Dr George Mkhari hospital after the upgrade, which includes the HCU and ICU

Consulting engineering and infrastructure advisory firm Zutari has registered the first Green Star-rated hospital in South Africa. “With regard to sustainability, we have an excellent track record in green building, with over 100 registrations to date,” comments Mechanical Building Services Associate, Willie Kotze.

When Rand Merchant Bank’s South Africa Pandemic Intervention and Relief Effort (SPIRE) fund required assistance to boost the country’s critical care capacity during the Covid-19 pandemic, it turned to Zutari.

The consultancy assisted with heating, ventilation and air-conditioning (HVAC) upgrades at Livingstone Hospital in Gqeberha, Eastern Cape and King Edward VIII Hospital in Durban. Zutari was also tasked to completely refurbish the High Care Unit (HCU) and Intensive Care Unit (ICU) at Dr George Mukhari Hospital in Ga-Rankuwa, Gauteng.

The company’s scope of work was structural, electrical electronics, wet services, fire engineering and HVAC. The timeframe was April 2021 to the beginning of 2022, with the HCU and ICU refurbishment running in parallel. However, the hospital had to maintain its ICU capacity due to Covid-19, meaning this portion of the project was extended to September 2022.

Like a private hospital

Technical Director Leon Esterhuizen, who has two decades’ experience in electrical engineering, explains that the refurbishment had to be designed in accordance with R158, the Department of Health’s specification for private hospitals.

“We carried out an assessment of the portion of the bulk infrastructure that supplied these wards to establish what was happening upstream.” In the end this portion, along with the electrical installation of the wards, was replaced completely to ensure compliance.

Fire engineering

In terms of fire engineering, being an ICU and HCU facility, critical patients must be evacuated in their beds by nursing staff or firefighting personnel in the event of a fire. Therefore, escape routes had to be widened to accommodate beds. In addition, the entire facility must contain the spread of fire and smoke.

The building was deemed to be non-compliant as the X-ray and HCU units were connected via ceiling boards, which meant a new firewall had to be constructed. There were numerous ramps throughout the site due to the high number of level changes, which required careful consideration of fire door placement and operation.

There were also various challenges in terms of the wet services installation due to the age of the existing infrastructure. To ensure plumbing installation of the two units was upgraded to modern standards, all new hot and cold-water pipe materials, with a new central hot water generating plant to SANS-XA, were installed.

No as-built information

“We had to try and reuse as much of the existing material as possible,” Leon points out. Instead of breaking down the entire structure and rebuilding it from the bottom up, Zutari came up with an elegant solution for lateral reinforcement of the brick walls by adding external fins. Another major challenge was the decades-old plant room, for which no as-built information was available, thus requiring a detailed assessment before work could commence.

HVAC was an important consideration regarding infection control via pressure cascading, air movement, humidity control, dilution and filtration. No water cooling was opted for, and no ozone-depleting refrigerants were used, while heat pumps were selected as opposed to resistance heating.

Critical coordination

“Coordination between the extensive number of services was critical to provide easy access for future maintenance,” stresses Leon. In addition, robust new systems provide simplified maintenance over the long term.

Despite the pandemic being over, Leon says that the healthcare sector presents major opportunities for Zutari’s specialised multidisciplinary skillset, especially in HCU and ICU facilities. “This is one of the most interesting and rewarding sectors in terms of engineering, as well as being essential to meet the healthcare needs of South Africa’s growing population,” he concludes.


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