mr. t karthik chandra

L&T CONSTRUCTION B&F EDRC - CHENNAI

India Advantage

Healthcare revenue in India is set to reach USD160 billion by 2017; expenditure is

likely to expand at a CAGR of 15.2 per

cent over 201117.

Rising incomes, greater health awareness, lifestyle diseases and increasing access to

insurance will contribute to growth.

Investment in healthcare infrastructure is set to rise, benefiting both hard

(hospitals) and soft (R&D, education)

infrastructure.

Medical tourism is emerging as one of the most lucrative investment areas in the

country.

Availability of a large pool of well-trained medical professionals in the country.

India has an advantage over its peers in the West and Asia in terms of cost of high-

quality medical services offered.


The government aims to develop India as a global healthcare hub

Policy support in the form of reduced excise and customs duty, and exemption in

service tax

Initiatives like NRHM would boost healthcare in rural areas

2011

Market

value:

USD

68.4

billion

2017 Market

value:

USD

160

billion


Hospitals Pharmaceutical

Market Revenue Breakup

Source: Hospital Market India by Research on India, Aranca Research

Diagnostics Medical

Equipment

Medical

Insurance

Segments of Health Care Industry


Inadequate for serving the needs of growing population. Efforts are made up to create Infrastructure and to provide Manpower. Build up Appropriate linkages between the various centers.

Sub centers 137271 nos. Dispensaries 27400 nos. Primary health centers 22971 nos. Community health centers 2935 nos. Hospitals 15097 nos.


HOSPITALS:

Government Hospital 4475 nos. 375987 Beds Charitable Trusts Hospitals 335 nos. 19677 Beds Private / Corporate Hospitals 10289 nos. 228155 Beds

TOTAL 15099 nos. 623819 Beds

HOSPITAL BEDS TO POPULATION RATIO:

DEVELOPED COUNTRIES

USA - 3:1000 UK - 3:1000 GERMANY - 8.3:1000 FRANCE - 6.6:1000 ITALY - 3.5:1000 CANADA - 3.2:1000 CHINA - 3.8:1000 SWEDEN - 2.7:1000 JAPAN - 13.7:1000

India - 0.9:1000

Source: Central Intelligence Agency


DOCTORS TO PATIENT RATIO:

DEVELOPED COUNTRIES

USA - 2.42/1000 UK - 2.77/1000 GERMANY - 3.69/1000 FRANCE - 3.38/1000 ITALY - 3.8/1000 CANADA - 2.07/1000 CHINA -1.46/1000 SWEDEN - 3.8/1000 JAPAN - 2.14/1000

India - 0.65/1000




STRONG ECONOMY:

$4.99 Trillion dollar economy. 4th largest economy in the world. 56.9% of GDP from service sector. 25.8% of GDP from industry sector.

STRONG ENABLERS:

Economy expected to grow at around 6% + annually. Young employable human resources. A market of 1,236,344,631(JULY 2014 EST.) Population.

OVERVIEW:

Indian healthcare market expected to touch USD 160 billion crores by 2017. Annual growth rate of 15% for the next 15 years.

India needs to add 80000

hospital beds each year for

next five years

India, emerging as a most

favored destination in medical

tourism


In a nut shell, it is clear evident that

900 MW plus (approx.) is required to

be generated every year to cater to the

anticipated growing demand of

4,00,000 plus beds 5 years down the

line in India.

Sector Total (in MW) % of total

Central Govt. 66,997.94 28.64%

Private 76,095.30 32.53%

State Govt. 90,836.70 38.83%

TOTAL 2,33,929.94 100.00%

Actual power supply position in terms of peak demand met during the year

2011-12 in India

Peak demand in MW Peak met in MW Surplus / Deficit

in MW in %

1,36,006 1,16,191 -13,815 -10.6


Given the backdrop of the power scenario, the way out to resolve the crisis is to reduce the demand to match with

the available supply.

As there remain a lot of social issues in bringing down the existing demand, the fresh demand that is being added

into the system should be managed.

Rational use requires that we obtain maximum efficiency from the energy consumption and from the facilities

required for the generation and distribution of such energy.


It has put onus on the companies developing the countrys infrastructure to bring down

the carbon footprint of the new immovable assets coming up in the country.

Power saving is equal to Power generation.

Necessity & Effective Implementation of energy conservation

measures to reduce the energy demand.

Exploring utilization of same materials for various purposes to the

maximum extent and Usage of extra/new materials will be

greatly reduced.


Power requirement for different electrical

appliances and installations for a typical

Health care building as stipulated by

National Electrical Code (NEC).

Re-arrangement of these loads by altering

the loading factors explained down the line

and witnessed the power savings possible.

Proportions of various loads & Power requirement in Health care buildings


DG SET -1

SECTION - 1 SECTION - 2

AMF CUM SYNCHRONIZING PANEL

i. LIGHTING

ii. SMALL POWER

iii. AHU PUMPS

iv. VENTILATION FANS

v. MONOBLOC, SOLAR HOT WATER

SYSTEM,DRINKING WATER COOLER ,OWC

vi. STP,WTP & RO PLANT

vii. SWIMMING POOL TREATMENT UNIT

viii. SEWAGE PUMPS

ix. SERVICE BUILDING LOADS LIGHTING &

SMALL POWER

x. KITCHEN LOADS

xi. CHILLERS

xii. FACILITIES LIGHTING

i. LIFTS

ii. PRIMARY PUMP , SECONDARY PUMP, CONDENSER

PUMP & COOLING TOWER LOADS

iii. HYDROPNEUMATIC & BOREWELL PUMPS

iv. FIRE PROTECTION SYSTEM

v. EXTERNAL LIGHTING

vi. CHILLERS

CBS UPS

B/C

CBS - CENTRAL BATTERY SYSTEM

ELV - EXTRA LOW VOLTAGE

UPS - UNINTERRUPTABLE POWER SUPLLY

EMERGENCY LIGHTING

i. BUILDING UPS LOADS

ii. IT & ELV SERVER

B/C SECTION - 3

ELECTROMEDICAL

EQUIPMENTS

DG SET -2 DG SET -3 DG SET -4

B/C AMF CUM SYNCHRONIZING PANEL

Transformer -1

GRID SUPPLY

Transformer -2 GRID SUPPLY


DG SET -1

SECTION - 1 SECTION - 2

AMF CUM SYNCHRONIZING PANEL

i. LIGHTING

ii. SMALL POWER

iii. AHU PUMPS

iv. VENTILATION FANS

v. MONOBLOC, SOLAR HOT WATER

SYSTEM,DRINKING WATER COOLER ,OWC

vi. STP,WTP & RO PLANT

vii. SWIMMING POOL TREATMENT UNIT

viii. SEWAGE PUMPS

ix. SERVICE BUILDING LOADS LIGHTING &

SMALL POWER

x. KITCHEN LOADS

xi. CHILLERS

xii. FACILITIES LIGHTING

i. LIFTS

ii. PRIMARY PUMP , SECONDARY PUMP,

CONDENSER PUMP & COOLING TOWER LOADS

iii. HYDROPNEUMATIC & BOREWELL PUMPS

iv. FIRE PROTECTION SYSTEM

v. EXTERNAL LIGHTING

vi. CHILLERS

CBS UPS

B/C

CBS - CENTRAL BATTERY SYSTEM

ELV - EXTRA LOW VOLTAGE

UPS - UNINTERRUPTABLE POWER

SUPLLY

EMERGENCY

LIGHTING

(90 MINUTES)

i. BUILDING UPS LOADS

(30 MINUTES)

ii. IT & ELV SERVER

(30 MINUTES)

B/C SECTION - 3

DG SET -2 DG SET -3 DG SET -4

B/C AMF CUM SYNCHRONIZING PANEL

Transformer -1

GRID

SUPPLY

Transformer -2 GRID

SUPPLY

ELECTROMEDICAL

EQUIPMENTS


Lighting system

Elevators

Electro-medical and its allied systems

Exploring same materials for multi use

and using of new materials are greatly

reduced.

Building Management Systems (BMS)

ELV systems


Designed to automatically manage a daily rhythm of light, promoting sleep-wake rhythm.

For better look out and healing environment, a colour rendering property and light reflectance values (LRV) shall

be ensured.

High Energy efficient light fixtures such as CFL, FTL (T5 lamps) and LED type pendant light fixtures in operation

theatre (replacement of Metal halide light fixtures) are

mostly used across these buildings,

The luminous efficacy i.e., Lumens per watts is increased without compromising the Illumination requirement in a

particular location.

SPECIAL CONSIDERATIONS:

Sustainable Lighting Solutions for a Healing Environment in patient

rooms

CONCEPT:


A Centralized lighting control system is used to control the

light fixtures in common

areas like corridor, Lobby,

etc. across various floors in

the multi-storey hospital

building.

The centralized lighting control panel can be

integrated with centralized

BMS system interfaced via

Programmable Logic

Controller..

Remote operation via BMS provides an integrated

approach to control and

energy management.

LPD of 0.8 to 0.9 and total power load percentage of 6.5

to 7.5% is achieved against

the requirement of 25% for

lighting load from the total

power requirement.


Elevator is a mechanical device which is used for vertical

transporting of people or goods from one level to another.

This is treated as one of the lifesaving element.

Gearless types elevators are emerged as effective one and control drive with VFD working in closed loop system.

This paves a way to reduce the energy requirement much appreciable value due to the advantage of requiring a less

powerful motor to turn the sheave.

This type of Elevators is proved to be efficient in terms of operating speed as well.

This way, the power requirement has been brought down to 4% from the total power requirement against 15%.

Passenger lifts. Bed lifts. Service lifts. Dumb waiters


Public Health Engineering (PHE) system, as a part of waste management system and infection control, an

amount of power is required to carry out certain

activities like Sewage treatment plant, Water treatment

plant and other treatment plant for radioactive wastes,

Infectious waste, etc.

This contributes to 10% of the total power load.

It is necessary to explore Energy efficient equipments such as selecting maximum efficiency between 70% to

80% for pumps/motors and Solar geysers/heaters for hot

water supply network with Electrical power back up.

Sewage treatment plant


Water &

landscape pumps

hot water boiler

ro plant

Solar geyser

Power requirement

has been brought

down to 4% from the

total power

requirement against

10%.


Medical equipment also known as Life support is

designed to aid in the diagnosis and is used greatly to

maintain a patient's bodily function.

Monitors to measure patient vital signs and other parameters.

Most of them of Electro medical installations are of sensitive electronic equipments.

In a hospital building, Electro medical & its related installations contribute to 20% approx. of the total power

requirement in that building.

This Power electronic equipments are susceptible to mis-operation caused by harmonic distortion.


The degree to which harmonics is determined by the susceptibility of the load (or power source) to them. The most susceptible type of equipment is that whose design or constitution assumes (nearly) perfect sinusoidal

fundamental input. CASE STUDY

Voltage variation Current variation

At Transformer Incomer Feeder,

Observed 230 volts to 236 volts which is normal as per

the standards variation. Observed1147amps to a max. of 1485 amps, Neutral

current 1068 amps to 1550 amps & led to system

unstable.


Power Factor Total Harmonic Distortion

The power factor is read between 0.84 to 0.89 against

the desirable value of 0.95 & more.

THD (I) is 5 to 6% and THD (V) is about 1.6% which

is quite normal as per the IEEE 519.


Voltage variation Current variation

At Medical equipment feeder,

Observed 234 volts to 238 volts which is normal as per

the standards variation. The phase current is about 40 amps in all the three

phases and the neutral current is about 230 amps which

is not advisable as it leads to unstable of the power

system.


Power Factor Total Harmonic Distortion

The power factor is read between 0.84 to 0.96 against

the desirable value of 0.95 & more.

THD (I) is 40% and THD (V) is about 1.4% which is

quite normal as per the IEEE 519.


Non-linear medical equipment's and sensitive loads like CATH lab, MRI CT scan, LINAC, PET

CT, etc. loads should be designed such that to have

separate impedance.

Using a separate feeding circuit for separate loads can reduce shared impedance and minimize load to

load interference.

Load balancing should be achieved for better and efficient operation such that life cycle of the

equipment's installed can be ensured very high.

Shared impedance circuit


Focusing on higher percentage of

84% towards Electricity calls for

Automation, wherein Energy

conservation is possible.

Proportions of Overall Energy

Consumption in a Typical

building

Monitor consumption

Control usage Save money

Lower risk of illness

(sick building syndrome)


Alarms for faulty equipment High Efficiency in operation Reduction in maintenance

staff

Lower emissions Reduced green house gas Usage of lesser fossil fuel


A Building Management System,

which is PC, based Management

system used in a building with /

without graphic interface for various

utilities for,

Central control & monitoring of various

Parameters.

Energy data management. Alarm management. Data management. Scheduling Preventative

maintenance.

Energy optimization. Minimum downtime.

Optimized man power, Control usage, Improved comfort. Flexibility in information availability via web link/Internet/Intranet. The health care buildings are designed by integrating other ELV systems like Nurse call system,

Hospital Management System, CCTV, Public Address system, CATV system, Data/LAN network

system, Telephone and EPABX system to make the operation & facilities much more user friendly and

for operational excellence.

BMS architecture

10/100/1000 Mbps

LAN

Printer

IBM

S

Serve

r

ACS

Workstat

ion

IBMS

Workstat

ion

CCTV Monitoring CCTV

Storage PA

Control

ler

Modbus BACnet LON

Building Manager

ACCESS

Controller

(Typ.)

Security System Manager

Cameras

(Typ.)

Life Safety Manager

Fire

Alarm

Control

Panel

Remote

Call

Station

Amplifier

LOC: HOSPITAL

COMMAND CENTER


Chillers Fans

PHE Pumps Fire Pumps

BTU

Meter,

Water

Meter

Unitary

Controller -

Integrator

(Typ.)

LOC: CONTROL ROOM

Third Party

Integration

1. Lift

2. VFD

3. CPM AHUs

General

Purpose

Controller -

DDC (Typ.)

Field

devices

Security System Network (10/100 Mpbs LAN)

BMS Workstation


Building Management system is provided for

Automated Control & Monitoring of HVAC Systems

Automated Control & Monitoring of PHE Systems

Monitoring of Fire Fighting Systems

Monitoring of Electrical Panels

Energy Billing (Yearly/Monthly/Daily)

Proposed Building Management System

will have following components;

IP Master DDC

Integrators

Felid Equipments

BMS Workstation


PCMS System has been designed for the Control and Monitoring of all main electrical panels(HT Panel,LT panel, Main

distribution panels.)exclusively;

Dedicated system for Electrical systems control & monitoring apart from BMS

Electrical Panels

DG

Lighting control

UPS

The system will have dedicated monitor for Control & Monitoring.

This system will integrate with IBMS software for Critical alarm monitoring through IBMS Screen.


BMS

Control & Monitoring of HVAC & PHE

Monitoring of Fire fighting systems

People count through Turnstile integration

PCMS (POWER CONTROL MONITORING SYSTEM)

Critical alarms from PCMS

Energy Management systems

Monitoring of Various Resources like Power, Water & Gas

Security systems

Critical alarms from CCTV & Access control systems

Safety systems

Monitoring of the healthiness of Fire Alarm & PA systems

IBMS Software is considered to integrate between various subsystems software's.


Hospital Management System Nurse Call system

Telephone & EPABX system Public Address system


Structure Earthing System and Equipotential Bonding A Structural steel bar is identified (among various existing rods) in the column and slab to make the required Grid /

Mat to achieve the step and touch potential.

Structure Earthing forms the faradays cage for the Entire building.

To be continued

TOUCH POTENTIAL STEP POTENTIAL

Precautionary measures to be taken:

Re-bar steel at beam/column/pile/pile cap level identified as part of structural earthing shall be maintained completely dry and clean.

In order to prevent rust/corrosion of that steel, it shall be painted with non-rusting primer and finished with not less than two stove enamel coating (finish can be with light grey with RAL standard color) throughout

the length.

EARTHING & BONDING OF SUBSTATION EARTHING & BONDING OF TECHNICAL

ROOMS


Interconnecting arrangement of structure rebar at piles & Columns.

DETAIL 1-1



DETAIL-2

For single sided welding, minimum

length of 100mm

shall be

maintained.

For double sided welding, minimum

length of 55mm

shall be

maintained.


Continuity

maintained

by welding

of

reinforceme

nt rods


Reinforcement steel is used for forming Grid/Mat as per the Calculation in order to meet the required Step and Touch Potential.


Earth strips laid below plinth

level to create low impedance

path

Earth grid formed as

per calculation


Interconnecting strips

are being joined using

DC welding to make

Grid formation

Earth rod of 3 mtrs being

driven at the junctions/

interconnecting strips

Earth rod is being joined

together with grids to enhance

the low impedance path to

meet out the required Step &

Touch potential as per design


STEP-1 Identified rod in on

Pile for structural

Earthing marked

using green colour

tape.

STEP-2

16mm non

reinforcing

rods used for

linking

linking the adjacent piles using non

reinforcing rod (16mm)

STEP-3 STEP-4

Distance between the two

identified pile rods is

measured

Identified

Pile rod for

Structural

Earthing

The length of

welding seam min

100mm (for single

side welding) and

min 55mm

(Double side

welding).

MAKE WELDING ON THE

CONNECTIONS


STEP-5 Link from

pile rods to

column.

Link

between

two

column

rods

Linking of column and pile rods

using 16mm reinforcing rods and

make welding at that points Green colour marking on

column rods used for

Structural Earthing

After the completion of concreting the particular column

rods are marked using green color tape for easy

identification.

STEP-6


Tangible benefits:

Equipment's operating within the building is highly protected against damage due to lightning protection as

well (Faradays cage).

Reliability is very high. Savings in materials usage. Since the requirement of Cu. Earth strip and Earth

Electrode is greatly reduced, cost incurring for the same

will be avoided.

Capital cost and Running cost is significantly reduced. No. of Activities involved for the system during

execution is very less.

To be continued.


Intangible benefits:

No. of Activities involved for the system during execution is very less.

Reduction in significant time is possible.

No additional external space is required for laying Earth pits.

Aesthetically the external environment can be maintained with high profile.

Clash free coordination with other services are easily possible which in turn saves design time significantly.

Possibility of theft is averted during construction.

Maintenance of Earth mat is not required to be done at regular intervals as like conventional Earth Electrodes.


Fire responder station at main Security

cabin at entry

Fire Alarm panel at

control room Repeater panel at

Reception

Fire Alarm panel at

Reception

Fire Alarm

panel for partial

Zone

Repeater panel at Partial Zone

Repeater station located

for Partial Zone

To BMS

Fire Alarm panel for

Service building


In a Nut shell, Re-arrangement of these loads by altering the loading factors is demonstrated.

Re-arrangement Proportions of various loads & Power requirement in

Health care buildings


Efforts are being taken for a further reduction in the power demand without compromising the energy

requirements by adopting innovative techniques.

Mammoth Targets Ahead

Its all about Imagineering L&T CONSTRUCTION

mr. t karthik chandra

Documents

hospital market india

years india

beds hospital beds

market value

indian healthcare market

healthcare infrastructure

hard hospitals

beds total