By Tanya Olckers with technical input from Kamva Ndlala, engineer with Maninga Engineering

Chris Hani Baragwanath Academic Hospital recently built an adult burns intensive care unit (ICU) that needed some special plumbing aspects for patient care.

(from left to right) Daniel Delport, Lungelo Sibande, Kamva Ndlala,Sikhulile Nhassengo

(from left to right) Daniel Delport, Lungelo Sibande, Kamva Ndlala, Sikhulile Nhassengo (from left to right) Daniel Delport, Lungelo Sibande, Kamva Ndlala, Sikhulile Nhassengo. Images supplied by Maninga Engineering

A bodily injury that is devastating to the patient: burns. Many incidents involving burns to an individual are life changing to say the least. Above all, these patients need highly specialised care during their recovery.

Patients recovering from burns to their bodies need different care to those recovering from surgery. There are specific environmental conditions needed because they have lost the protective layers of their skin that affect the body’s ability to regulate its internal temperature. Hypothermia can affect most patients. This makes temperature, humidity control, and other aspects of patient care, critical. Therefore, it is vital to maintain higher levels of temperature and a minimum of 50% relative humidity since hypothermia can increase the patient’s risk of death.

Chris Hani Baragwanath Academic Hospital has opened a state-of-the-art adult burns unit. The project was funded by a donation from University of Witwatersrand alumni. “Meticulous coordination among the Maninga Engineering team and various consultants and contractors was imperative as the project encompassed the full suite of mechanical engineering services (such as, wet services, medical gases, lifts, and HVAC systems) designed by Maninga Engineering, “Managing these disciplines ensured seamless integration and adherence to project timelines,” says Kamva Ndlala, the lead engineer with Maninga Engineering.

“We designed the burns unit using international guidelines due to the lack of local standards. In these burns units, the temperature is kept between 26°C and 28°C, and the humidity is set between 50% and 60%.” This is much warmer and more humid compared to regular hospital rooms. As a result, the HVAC systems for these units were specially designed to maintain these conditions consistently, ensuring a safe and effective environment for burn patients.

The level of thermal comfort varies depending on the type of clothes worn; the movement of air around the person; the heat of surfaces in the immediate surroundings; moisture contained in the air; and the metabolism rate (which includes the layers of skin) all contribute to the temperatures felt by the patient. It is not just a case of putting the patient into any available room.

Of course, the ICU has to be maintained as a sterile environment so that patients don’t succumb to infection – something which is especially dangerous in burn victims. To maintain the desired temperature, humidity and level of sanitation required, both plumbing and HVAC had to be scrutinised.

Detailing the integration of plumbing solutions, Ndlala highlights the use of a calorifier for efficient steam utilisation in water heating. “The calorifier, akin to a large geyser, harnesses steam from the hospital’s boilers to produce hot water. The hot water is circulated around the facility through a multilayer pipe composed of PE-RT and aluminium.”

Piping reticulation

Piping reticulation

The hot water system was designed to avoid creating any ‘dead legs’ that could reduce the effectiveness of the hot water circulation. Recirculating hot water is crucial in hospitals as it ensures that hot water is always available at the right temperature for sanitation, patient care, and comfort. The design ensures a consistent temperature throughout the system is maintained, prevents delays in getting hot water, and minimises the risk of bacterial growth in the water supply.

The project started in 2022 with the demolition of the pre-existing burns unit. Work continued until 2024. Back up water installations had to be done, and these needed to be filtered and purified from the back up tank to remove dissolved substances such as chlorine and byproducts thereof. The back up water installation allows for continuous operation of the ward, crucial for both operational efficiency and patient care during water shortages.

“A lot of thought went into providing consistent hot and cold water due to the special needs of a burns ICU and burns patients. “It was of utmost importance that a system with minimal maintenance requirements was implemented – ensuring a sustainable solution for the current hospital staff and future,” Ndlala says. Doctors and nurses were provided with showers and private ablution areas. Patients were provided with hand basins in their wards due to ICU patients generally not making use of baths and showers.

Piping was changed from copper pipes to multilayer pipe composed of PE-RT and aluminium. This meant getting the best of both plastic and metal piping systems. The substantial aluminium layer also provided stability and mechanical strength.

Throughout the project, collaboration with structural engineers and other consultants was pivotal. Ndlala highlights the seamless coordination with external partners in achieving project milestones through clash detection and general design philosophy.

Critical to the design and energy efficiency, was a pre-existing boiler at the hospital. The boilers vast capacity as a strategic advantage, Ndlala explains, “The hospital’s boilers, originally used for water heating, proved instrumental in our humidification strategy. By utilising steam from these boilers, we minimised additional electrical load and ensured consistent, isothermal humidification in the HVAC air handling unit which was essential for maintaining air temperature stability and system reliability.

“To manage energy consumption effectively, we integrated a steam-to-steam humidifier. This innovative approach leverages existing hospital infrastructure, such as boilers, to minimise additional electrical load,” says Ndlala.

Ndlala highlights the project’s focus on sustainability and cost-effectiveness. “We aimed to integrate sustainable solutions that make the most of existing resources. Our system design had to consider cutting operational costs but also improves reliability by keeping control mechanisms simple, particularly in humidification during winter.

Reflecting on the project’s challenges, Ndlala cites space constraints as a significant hurdle. “Despite building from scratch, space limitations posed logistical challenges, particularly for accommodating the required pipe routing. While the initial design accounted for technical requirements like centrally placed steam, hot water, and potable water main piping to streamline piping placement—a critical factor in the maintenance strategy of the ICU environment – on-site realities often presented unforeseen obstacles.”

Ndlala recounts one such challenge: “A misplaced pipe required careful coordination among contractors to ensure minimal disruption. However, the main issue was a face brick wall that initially hindered airflow from the plant room to the ICU. Fortunately, once removed, internal installations proceeded smoothly.”

The huge colorifier

The huge colorifier

The HVAC stuff

Healthcare facilities need an accurate and higher air change rate even if they are similar to other structures. Healthcare facilities need air circulation that is preferably free of contaminants. If the air is appropriately positioned and filtered where necessary, it can be regarded as being free of contaminants.

“We opted for hybrid air handling units with a three-stage filtration system,” says Ndladla regarding the HVAC system. “This includes primary, secondary, and tertiary (HEPA) filters to ensure the air is free from contaminants, especially crucial in an ICU environment. We also installed Variable Refrigerant Flow (VRF) units to aid in the conditioning of the air.”

The project also grappled with energy efficiency challenges, particularly in humidification during winter. “To manage energy consumption effectively, we integrated a steam-to-steam humidifier. This innovative approach leverages existing hospital infrastructure, such as boilers, to minimise additional electrical load,” says Ndlala.