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How fast can a hospital be built in Hong Kong?

How fast can a hospital be built in Hong Kong?

By the Architectural Services Department of the HKSAR Government, China State Construction Engineering (HK) Limited and China State Construction International Medical Industry Development Co. Limited

 

 

No time to wait

Since the outbreak of COVID-19, the situation had not calmed down. Infectious cases leading to clinical demands for isolation facilities were higher than ever. The isolation facilities in existing hospitals were full and immediate action was critical.

 

The situation persists

A third wave of COVID-19 had been sweeping the city since July 2020. The surge in confirmed cases, was five times that of the situation in May/June 20201. There was an urgent need to relieve the pressure on isolation facilities in public hospitals and to enhance society’s ability to handle yet another wave of the epidemic. To this end, a temporary hospital1 which was later named the “North Lantau Hospital Hong Kong Infection Control Centre (HKICC)” was commissioned within just 16 weeks. With support from the Central Government1, an almost impossible task was successfully completed thanks to the collaborative efforts of the Government, the team of contractors and various stakeholders. ‘Thinking out of the box’ by applying innovation and technology (I&T) and collaborative efforts from stakeholders were crucial to the success of the project.

 

Self Photos / Files - 1

 

With only around 1,750 Tier I and Tier II isolation beds2 scattered among existing public hospitals as at August 2020, the need for additional isolation facilities was pressing. Commissioning around 800 additional isolation beds could alleviate the rising pressure on isolation facilities and increase Hong Kong’s ability to fight against the disease.

 

Despite the initial idea being set to provide a ‘temporary hospital’, the HKICC was neither a compromise or different in scale from any existing public hospital and it was designed and constructed up to the standards of permanent buildings in Hong Kong3.

 

In order to provide infectious disease isolation facilities which require round-the-clock operation, sufficient reliability, adequate resilience, and the ability to control infections as well as keep staff safe, the design  considerations for HKICC were no less than for any existing public hospital handling infectious diseases.

 

Self Photos / Files - 2

 

“A ‘temporary hospital’ should not and is not a compromise”

 

For such a fast and demanding project, developing successful early coordination through collaborative efforts among various stakeholders (the contractor, government bodies, statutory authorities, client, suppliers, etc.) was the cornerstone to completing this project. This was one of the major roles of the Architectural Services Department (ArchSD) which was tasked as the facilitator. Before commencing site works, key stakeholders including the main contractor, China State Construction Engineering (HK) Ltd (CSHK), the Airport Authority Hong Kong (as landlord), the Fire Services Department (FSD), the Civil Engineering and Development Department (CEDD), the Water Supplies Department (WSD), the Electrical and Mechanical Services Department (EMSD), the Transport Department (TD), the Highways Department (HyD), the Environmental Protection Department (EPD), the Lands Department (LandsD), the Labour Department (LD), the Marine Department (MD), the Hong Kong Police Force (HKPF) and CLP Power Hong Kong Ltd. (CLP) were fully engaged in providing advice on the planning, design and commissioning. Given the high complexity of the existing underground utilities at the site including high tension electric cables underneath which inhibited site utilisation, CLP was engaged in the first instance to divert the power cables within a very short time before commencing site works. In addition, the ArchSD had encouraged early coordination between the end user, the Hospital Authority, and the maintenance agent the EMSD to set criteria for the handover of the works in one-go by getting their involvement from the design to the commissioning stages.

 

This task might be unprecedented in local industry, but the challenges were not underestimated. Innovative thinking and the adoption of technology were the ways to overcome the constraints and allow the design and construction to run in parallel. The large-scale adoption of Modular Integrated Construction (MiC) and MultiTrade integrated Mechanical, Electrical and Plumbing (MiMEP) with the assistance of full Building Information Modelling (BIM), Virtual Reality (VR) and Augmented Reality (AR) technology, advanced and tightened site asset management and positioning systems. These were the keys to completing the HKICC project in just four-months’ time and fulfilling the stringent infection control requirements with robust building services installations.

 

Basic facts of the HKICC

HKICC sits on a site of area about 3 hectares, which was land originally reserved for future development of AsiaWorld Expo. The construction floor area is about 43,000 m2 and consists of:3

 

  1. six 2-storey Ward Blocks, providing over 800 negative pressure beds,
  2. a Central Medical Block with a pharmacy and laboratory providing nucleic acid testing services, and
  3. an Energy Center for a major BS plant

 

Design

 

Preparation of this fast-track project

Immediately after the Central Government’s support, extensive meetings and collaboration between Hong Kong and the Shenzhen Municipal Government were conducted to pave the way for implementation in August and September 2020. All works related to the design, procurement, logistics and construction had to be completed within an extremely tight schedule. But there were also numerous challenges that had to be overcome ahead of the project. Site related issues needed to be resolved including, land acquisition, the diversion of underground utilities, the relocation of the entrance to the bus terminus. Site logistics and precautionary measures had been set up including contingency plans for adverse weather in the typhoon season and ensuring worker’s safety in the uncertain epidemic conditions.

 

“‘Thinking out of the box’, the application of innovation and technology (I&T) and collaborative efforts from various stakeholders were essential for the success of the project.”

 

Collaborative efforts

Both the ArchSD and the CSHK worked collaboratively with all stakeholders to identify constraints and jointly work out solutions. Intensive meetings were set up with stakeholders. For critical items, several design options were prepared in advance to smooth the collaboration process. In view of the tight timing, various authorities were engaged at the beginning to agree and accept the design best suited to the statutory requirements. With these concerted efforts, and effective planning and logistic arrangements, all the required materials and equipment were procured and delivered on time for installation even though the pandemic had still not eased around the world and the city lock down severely affected the production lines and global traffic.

 

Self Photos / Files - 3

 

Building services systems

No compromise on design standards for the HKICC and full compliance with international medical and infection control standards were the prime design criteria and guiding principles for the building services design for the HKICC.

 

Air-conditioning and Mechanical Ventilation System

Isolation cubicles adopted the most stringent international infection controls and user operational requirements. Anterooms were provided for each isolation cubicle to serve as a buffer zone between the cubicle and the corridor. Uni-directional air flows by maintaining pressure differences were designed according to the international standard and guideline.

 

To enhance the resilience and reliability of the system, ‘N+2’ plug fans were designed for Primary Air Units (PAU) for the isolation ward cubicles. Each PAU served limited isolation cubicles so that any interruption due to maintenance or equipment failure could be minimised. The operation sequence of supplying air fans in the PAU, exhaust air fans for isolation bed cubicle were carefully considered so that interlocking control of the fans and the led operation of the exhaust air fans were designed with a view to ensuring the right pressure relationship between the cubicle, anteroom and the corridor. Differential pressure sensors were provided for real-time monitoring of the pressure relationship by the hospital.

 

Self Photos / Files - 4

 

In the selection of the refrigeration plant, time, reliability and maintainability were the key consideration factors. After considering the pros and cons of a central chilled water plant and direct expansion (DX) system, the DX type PAU was adopted. For the laboratory in the Medical Block, an independent exhaust system equipped with high plume jet fans with 100% standby provision were designed for the bio-safety cabinets.

 

Internet of Things (IoT) technology was incorporated in the Central Control and Monitoring System (CCMS) to provide remote control and monitoring of critical systems like the ventilation system for the isolation wards. A CCMS designed for web enabling allowed remote monitoring from the Internet when necessary. A strategically designed CCMS network backbone in a ‘ring’ arrangement enhanced the system reliability by minimising vulnerability to any network breakdowns at a single location. Besides being supported by emergency generators, secondary backup provisions like an uninterruptible power system (UPS) were equipped for critical control equipment serving ventilation fans for pressure control in isolation cubicles to further safeguard the continuity of the operation by minimising any single point of failure.

 

Promotion of MiC in public works projects

The DEVB promulgated Technical Circular (Works) No. 2/2020 set out the policy for the adoption of MiC for new building works with total construction floor areas (CFA) larger than 300 m2 under the Capital Works Programme (CWP) to be tendered on or after 1 April 2020.

 

It was considered that MiC would deliver major benefits in enhanced efficiency, a shortened construction period, improved site safety performance, better building quality, reduced construction waste, and less site labour as well as less construction nuisance, etc.

 

Electrical system

A highly reliable power supply to the HKICC was one of the critical considerations when coordinating the infrastructure at the design stage. With the quick assistance of CLP, two 11kV feeders from different power ‘ring’ networks were installed. Emergency generator sets were provided for essential power to meet the critical load of the hospital.

 

The locations of the main electrical plant rooms including the transformer rooms, low voltage switch rooms, and emergency generator rooms were strategically designed to be away from clinical areas to facilitate routine access for operation and maintenance. Raised levels were designed for these electrical plant rooms to minimise the risk of flooding. A water leakage detection system was installed in the water-sensitive plant rooms.

 

Interconnection and changeover facilities in the electrical system were installed to enhance the reliability and resilience of the power supply. Dual risers were equipped in the power distribution system for each Ward Block such that the risk of power interruption would be reduced. Each Ward Block was supported by two individual Central Battery Systems (CBS) for emergency lighting for resilience and to facilitate remote monitoring of the battery without having to enter the clinical areas.

 

The final circuit design followed statutory and user requirements. Inside the isolation ward bed cubicles of the Ward Blocks, a final circuit terminated at the bedhead trunking with built-in medical gas outlets and sockets for medical equipment. To suit the prevailing needs of patients using mobile communication devices, USB outlets were provided as mobile charging facilities. A Wi-Fi network for the patients was also installed by the hospital to facilitate communication.

 

Fire service system

The fire service (FS) system complied with the prescribed codes to suit the existing site conditions. In view of the extremely tight construction timing, the FSD and relevant stakeholders were engaged at an early stage to discuss and confirm the FS provisions. An improvised system was accepted for the sprinkler, fire hydrant and hose reel systems. To enhance the system reliability and minimise unwanted fire alarms during the operation of the hospital, multi-sensing type detectors were adopted in the clinical areas.

 

Lifts/ Vertical lifting platform/ Dumbwaiter

To answer the hospital’s operational needs, a stretcher lift and a vertical platform were designed for each Ward Block. For the Medical Block, a vertical lifting platform and a dumbwaiter were equipped for efficient transportation. With the collaborative efforts of various parties, the construction of lifts including a modular lift shaft were completed and inspected for use within four months.

 

Medical gas system

Three different types of medical gases including oxygen, medical compressed air and vacuum air were distributed with dual supply gas pipes to each Ward Block in a ring main network arrangement. An 11,000 litre Vacuum Insulated Evaporator (VIE) tank was installed to serve as the primary oxygen supply with a secondary backup by a gas cylinder manifold. Primary and secondary medical compressed gas networks were also provided for reliability.

 

Plumbing system

Dual incoming water supplies were arranged. Various water tanks including potable water, non-potable water, cleansing water, flushing water, and laboratory water in twin-tank arrangements fed different water supply systems through separate pumping systems to minimise the risk of cross contamination. A hot water supply was provided by instantaneous water heaters inside each block.

 

Drainage system

A two-pipe system (i.e. separate pipes for waste and soil water respectively) was employed to minimise the risk of cross contamination. Floor drains were connected to W-traps with refilling water pipes linking with the nearby sanitary fitments to enable effective water seals. A resealing trap was used for the isolation wards to eliminate the risk of the malfunctioning of any anti-symphonic valves leading to dirty air leakage.  Ventilation pipes were terminated 3 m above the roof floor level and at positions of restricted entry.

 

Self Photos / Files - 5Vertical transportation system at HKICC

 

Testing and commissioning

It usually takes months to conduct the testing and commissioning (T&C) for a hospital project. For the HKICC, the adoption of MiC and MiMEP facilitated earlier quality assurance procedures in the factory and shortened the on-site T&C time. For the isolation cubicles, a high degree of air-tightness was crucial for the effective operation of the ventilation system and to create negative pressure. It is always tedious and time-consuming to identify and locate defects if high leakage rates are found in the MiC module that is more than expected. Air-tightness tests were conducted for individual MiC modules in the factory and the final leakage inspections were carried out on site after assembly. The MiC pre-test arrangement contributed to the timely completion of the project at such a fast track pace. The ventilation systems were tested for uni-directional air flow and differential pressures were maintained between the corridor, anteroom and isolation rooms. A Differential Pressure Monitor was installed and tested to monitor the operating air pressure difference between the compartments.

 

Construction management

Challenges

It was a race against the time to complete this project with no compromises in terms of functionality and quality within an unprecedented short period of time. To meet the deadline, the CSHK adopted a variety of smart technologies to assist in the design and construction process. Building Information Modelling (BIM) became the key appliance for the success of the project. BIM was used for the design from the beginning of the project and for construction to facilitate real time monitoring of the site installation according to the plan. By applying MiC and MiMEP extensively, the quality control and construction process were greatly enhanced. Virtual Reality (VR) and Augmented Reality (AR) also assisted in finalising the construction details for accurate mass production and positioning for on-site installation.

 

MiC and MiMEP with full BIM

The design of the Ward Block was divided into various mass modules for MiC. Each typical ward cubicle comprised three MiC units. These units were prefabricated with major interior fittings and building services in the factory on the Mainland and fixtures were assembled with airtightness tests passed before being transported to the site for installation. The same procedures were repeated off-site and on-site until all MiC and MiMEP units were completely in place.

MiC units were manufactured in Zhuhai, China and delivered to Hong Kong for assembly. The construction progress was significantly expedited by paralleling the site preparation and off-site MiC unit construction at the factory. This made it possible for thousands of workers to work simultaneously both on-site and off-site in the Zhuhai MiC factory. For this, establishing close coordination and communication on logistics between the teams in Hong Kong and mainland China was essential.

 

Self Photos / Files - 6Isolation room construction by three MiC units

 

Self Photos / Files - 7Smart technology applications for design and construction

 

Self Photos / Files - 8BIM assisted site coordination at the site office

 

Self Photos / Files - 9MiMEP applications

 

VR and AR for installation appropriateness

Integrating VR with MiC/ MiMEP in the design was another innovative and key success factor in the project. By importing BIM modelling to VR, visualising the outcome and ‘inspecting’ the interior of each MiC/ MiMEP unit at an early stage in the design, it became possible to ensure detailed coordination before production. The defects commonly seen on site were minimised and resources were saved. 

 

With the assistance of AR, the process of on-site inspection was streamlined. The AR application combined the design BIM model with the actual site conditions for direct comparison and checking. Detailed information on each installed component could be shown on the portable device when carrying out the inspection. This provided great convenience and flexibility on inspection while any discrepancies in the design could be easily identified. For future maintenance, the BIM model could also facilitate the identification of building services components more conveniently.

 

Self Photos / Files - 10AR technology application – design BIM Model vs site condition to facilitate inspection (MEP)

 

Self Photos / Files - 11

AR technology application – design BIM Model vs site conditions to facilitate inspection (Building)

 

Self Photos / Files - 12Asset management information in AR device

 

New applications for manpower consuming activities

The CSHK set up a smart-site control system in the operation office of the project site. The system provided information and updates on the progress of the installation, workers deployment statistics, real-time CCTV images, security system status, and MiC production logistics, that the project team found useful for the management and supervision of the construction works. To facilitate monitoring, the system summarised the most important information and figures on site activities such as the number of workers, real-time site images, and logistic figures, to the control centre for smart site management.

 

Self Photos / Files - 13

Smart site management

 

Concluding key elements for fast construction of HKICC

It was not considered possible to build a public hospital equipped with infection isolation facilities in just four months from design to commissioning using traditional construction methods. ‘Thinking out of the box’ and the application of innovation and technology (I&T) and collaborative efforts from various stakeholders were essential for the success of the project. This fast-track project demonstrated that the application of MiC and MiMEP with full BIM can speed up the design process and shorten the construction cycle substantially from the planning stage. The use of a smart site management platform also facilitated real-time information flow at a glance. The experience of this fast-track project, clearly demonstrated that these technologies have raised design, construction and operation to new heights by offering an extremely efficient way of information exchange and collaboration. The remarkable performance of these technology applications has a high potential for wider application in the construction industry.

 

References

  1. HKSAR Government Press Release, 2 August 2020 & 7 August 2020. Available at: https://www.news.gov.hk/chi/2020/08/20200802/20200802_095438_576.html
  2. HKSAR Government Press Release (21 August 2020).
  3. DEVB-My Blog No. 427.
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