# Economic and Environmental Impact of Energy Saving in Healthcare Buildings
## 2 Materials and Methods  
Between 2005 and 2013, an analytical study was performed in 12 hospitals and 70 healthcare centres belonging to the Public Health System in Spain, which were built between 1980 and 2005, all located in Extremadura, a region in the southwest of Spain. The original energy consumption of all those buildings was analysed by using the data collected through audits carried out during the period 2005-2012 by the Extremadura Energy Agency. The final energy consumption, after energy efficiency modifications, was obtained by considering the mean saving values for the following three years. The economic and environmental impacts of energy saving were assessed as well.  
The design conditions of the facilities were evaluated by analysing the building construction projects. Additionally, those architects and engineers responsible for the construction were interviewed for information purposes.  
The energy savings measures were assessed after some previous meetings with the hospital's maintenance engineers, which involved a detailed analysis of the records, the measurement of energy flows, individual surveys on energy consumption and monitoring of habits of patients, visitors, and staff as related to energy consumption in the building.  
For research purposes, the hospitals were classified into two categories: those with more than 5000 m\({}^{2}\), with hospitalization beds; and health centres without hospitalization beds, with less than 5000 m\({}^{2}\)[13].  
The average emissions of CO\({}_{2}\), sulphur dioxide (SO\({}_{2}\)), and nitrogen oxide (NO\({}_{\rm x}\)) were estimated as 331.0 g/kWh, 0.61 g/kWh and 0.4325 g/kWh, respectively [14]. Additionally, it was taken into account that 1 kWh of primary energy in Spain is equivalent to 2.368 kWh of final energy.  
To quantify the energy consumption in all healthcare building, network analysers, digital luxometers, flowmeters, combustion gas analysers, thermographic cameras, digital thermometers, hygrometers, and energy counters were used [15]. Field inspections were carried out to analyse the initial conditions and check the development of the implemented measures.  
To calculate annual consumption of gas and electricity, billings from supply companies were analysed [16]. The electric energy, domestic water heating (DWH), air conditioning systems (HVAC), lighting system, external enclosures, maintenance strategy and renewable energy generation were also analysed.  
The useful floor area of each hospital was regarded as that of the outer perimeter of a covered space, subtracting the constructive elements related to the building's closures, partitions, structure, and installations. Built and useful floor areas of the hospitals under study were obtained from the construction projects.  
In the course of the investigation, certain parameters were identified in the relationship between planned savings and other functional and operating costs for each healthcare building, such as construction year, construction surface area, number of workers, number of medical visits, and assistance activity, by means of mathematical techniques.