systems all play a vital role in the

ability of the hospital to deliver uninterrupted and high-quality medical services. Hospital

maintenance backlogs have increased in recent years and reports have warned that this will

have an impact on delivery of health care services (Pantzartzis et al 2016 and Carter, 2015).

For example, in the UK, the cost of high-risk maintenance backlog in hospitals increased by

69.3% from £458m to £776m, while the significant risk maintenance backlog increased by

47.6% from £1.06bn to £1.57bn from 2015-2016 in National Health Service (NHS)

hospitals (Pantzartzis et al 2016). In Canada, Roberts and Samuelson (2015) estimate that

deferred maintenance across Canadian hospitals is between C$15-20 bn and that an average

annual investment of C$3 bn is needed to keep this figure from rising. Provision of health

care services through long-term Public–Private Partnership (PPP) contracts is also on the

rise (Javed et al, 2013). In PPP hospital projects the private sector is typically involved in

the construction and maintenance of the facility throughout the concession period, whereas

a third party is responsible for the provision of health care services. PPP hospital contracts

usually have comprehensive performance specifications regarding the condition and

maintenance of the hospital and its systems (Javed et al 2013). As such, the financial

viability of the private sector investment in hospital PPPs is predicated on the efficient and

effective deployment of maintenance and rehabilitation activities within pre-determined

contractual performance requirements. Deteriorating hospital structures, limited

rehabilitation and maintenance budgets, and performance-based hospital maintenance

2|Page
 contracts are putting pressure on hospital facility managers to embrace a more scientific and

structured approach to maintenance activities to ensure a balance between maintenance

costs, system performance, and risk to hospital operations.

Background

Hospital Systems
Delivery of health care services in a hospital is typically undertaken in four keys areas 1)

Operating Rooms (OR), 2) Intensive Care Units (ICU), 3) Emergency Rooms (ER) and 4)

Regular Rooms (RR). In comparison to residential and commercial buildings, hospitals are

considered sophisticated and complex facilities to manage due to the presence of several

specialized specialty systems that work together for delivering the service. Systems in that are

critical for provision of health care services include:

1- Medical Gases: Medical gas systems are required to supply patients with oxygen,

medical air and nitrous oxide. These gases flows through an elaborate pipe network

that has outlets in patient rooms, intensive care units and operation rooms (Abu Al-

Ainin, 2014). Oxygen is primarily used in respiratory therapy and anesthesia. Oxygen

gas normally is supplied through liquid oxygen tanks and oxygen cylinders are

available as a backup. Nitrous Oxide is primarily used as an anesthetic. It exists in the

normal conditions in atmosphere as a gas, its smell is somehow a sweet itch, capable of

producing the first and second stages in anaesthesia when inhaled. It is used commonly

in operating rooms (ORs), and in some ICUs (Abu Al-Ainin, 2014). Finally medical air

is used to provide normal respiration to patients. Its composition is identical to regular

air in the atmosphere and is supplied using a medical air compressor plant. Failure of

any of these systems has a direct impact on numerous health care services and can

directly jeopardize the safety of patients in the ER, OR, ICU and RR.

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2- Elevator systems: Elevators are used for vertical transportation of patients, health

care workers and hospital visitors between different floors. In hospitals, elevator plays

major role for patients especially for those who suffer from inabilities and require

companion. Dimensions of elevators in hospitals follow a standard that at least allow

one stretcher with one companion. In addition, patient elevators should follow hygienic

rules in terms of health and precautions should be taken towards anti-bacterial

prevention. The interior space of elevator is usually stainless steel and lighting should

be kept at a level that does not disturb the patient. Buttons are at low position unlike

other elevators and wider doors are used (KONE Solutions, 2016). Failure of this

system has an impact on the performance of OR, ICU, and RR. The ER operation is

least impacted by the failure of this system as it is typically located on the ground floor

of a hospital.

3- HVAC Systems: The presence of proper ventilation systems in a hospital operating

room and other rooms is crucial for human comfort and plays a critical role in

preventing the spread of infectious diseases across the hospital. Hospitals typically

have two separate HVAC systems, a primary HVAC system for OR and ICU and a

secondary for the rest of the building. OR and ICU requires an anti-bacterial

environment hence special filters and exhaust systems are installed to provide a clean

air from bacteria and send off the exhaled air that contain microbes and anaesthetic

gases outside the room, consequently 100% fresh air HVAC system is a must. HVAC

system design relies on the use of laminar flow ventilation whereby a supply air

diffuser is located at the ceiling directly above the operation area and low-level exhaust

outlets at the room periphery (Chow and Yang, 2003).

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Table 1 summarizes the impact of a failure of key hospital systems on health care service

delivery. Medical gas systems have the largest impact in case of failure, followed by

elevators, primary HVAC and finally secondary HVAC.

Hospital maintenance and rehabilitation management

Shohet et al (2003) developed a regression model that predicts maintenance costs based on

hospital age, occupancy levels, and the extent of outsourcing maintenance services.

Lavy and Shohet (2007) developed a decision support system model for health care facility

management that is based on heuristics and case based reasoning. Their model is used to aid

facility managers in the prediction of maintenance costs, building performance, and risk of

operations in the health-care sector. Their research determined that building age, occupancy,

and surrounding environment affect the maintenance costs of the facility. Liyanage et al (2008)

developed a performance framework for cleaning services in an attempt to control and prevent

healthcare associated infections. Miniati et al (2012) developed a database-driven decision

support system for optimal preventive maintenance planning of medical devices. Their model

developed a maintenance priority index for various medical devices based on their impact on

patient safety, the complexity of the device, and the expected time to repair and unplanned

failure of a device. The use Building Information Modeling (BIM) in healthcare facility

management was addressed by Lucas et al (2013) who developed a BIM model to capture the

information needed through the healthcare facility lifecycle with the objective of supporting

facility management response to emergency situations within a healthcare environment.

Enshassi and Shorfa (2013) studied the key performance indicators that impact the maintenance

of hospitals. Four key performance indicators (KPIs) were considered in this study that include

building performance indicators, maintenance efficiency indicators, annual maintenance

expenditure and urgent repair request. The KPIs were applied on several public hospital in

Gaza Strip to measure their performance. It was recommended to develop a vision to improve

5|Page
the working style and culture towards maintenance. Ali and Hegazy (2014) developed a

framework based on a multi-criteria performance assessment for hospitals. The proposed

framework was used to prioritize the renewal funding for different hospital subsystems. Several

KPIs were considered in the study that include the level of service (LOS), sustainability,

condition and risk of failure. Surveys were conducted to collect the required data and validate

the proposed framework. The framework was applied on six subsystems which are (boiler,

water pipelines, electrical distribution and three roof sections). In this case study, the proposed

framework gave the boiler the highest priority followed by water pipelines and electrical

distribution and finally the roof sections.

This paper addresses several shortcomings in the literature and practice of hospital maintenance

management through 1) Applying concepts of reliability-centered maintenance (RCM) to

develop more efficient maintenance plans for mission-critical hospital systems, 2) mapping and

better understanding how unplanned interruptions to hospital systems impact the delivery of

health care services with the objective of aligning maintenance activities with performance

objectives, 3) Developing optimal maintenance schedules for multiple hospital systems under

a constrained budget.

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Hospital-level reliability-centered maintenance model
Maintenance theory and practice has witnessed considerable advancements in the past

century. One of the latest advancements is the application of Reliability Centered-

Maintenance (RCM). Initially conceived in the airline industry to address alarming plane

crash rates, RCM rationalizes the maintenance activities of components within a larger

system with an objective of increasing overall system reliability at minimum cost. RCM

integrates preventive maintenance (PM), condition-based maintenance (CBM), and corrective

maintenance (run to fail) to increase the probability that a component will function in the

required manner over its design life-cycle with a minimum amount of maintenance and

downtime (NASA RCM, 2008).

Mwanza and Mbohwa (2015) developed a study to assess the effectiveness of equipment

maintenance in public hospitals. They have assessed the current performance for hospital

equipment for three hospitals. The results showed a poor performance for hospital equipment

due to ineffective maintenance practices. As such, they have proposed the use of RCM in

hospital system maintenance planning expecting that it will improve overall equipment

reliability and service availability.

Moubray (1997) identifies several questions that need to be answered to apply RCM:

1. What are the functions required by the asset in its present operating context?
2. What are the functional failures?
3. What are the failure modes (causes)?
4. What happens when each failure occurs?
5. What are the failure consequences?
6. What can be done to prevent or predict failure?
7. What should be done if suitable proactive task cannot be found (default actions)?

Application of FMEA
Questions 1-5 can be answered through various failure analysis technique like Failure

Mode Effect Analysis (FMEA) and Failure Mode Effects and Criticality Analysis (FMECA).

The outcome of this approach is a tailored and optimal maintenance plan for each component

7|Page
within the system. FMEA categorizes maintenance strategies into two broad categories.

Proactive maintenance refers to a strategy where an action is taken prior failure occurring.

Reactive maintenance (sometimes referred to as default action) is a strategy where no action

is taken until a failure occurs (e.g., run to failure strategy). Under the proactive maintenance

strategy the maintenance manager can either employ a preventative or a predictive

maintenance strategy. With preventative maintenance, the strategy is based on scheduling a

maintenance action on a fixed interval based on component age or system operating hours.

Under this strategy, two actions are possible scheduled discard or scheduled restoration.

Under predictive maintenance (sometimes referred to as condition-based maintenance), the

maintenance manager schedules an inspection activity to identify signs of component

deterioration. The objective is to replace or fix components that have experienced actual

deterioration prior to failure occurring and regardless component age. Generally speaking,

preventive maintenance is used for age-related failures while predictive maintenance is used

for non-age related failures. The objective of the predictive maintenance approach is to avoid

service interruption as a result of failure. The warning point is called a “potential failure” at

which the component starts deterioration and exhibits detectable signs of degradation, while

the point of failure is called a “functional failure”. The time interval between the two points is

called the p-f interval (Moubray, 1997). Predictive maintenance aims to inspect the

component at specific time interval such that it should be less than the p-f interval. This

requires maintenance managers to identify the condition monitoring techniques (e.g. vibration

analysis for a pump) for detecting the potential failure effects and the p-f interval. In this

research, FMEA is used to analyze the following mission-critical hospital systems 1) medical

gas systems, 2) primary HVAC systems, 3) secondary HVAC systems and 4) elevator

systems. A total of 13 interviews with maintenance professionals specialized in these systems

were conducted as part of this research. All interviewees had at least 10 years of experience

8|Page
in their respective fields of specialization. Information collected from the interviews was used

to 1) Conduct the FMEA, 2) Estimate durations and costs for various inspection activities,

and 3) Obtain information on typical p-f intervals for various component failure modes.

Sample results of these interviews are shown in Tables 2 and 3. More information can be

found in the supplemental material to this paper. Tables 2 and 3 summarize the outcome of

the FMEA analysis for medical gas systems and HVAC systems. The analysis revealed that

the optimal maintenance strategy for the majority of system components is predictive

maintenance with the exception of primary and secondary filters for HVAC systems. The

detailed FMEA analysis for all systems is provided as supplemental material to this paper for

the interested reader.

Optimization model formulation

Using RCM is a first step towards developing an optimal maintenance plan as it helps define

the most suitable maintenance strategy for each component in a larger system. Alone RCM

cannot determine the optimal trade-off between system reliability and cost of maintenance

activities. As such this research develops an optimization model that takes into account

maintenance tasks and expected downtime due to failures for the four hospital systems within

the scope of this work. The model can be easily extendible to include other specialist systems

that may be in hospital. Genetic algorithms (GA) were selected to develop an optimization

model as they are suitable to deal with complex problems having large solution spaces where

the problem cannot be formulated in a closed mathematical form (Osman et al, 2003). GA are

search algorithms based on the mechanics of natural selection and genetics to search through

decision space for optimal solutions (Goldberg, 1989). Genetic algorithms utilize three

operators (selection, crossover and mutation). A solution is represented by a chromosome

which is comprised of genes, selection process take place by random selection of two

chromosomes for reproduction. Crossover takes place where the parents exchange

9|Page
information to produce offspring. Mutation takes place to avoid local minima and it takes

place by altering one or more genes (Holland, 1992).

Decision variables: Maintenance intervals (Xij is the inspection interval for failure mode i

and system j).

Objectives: Maintenance cost (MC) & Expected Downtime (EDT)

𝑓
365
𝑀𝑖𝑛𝑖𝑚𝑖𝑧𝑒 𝑀𝐶𝑗 = ∑ 𝑥 𝐻𝑖𝑗 𝑥 𝐶𝑖𝑗 (1)
𝑋𝑖𝑗
𝑖=1

Where;

i is the failure modes counter;

j is the systems counter;

f is the total number of failure modes;

MCj is the total maintenance cost for system j;

Xij is the maintenance interval for failure mode i and system j.

Hij is the maintenance task duration in hours for failure mode i and system j;

Cij is the maintenance task unit cost for failure mode i and system j.

Pij = P (Aij <= Xij) (2)

Where;

i is the failure modes counter;

j is the systems counter;

Aij is the minimum p-f interval for failure mode i and system j;

Xij is the maintenance interval for failure mode i and system j;

Pij is the probability of failure for failure mode i and system j.

𝑀𝑖𝑛𝑖𝑚𝑖𝑧𝑒 𝐸𝐷𝑇𝑗 = ∑ 𝑃𝑖𝑗 𝑥 𝐷𝑇𝑖𝑗 (3)

𝑖=1

10 | P a g e
Where;

i is the failure modes counter;

j is the systems counter;

f is the total number of failure modes;

EDTj is the total downtime in hours for system j;

Pij is the probability of failure for failure mode i and system j as a result of maintenance

interval Xij;

DTij is the downtime in hours for failure mode i and system j determined in FMEA

In order to determine the impact of a failure of each system on the four hospital systems

within the scope of this research (intensive care units, regular rooms, emergency rooms and

operation units), a degree of criticality score (DC) is defined based on the impacts showed in

table 1 such that for High Impact, DC=1.0, Moderate Impact DC=0.5 and None DC=0.

The optimization model provide several solutions (maintenance cost and the associated

expected downtime), hence the total number of un-served patients will be calculated using the

downtime resulted as shown in equation (4). Genetic algorithm optimization engine was

required to optimize the allocation of maintenance budget among different hospital systems.

The decision variable is the percentage of the budget allocated and decided by the user and

the objective is to minimize total un-served patients from all systems as shown in equation

(4).
𝑠 𝑚

𝑈𝑃𝑡𝑜𝑡𝑎𝑙 = ∑ ∑ 𝑃𝐻𝑦 𝑥 𝐷𝐶𝑦𝑗 𝑥 𝐸𝐷𝑇𝑗 (4)

𝑗=1 𝑦=1

Where;

UPtotal is the total number of unserved patients;

y is the hospital units counter;

11 | P a g e
j is the systems counter;

s is the total number of systems;

m is the total number of hospital units;

PHy is the number of patients served per hour for hospital unit y;

DCyj is the degree of criticality score of system j for hospital unit y;

EDTj is the downtime in hours for system j.

Case Study
A hospital located in the Egyptian city of Beni-Suef was used as a case study to demonstrate

the capabilities of the developed model. The hospital was constructed in 1981 with a total

built-up area of 5,200 m2 over 5 floors. The hospital contains 340 beds including regular

rooms, emergency units, and intensive care units in addition to 5 operating units. The hospital

is served by a medical gas system that includes central oxygen plant and medical air

compressor. Moreover, 5 air handling units for serving the ORs and ICUs, in addition to 22

air handling unit for the remaining rooms. Furthermore, 6 elevators were used for the vertical

transportation to and from the operating units, intensive care units and regular rooms.

Single System Optimization

Monte-Carlo simulation (500 iterations) was used to simulate the p-f interval given by the

experts to identify the probability of failure of different inspection intervals. Table 4 shows

the results for the medical gas system. Results for other systems are provided as supplemental

material to this paper. Using the probability of system failure, the Expected Downtime (EDT)

is derived. Increasing the inspection interval of system component will have higher

probability of failure hence, more expected downtime.

Results obtained from the Monte-Carlo simulation were used to provide a trade-off between

the maintenance cost (Equation 1) and the EDT (Equation 3) using genetic algorithms. As

12 | P a g e
mentioned, the decision variable is set to be the inspection intervals which will result in a

probability of failure hence the (EDT) is calculated together with the maintenance costs. The

population size was set to be 100, the crossover and mutation threshold were 90% and 10%

respectively and the termination condition is to achieve 500 trials with maximum change

0.01%. Figure (1) depicts the results obtained from the optimization engine for the primary

HVAC system (1 USD = 8.9 Egyptian Pound - EGP at the time of data collection). The

results indicate a direct relation between the maintenance cost and the (EDT), as increasing

the maintenance budget will be reflected on the performance of these systems by reducing the

hours of service suspension and vice versa. Results show a dramatic increase in downtime

when annual maintenance budgets are cut beyond EGP 300,000. Such analysis is vital to

communicate the impact of cuts in maintenance budget to hospital administration. Table 5

shows the maintenance plan for primary HVAC that will result in a total maintenance cost of

EGP 274,200 and EDT of 46 hours. However, for practical application it was suggested

aggregate the inspection tasks into a more manageable number in order to reduce the

mobilization cost of the inspection crews. In this context, the inspection crew can inspect for

several failure modes of different components per visit without violating the original

maintenance plan developed. Table 5 depicts the modified inspection intervals, this plan will

result in 8% decrease in EDT to be 42 hours instead of 46 hours of the original one, and in

addition the maintenance cost will be increased by 3% to be EGP 282,500.

Multiple system optimization

Hospitals typically manage system maintenance in a holistic manner. As such, maintenance

planning should consider the needs of all systems and the impacts they have on hospital

operations under a constrained maintenance budget for all systems. As such, a multi-system

budget optimization was conducted with the objective of developing a globally optimal

maintenance plan considering impacts to overall hospital operations. In the case study at

13 | P a g e
hand, ICU, ER, OR and RR served an average of 1000, 600, 1200 and 2000 patients per

month. Based on the degree of criticality scores (DC) assigned based on table 1, the average

number of patients impacted per hour due to a failure in the elevators system, primary

HVAC, secondary HVAC and medical gas systems are estimated as 4,3,2 and 7 respectively.

Note that the analysis does not include impacts to medical staff or hospital visitors which was

not considered in the model. Solutions from the single-objective maintenance optimization

model (maintenance cost and their associated expected downtime for each system) were fed

into the multiple systems integration optimization module in order to calculate the total un-

served patients for every solution according to equation (4).

Genetic algorithms were used in optimization where the population size was set to be 100, the

cross over and mutation threshold were 90% and 10% respectively and the termination

condition is to achieve 500 trials with maximum change 0.01%. Based on the impact to

hospital level of service, medical gas system has the greatest contribution to the level of

service followed by the elevators followed by the primary HVAC and finally the secondary

HVAC. Based on the solutions obtained from the maintenance optimization module, the

maximum maintenance budget that provide the minimum expected downtime for primary

HVAC, secondary HVAC, medical gas system and elevators are EGP 515,000.00, EGP

1,261,200.00, EGP 115,651 and EGP 251,918.46 respectively. Table 6 shows the results

obtained by the optimization of budget allocation. The results were logical as the priority was

given to the systems that highly contribute to the service delivered. The budget allocated to

the medical gas system was EGP 115,000 which covers 99% of the maximum maintenance

budget, followed by the elevators which was given EGP 246,026 that covers 97% of the

maximum maintenance budget, then primary HVAC which was given EGP 393,018 that

covers almost 76% of maximum maintenance budget, and finally the secondary HVAC was

given EGP 745,315 that covers 49% of the maximum maintenance. The total number of

14 | P a g e
patients impacted by unplanned system interruptions was 190 per year which represents 2.3%

of all patients served by the hospital.

It should be noted that the proposed model does not undertake a trade-off between

maintenance cost and level of service (EDT). This trade-off inherently depends on the

preferences and constraints of the hospital management. As such, the models presented in this

paper empower the decision makers to make more informed decisions on this trade-off.

System Validation
In order to demonstrate the added-value of utilizing RCM and system optimization in

hospital maintenance management a comparison was conducted against performance-based

maintenance contracts and the proposed system. Service providers were asked to provide a

quote for providing a guaranteed level of service under a performance-based contract for

maintaining medical gas systems, HVAC systems and elevators. Cost savings ranged from

6% - 16% when utilizing the RCM and optimization approach proposed in this paper. Table 7

depicts the results of comparison of performance-based maintenance costs.

Summary and conclusions

This paper presents a reliability-centered maintenance (RCM) approach to manage four key

hospital building systems. FMEA was used to identify specific failure models and most

suitable maintenance strategies for components within these systems. With lack of available

failure data for system components, expected ranges for p-f intervals were collected from

domain experts for each failure mode. Monte Carlo simulation and genetic algorithms were

subsequently used to determine optimal inspections durations for system components

considering two conflicting objectives: 1) minimizing system down time and 2) minimizing

maintenance costs. The result of the multi-objective optimization is a series of Pareto-optimal

solutions that the facility manager can choose from depending on budget availability and/or

15 | P a g e
acceptable system downtime. A multi-system optimization model demonstrated the ability to

allocate maintenance budgets across multiple system considering direct impact to patients

served in the hospital. The model was subsequently validated and demonstrated savings

ranging from 6% - 16% compared to existing preventative maintenance strategies used by

system operators. Existing limitations of the model that warrant further enhancement include

1) Inability to consider built-in system redundancy, 2) The model was applied to only four

hospital building systems. Other systems that are typically designed with built-in redundancy

and would warrant further investigation include electrical systems. Other vital areas of

hospital service delivery like medical diagnostics can also be considered in future work.

16 | P a g e
List of Notations

Aij is the minimum p-f interval for failure mode i and system j.

Cij is the maintenance task unit cost for failure mode i and system j.

DCyj is the degree of criticality score of system j for hospital unit y

DTij is the downtime in hours for failure mode i and system j determined in FMEA.

EDTj is the total downtime in hours for system j.

EGP is Egyptian Pounds (1 USD = 8.9 EGP at the time of data collection)

Hij is the maintenance task duration in hours for failure mode i and system j.

MCj is the total maintenance cost for system j.

PHy is the number of patients served per hour for hospital unit y.

Pij is the probability of failure for failure mode i and system j.

UPtotal is the total number of unserved patients.

Xij is the maintenance interval for failure mode i and system j.

17 | P a g e
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List of Tables
Table 1: Impact of key hospital systems on health care service delivery
Table 2 Recommended maintenance approach and durations for medical gas system as a

result of the FMEA analysis

Table 3 Recommended maintenance approach and durations for primary HVAC system as a
result of the FMEA analysis
Table 4 Probability of medical gas system failure with optimal inspection interval for system
components
Table 5: Maintenance plan for primary HVAC system

Table 6 Optimal maintenance budget allocation across hospital systems

Table 7 Comparison of performance-based maintenance costs

20 | P a g e
 Hospital Secondary
Elevators Primary HVAC Medical Gas
Unit HVAC
High - Primary HVAC
serves ICU and OR
High- Patients will not be
directly due to their
able to access ICU. None - Served by
Intensive special needs. Failure
Patients already admitted primary HVAC
Care Unit will directly impact
to the ICU will not be system
unit function and may
impacted.
lead to total
suspension of services.
None-Emergency room is
typically located on the
None - Served by High - may lead to
Emergency ground floor. As such its
secondary HVAC total suspension of
Room function is not impeded High -
system services
by failure to the elevator Directly
system. affects the
High - Primary HVAC ability of unit
High-Patients will not be to provide
serves ICU and OR
able to access the OR. services to
directly due to their
Due to the limited time None - Served by patients
Operating special needs. Failure
spent by patients in OR, primary HVAC
Room will directly impact
frequent access and system
unit function and may
egress is expected and
lead to total
impact is considerable.
suspension of services.
Moderate-Some patients
Moderate - may
may not be able to access
lead to
their rooms. This will None - Served by
Regular inconvenience
depend on their degree of secondary HVAC
Room and/or partial
mobility. Patients already system
suspension of
in their room will not be
services
impacted

21 | P a g e
Failure Failure Mode Maintenance Minimum Maximum Maintenance
Code Approach P-f P-f Task
Interval Interval duration (h)
(days) (days)
MG-1 VIT crack Predictive 120 210 4
MG-2 Evaporator crack Maintenance 90 120 2
MG-3 Control Valves 30 60 2
wearing
MG-4 Safety Valve failure 30 60 2
MG-5 Super-heater crack 15 30 4
MG-6 Regulators high 30 60 1
flow rate
MG-7 Inlet Filter 120 150 1
saturation
MG-8 Carbon Filter 120 180 1
saturation
MG-9 Bacterial Filter 90 120 1
saturation
MG-10 Relief Valve 30 60 2
spring’s failure
MG-11 Tanks drain 10 30 2
Dryer coil’s crack 90 120 2
MG-12 High flow rate of 30 60 1
reducer

22 | P a g e
Failure Failure Mode Maintenance Minimum Maximum Maintenance
Code Approach P-f P-f Task duration
Interval Interval (h)
(days) (days)
HV-1 Ripped/torn filters Predictive 5 10 1
Maintenance
HV-2 Cooling coil 5 10 3
rupture
HV-3 Leakage of Freon 60 90 2
pipe
HV-4 Defective fan belt 30 60 2
HV-5 Bending of shaft 20 45 2
HV-6 Bearings fatigue 30 60 2
HV-7 Improper 60 90 1
lubrication of
bearings
HV-8 Impellers fatigue 60 90 2
HV-9 HEPA filter leaks 10 25 1.5
HV-10 Pre-filter Scheduled N/A N/A 1
saturation Restoration
HV-11 Secondary filter Scheduled N/A N/A 1
saturation Discard

23 | P a g e
Probability Inspection Interval (days)
of failure
Vacuum Evaporator Control Safety Super Regulator Inlet Carbon Bacterial Relief Air Dryer Pressure
insulated Valve Valve heater Filter Filter Filter Valve Receiver reducer
tank tank
5% 124 92 31 31 8 32 121 123 92 31 11 92 32
10% 129 93 33 33 9 33 123 126 93 33 12 93 33
15% 133 94 34 34 10 34 125 129 94 34 13 94 34
20% 138 96 36 36 12 36 126 132 96 36 14 96 36
25% 142 97 37 37 13 38 127 135 97 37 15 98 37
30% 147 99 39 39 14 39 129 138 99 39 16 99 39
35% 151 100 41 40 15 40 130 141 100 41 17 100 40
40% 156 102 42 42 16 42 132 144 102 42 18 102 42
45% 160 103 44 43 17 43 133 147 103 43 19 103 44
50% 165 105 45 45 18 45 135 150 105 45 20 105 45
55% 169 107 46 46 20 47 137 153 106 47 21 106 46
60% 174 108 48 48 21 48 138 156 108 48 22 108 48
65% 179 109 50 50 22 49 139 159 109 49 23 109 49
70% 183 111 51 51 23 51 141 162 111 51 24 111 51
75% 187 112 53 52 24 52 142 165 112 52 25 112 52
80% 192 114 54 54 25 54 144 168 114 54 26 114 54
85% 196 115 55 55 27 55 145 171 115 55 27 115 56
90% 201 117 57 57 28 57 147 174 117 57 28 117 57
95% 205 118 58 59 29 58 148 177 118 58 29 118 58

24 | P a g e
1
Component Failure mode Optimal inspection Practical inspection
intervals intervals

HEPA Filter HEPA Filter leaks 14 days 15 days

Pre-filter Torn Filter 20 days 20 days

Secondary Filter Torn Filter 19 days 20 days

Blower Bearing improper 18 days 20 days

lubrication

Cooling Coil Freon gas pipe leaks 37 days 40 days

Blower Defective fan belt 43 days 40 days

Blower Shaft bent 31 days 30 days

Axial Blower Bearing improper 28 days 30 days

lubrication

Blower Ball bearing fatigue 60 days 60 days

Blower Impellers Fatigue 62 days 60 days

Axial Blower Defective fan belt 43 days 40 days

Axial Blower Bent Shaft 60 days 60 days

Axial Blower Impellers Fatigue 83 days 80 days

Axial Blower Ball bearing fatigue 77 days 80 days

Page | 25
8

Item Elevators Primary Secondary Medical Gas

HVAC HVAC
% of Budget 16.4% 26.2% 49.7% 7.7%

% of Max maintenance cost required 97% 76% 49% 99%

Amount allocated (EGP) 246,026 365,650 745,315 115,000

Expected Down Time (hours) 12 6 25 10

Number of patients impacted (per year) 50 17 56 67

Page | 26
 9

Maximum
Downtime Vendor Cost Model Cost
System (h/year) (EGP/year) (EGP/year) % Savings
50 320,000 270,000 16%
Primary HVAC 100 280,000 250,000 10.7%
System 150 250,000 235,000 6%
50 230,000 204,000 11.3%
100 190,000 170,000 10.5%
Elevators 150 160,000 150,000 6.3%
Medical Gas 10 128000 115,651 9.64%
Systems 24 118000 107043 9.29%
10
11

12

13

Page | 27