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DOI: 10.14738/aivp.91.9106
Publication Date: 20th November, 2020
URL: http://dx.doi.org/10.14738/aivp.91.9106
Applications of Distributed Electricity Generation Systems in
Hospitals
John Vourdoubas
Consultant Engineer
vourhome@otenet.gr
ABSTRACT
Distributed energy generation systems have currently increasing applications in many sectors due to
the resulted benefits. In the current study the application of distributed electricity generation systems
in hospitals is investigated. The energy consumption in hospitals in many countries varies between
254.9 KWh/m2 and 738.5 KWh/m2
. Various distributed energy generation systems have been
examined and their characteristics are mentioned. The fuels used in them are either natural gas or
renewable energy sources. Some energy systems generate only power while others co-generate heat
and power. Our results indicate that various distributed generation systems are mature, reliable and
cost-effective and they are currently used in health care centers. Others could be used in the future
after improvements in their technology and reduction of their cost. Use of the abovementioned
energy systems in hospitals would result in the increase of their sustainability, decrease of
conventional fuels used as well as in lower carbon emissions into the atmosphere. Taking into account
that the use of unconventional green energy sources in hospitals is currently rather limited our results
could trigger the increasing use of low or zero carbon emission energy sources in them contributing in
the global effort for climate change mitigation.
Keywords: co-generation of heat and power; distributed electricity generation; energy consumption;
fuel cells; hospitals; renewable energies.
1 Introduction
Distributed energy generation systems have many advantages and they find increasing applications in
many sectors. They often use renewable energies like solar and wind energy or very efficient energy
technologies like heat and power co-generation systems. Their advantages include higher grid
stability, increase of electricity security, increase of locally available renewable energies use, lower
use of fossil fuels and lower carbon emissions into the atmosphere. The majority of the hospitals are
currently using conventional energy sources and fuels like grid electricity and heating oil or natural
gas. Our current research is focused in the application of various distributed generation technologies
in hospitals. Some energy systems are already used in them while others could be used in the future
under specific conditions. The increasing use of distributed electricity generation systems in health
care centers is desirable, feasible and it is promoted with public policies for many environmental,
economic and social reasons. Our research is important since it offers a review of the distributed
electricity generation systems which could be used in hospitals. Some of these systems are mature,
reliable, cost-effective and they are already used in them. Others need technological improvements
in order to be used in the future while others could be used only under specific conditions. Since
hospitals are large electricity consumers the use of the abovementioned sustainable energy systems
in them would result in the reduction of their carbon footprint due to energy use. Additionally the use
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European Journal of Applied Sciences, Volume 9 No. 1, February 2021
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of these energy technologies in hospitals will assist them to contribute in the mitigation of climate
change which consists of the major environmental problem for humanity.
2 Literature survey
2.1 Energy consumption in hospitals
Gonzalez Gonzalez et al [1] have evaluated the energy consumption in German hospitals. The authors
mentioned that during 2005-2015 twenty three (23) public hospitals in Germany were audited
regarding their energy behavior. Their average annual energy consumption was estimated at 270
KWh/m2
, 14,370 KWh/worker and 23,410 KWh/bed. Hu et al [2] have estimated the energy
consumption and the energy cost in a large hospital in Taipei, Taiwan. The authors stated that its
annual energy consumption was at 259.45 KWh/m2
. They also mentioned that its highest monthly
energy consumption was recorded in July at 25.5 KWh/m2 while more than 50% of the electricity was
consumed in air-conditioning of the hospital. Garcia-Sanz-Calcedo et al [3] have estimated the energy
consumption in Spanish hospitals. The authors studied the energy behavior of eighteen (18) Spanish
hospitals during 2005-2014. They stated that their average annual energy consumption was at 270
KWh/m2
, 10,000 KWh/employee and 35,000 KWh/bed. Biglia et al [4] have studied the energy
behavior in Brotzu hospital in Cagliari, Italy. The authors estimated its annual energy consumption at
254.9 KWh/m2
. They also mentioned that electricity had a share at 57% in the final energy use while
fuel oil at 43%. Bawaneh et al [5] have estimated the energy consumption in healthcare facilities in
USA. The authors stated that the annual energy consumption in U.S.A. hospitals varies between 640.7
KWh/m2 (in hot zones) to 781.1 KWh/m2 (in cold zones) with an average value at 738.5 KWh/m2
. They
also mentioned that their energy consumption was approximately 2.6 times higher than in other
commercial buildings while it was also higher than in European hospitals. Jiang et al [6] have
estimated the energy consumption and carbon emissions of hospitals in Tianjin, China. The authors
have audited twenty two (22) hospitals in Tianjin estimating their average annual energy consumption
at 348 KWh/m2 and their average annual CO2 emissions at 157kgCO2/m2
. They also mentioned that
the heating system consumed the highest amount of energy (42.12%) followed by the cooling system
(6.78%) the medical system (4.98%) and the lighting system (3.63%). Vourdoubas [7] estimated the
energy consumption and the CO2 emissions in Venizelio hospital located in Crete, Greece with capacity
400 beds. The author estimated its annual energy consumption at 280.4 KWh/m2 and its annual CO2
emissions at 168kgCO2/m2
. He also mentioned that electricity had a share at 72.11% in the final energy
use while heating oil at 27.89%. Santamouris et al [8] have studied the energy performance and
energy conservation in Hellenic health care buildings. The authors studied the energy behavior of 30
health care buildings calculating the annual energy consumption in Hellenic hospitals at 407 KWh/m2
.
They also mentioned that 73.4% of the overall energy consumption was used for heating while they
estimated that their energy consumption could be reduced by 20% with energy conservation
measures.
2.2 Distributed electricity generation systems
Huang et al [9] have studied the fuel cell technology for distributed generation. The authors
mentioned that fuel cells consist of a promising and competent power generation technology which
could be used in distributed generation systems. They also stated that fuel cells have various
advantages compared with other energy systems including high energy conversion, possibility for co- generation, low emissions when using H2 as fuel, modularity, quick installation and absence of moving
parts. Yekini Subern et al [10] have reviewed the renewable energy distributed generation in rural
villages. The authors stated that the renewable energy resources which could be used for electricity
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generation include solar energy, wind energy, bio-energy and small hydropower. They also mentioned
that micro-grid power systems based on a large number of reliable small renewable energy systems,
which are properly managed, could be reliable and effective like larger grid systems. Hidayatullah et
al [11] have analyzed distribution generation systems and smart grid technologies. The authors stated
that current problems including climate change, increasing energy prices, energy security and energy
efficiency require changes in the way that energy is produced, transmitted and utilized. They also
described various distribution generated systems including solar-PVs, wind turbines, micro-gas
turbines and fuel cells. Hansen et al [12] have studied the economic performance of various
distributed generation technologies in rural areas in India. The authors mentioned that renewable
energy and small scale distributed generation technologies have the potential to provide electricity to
nearly 2 billion people who currently have not access to grid electricity. They found out that distributed
generation systems can provide electricity in a cost-effective way in rural areas if local energy
resources like solar energy, wind energy and biomass are adequate. Vourdoubas [13] studied the
sustainable energy technologies used in buildings in Mediterranean basin. The author stated that for
electricity generation in buildings the sustainable energy technologies which could be used include: a)
Solar thermal systems with parabolic collectors and Sterling engine, b) Solar-PV systems, c) Wind
turbines, and d) Co-generation of heat and power systems. U.S.A. Environmental Protection Agency
[14] has reported on distributed generation of electricity. The report mentioned various distributed
generation systems which are used in the residential the commercial and the industrial sector. It is
also stated that distributed generation technologies can reduce the environmental impacts of
centralized electricity generation while they can also result in negative environmental impacts mainly
when they are combined with combustion processes. Purchala et al [15] have studied the distributed
generation and the grid integration issues. The authors mentioned that although distributed
generation is conceived as a small scale electricity generation there is no consensus among
international organizations regarding the capacity of these power systems. They also stated that
during the last years the concept of many small scale conventional or renewable energy sources
generating electricity dispersed into the grid has become popular since those systems have various
advantages as well as drawbacks. Paliwal et al [16] have studied the distributed generation
technologies and their integration into the grid. The authors mentioned that integrating renewable
energies, based on distributed generators, into the grid could be a solution to current problems
including depletion of fossil fuels, mitigation of climate change and increase of energy security. They
also stated that integration of distributed generators into the grid should take into account the fuel
and technology used, the operating characteristics of the grid as well as the economics of the energy
generation. Moroni et al [17] have analyzed the ideas of distributed generation and energy
communities which are very popular among politicians and scholars. The authors stated that although
there is global consensus for those two ideas there are profound differences between them. They
proposed that different policies based on their differences are required for the promotion of energy
communities and the distributed generation systems. Ali et al [18] have studied the current micro- grid policies in EU, USA and China. The authors mentioned that distributed generation systems utilizing
renewable energies are desirable in achieving lower fossil fuels use, lower carbon emissions, higher
energy security and increased electricity demand. They also stated that effective micro-grid policy
instruments are necessary for successful integration of distributed generation systems using
renewable energies in the operation, control and stability of micro-grids.
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2.3 Use of sustainable energy systems in hospitals
Tahboub et al [19] have investigated the possibility of using clean energy technologies in Al-Ahli
hospital in Palestine with capacity 500 beds. The authors estimated that its annual energy
consumption could be reduced by 30-40% with the use of a wind turbine with capacity 750 KW in the
hospital. Alternatively they proposed that using hybrid wind energy – solar energy system having a
smaller wind turbine capacity at 330 KW could also achieve the same target of the overall energy
reduction in the hospital by 30-40 %. Franco et al [20] have reviewed the use of various sustainable
energy technologies in hospitals located in developing countries which are often lacking reliable and
affordable energy. The authors have examined the use of solar energy, wind energy, co-generation of
heat and power, small hydroelectricity combined with electricity storage systems based on batteries.
They stated that the use of solar and wind energy, which are intermittent energy sources, should be
combined with electric batteries in order to provide continuous and reliable electricity in the hospitals.
Gupta et al [21] have studied the use of solar and wind energy in hospitals focused in a large hospital
in New Delhi, India. The authors investigated the use of solar thermal systems, solar-PV systems and
small wind turbines placed on the rooftop of the buildings. They stated that the use of wind turbines
was not attractive, due to low wind speeds at the specific site, while the use of solar thermal systems
for heat production was a viable solution. Results from a European project regarding zero carbon
emission hospitals due to energy use have been published [22]. It is mentioned that promotion of
renewable energies in E.U. hospitals has not received so far high priority. It is also stated that among
various renewable energy sources biomass is considered as the best option to achieve 50%
penetration of renewable energies in hospitals. Kantola et al [23] have compared the use of
renewable energies with conventional energy sources in Finnish hospitals. The authors mentioned
that the most commonly used energy sources, district heating and grid electricity, were the most
expensive and polluting solutions. They stated that, with reference Espoo hospital, the most
affordable solutions were biogas energy, wood chip heating and ground source heat pumps heating.
They concluded that biogas energy was by far the most affordable solution while solar electricity was
the most expensive technology. Mat Isa et al [24] have studied a combined heat and power
generation system providing energy in a Malaysia hospital. The authors assessed a hybrid co- generation system consisted of a solar-PV, a fuel cell and a battery generating heat and electricity for
the hospital. They stated that the hybrid co-generation system had lower levelized cost of electricity
and less CO2 emissions compared with conventional energy technologies used in hospitals.
Buonomano et al [25] have studied a novel renewable poly-generation system providing electricity,
heat and cooling in an Italian hospital located in Naples. The poly-generation system was consisted of
concentrated photovoltaic thermal collectors combined with an absorption chiller while the hospital
was equipped with a gas turbine co-generation system. The authors mentioned that, according to
their simulation, the system was profitable with pay-back period at 12 years without any public
subsidies. Teke et al [26] have proposed a methodology for sizing co-generation and tri-generation
energy systems in hospitals. The authors mentioned that the use of combined cooling, heat and power
tri-generation systems or heat and power co-generation systems in hospitals, with overall efficiency
at around 80%, has many benefits. They estimated that the use of these high-efficiency energy
systems in a medium size hospital could reduce its energy consumption by 19-20%. A study concerning
the use of renewable energies in rural health care clinics has been published by NREL [27]. The report
mentioned the most promising renewable energy technologies covering the electricity needs in rural
health care facilities. Among them the most appropriate is the solar-PV technology which is often used
combined with diesel generators and batteries. Wind turbines could be also used when the average
annual wind speed at the site is higher than 4.5 m/sec. The installation of hydrogen fuel cells in a
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military hospital located in Johannesburg, South Africa has been announced [28]. For the
implementation of this project cooperation of the public sector the private sector and the Academia
according to the triple helix model is followed. IEA [29] has reported on the use of solar-PVs in health
care facilities in developing countries. The report mentioned that for the medium and large health
care facilities in rural areas the most economic and reliable power option is hybrid systems consisted
of solar-PVs with diesel generators. Taseli et al [30] have studied the use of biogas for generating heat,
cooling and electricity in a 900-bed university hospital located in Turkey. The authors stated that
biogas could be produced either by anaerobic digestion of organic wastes produced in the free land
surrounding the hospital or by anaerobic digestion of the livestock wastes of an organic farm created
by the hospital in the nearby area. Pina et al [31] have studied the opportunities of integrating solar
thermal, solar-PV and biomass technologies for energy generation in a Brazilian hospital. The authors
mentioned that biomass was economically the most appropriate fuel for heat production. They also
stated that solar-PVs could be used in the hospital for offsetting the annual grid electricity
consumption while solar thermal technology had various drawbacks compared with biomass and
natural gas. Donuk et al [32] have reported on an application of a parabolic trough collector system
to a hospital building located in Aydin, Turkey. The authors mentioned that the power of the tri- generation system was 1 MW while it was going to generate electricity, heat and cooling used in the
hospital. They also mentioned that solar energy was going to heat an oil at 225o
C which was used in a
Organic Rankin cycle system for electricity generation. The remaining low enthalpy heat was used for
heating in the winter and for cooling in the summer. Good et al [33] have reviewed various projects
related with the use of hybrid photovoltaic-thermal systems in buildings. The authors mentioned that
the PV/thermal market is still small while these systems are not cheaper than alternative installations.
Chow et al [34] have reviewed the integration of solar thermal and solar-PV systems. The authors
mentioned that the limited available space in buildings for solar energy systems installation and the
promotion of low carbon/zero energy buildings have increased the demand for hybrid solar energy
systems. They also mentioned that innovative hybrid solar energy systems have been developed and
commercialized but real system applications are limited so far.
Aim of the current work is the review of various distributed generation systems which could be used in
hospitals.
Initially the existing literature is surveyed followed by an estimation of energy consumption in
hospitals. After that the main distributed generation systems are presented and the possibility of using
them in hospitals is investigated. The findings of the work are discussed followed by the presentation
of the conclusions drawn and some proposals for further work.
3 Energy consumption in hospitals
Hospitals utilize energy for heating, cooling, hot water production, lighting and the operation of
various electric devices, medical equipments and machinery including those in the kitchen, laundry
and surgery rooms. Hospitals are among the most energy consuming buildings having higher energy
consumption than hotels, offices, commercial buildings, schools and residential buildings. Published
research, presented in table 1, indicates that the annual specific energy consumption in hospitals
worldwide varies between 254.9 KWh/m2 and 738.5 KWh/m2
.
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Table 1. Energy consumption in hospitals
Author Year Country Annual energy
consumption (KWh/m2)
Gonzalez, Gonzalez et al 2018 Germany 270
Hu et al 2004 Taiwan 259.45
Garcia-Sanz-Calcedo et al 2018 Spain 270
Biglia et al 2015 Italy 254.9
Bawaneh et al 2019 USA 738.5
Jiang et al 2012 China 348
Santamouris et al 1994 Greece 407
Vourdoubas 2018 Greece 280.4
Source: Published literature
According to many researchers (Biglia et al [4], Jiang et al [6], Vourdoubas, [7]) the main energy
source used in hospitals is electricity having a share at 57 % to 72.11 % in the total energy mix while
the share of fuel oil varies between 27.89 % and 43 %. Use of various renewable energy technologies
in European hospitals has not been prioritized so far [22].
4 Distributed electricity generation systems
Various distributed electricity generation systems are currently used for electricity generation, co- generation of heat and power or tri-generation of electricity, heat and cooling. These include:
4.1 Solar photovoltaic systems
Solar-PV systems are currently used for electricity generation. Depending on the intensity of the solar
irradiance these systems are more or less attractive while they could generate part or all of the annual
electricity requirements of the grid connected consumer. They are intermittent energy generation
systems while their cost has been substantially reduced during the last 15 years. Their average energy
efficiency varies between 14-18%. In areas with high solar irradiance solar-PV systems are cost
competitive with conventional electricity generation systems using fossil fuels.
4.2 Heat and power co-generation systems, tri-generation systems
Co-generation systems generate both heat and electricity from the same machine. Their energy
efficiency is high at approximately 80-90% while the most often used fuel is natural gas. They are cost- effective and they are currently used in industry, in buildings and in agriculture achieving continuous
energy generation. Due to their high energy efficiency their carbon emissions into the atmosphere are
low compared with other electricity generation technologies. Tri-generation systems use the same
technology with co-generation systems but during the summer the co-generated heat is utilized by
thermal chillers for cooling production resulting in electricity, heat and cooling production.
4.3 Fuel cells
Fuel cells are modern energy production systems utilizing H2 or some compounds containing H2, like
CH3OH or CH4, for electricity generation with electrochemical processes. They can co-generate heat
achieving power efficiencies at 40-50% and heat efficiencies at 30-40%. Therefore their overall energy
efficiency is high. Their commercial applications are rather limited due to their high initial cost while
in some countries their installation is subsidized by the government. The main fuel used is natural gas
resulting in low carbon emissions into the atmosphere. Hydrogen can be also utilized in fuel cells while
in the case that the H2 is produced from renewable energies the carbon emissions due to energy
generation are zero.
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4.4 Wind turbines, biogas, small hydroelectric systems, hybrid PV-solar
thermal and solar thermal power systems
Additionally various other renewable energy technologies could be used for electricity generation in
large buildings whenever it is technically and economically feasible. These include:
4.4.1 Wind turbines
Small size wind turbines can be integrated in buildings for electricity generation. Necessary pre- condition for that is the high annual average wind speed at the site of the building. Wind turbines
require more maintenance than solar-PVs and their applications in residential or commercial buildings
are still limited.
4.4.2 Biogas
Biogas can be used for electricity generation in hospitals while the co-produced heat can be also used
for covering part of their heating needs. Biogas production by anaerobic digestion of organic wastes
is currently technically and economically feasible and this fuel is used for energy generation or co- generation of heat and power.
4.4.3 Small hydroelectric systems
In some cases small hydroelectric systems could be used for electricity generation. This is a preferable
solution in developing countries when the health care center is located in remote areas without
electric grid infrastructure. A solar-PV system or a small hydroelectric system combined with an
electric battery and a diesel generator could be a feasible solution providing electricity in organizations
located in areas without electric grid infrastructure.
4.4.4 Hybrid PV-solar thermal
Hybrid solar-PV and solar thermal energy systems generating both electricity and hot water could be
integrated in various buildings. Various products are available in the market although the reliability
and the cost-effectiveness of this technology has not been well proven yet and the existing
installations are limited so far.
4.4.5 Solar thermal power systems
Solar thermal power systems with parabolic or disc solar collectors equipped with sterling engines
could be used for co-generation of heat and power. During the last years various products are available
in the market but their reliability and cost-effectiveness has not been proven yet.
Various characteristics of the abovementioned distributed electricity generation systems are
presented in table 2.
Table 2. Characteristics of distributed electricity generation systems
Technology used Total energy efficiency CO2 emissions
Photovoltaic panels 14-18% zero
Parabolic trough or disc solar collectors and steam to power engines 40-50% zero
Hybrid PV – solar thermal 40-50% zero
Wind turbines Low depending on the
average annual wind speed
zero
Hydroelectric turbines 70-80% zero
Biogas burning and steam to power engines 70-80% zero
Electrochemical generation-fuel cells 70-80% Low or zero (if H2
is used)
Gas engines or other technologies - co-generation 80-90% Low
Gas engines and absorption chillers – tri-generation 70-90% Low
Source: Own estimations
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5 Use of distributed electricity generation systems in hospitals
Various distributed generation systems based either in renewable energies or in very efficient energy
technologies could be used in hospitals reducing their conventional energy and fuel consumption and
their carbon footprint. Their use is desirable since they increase their energy security and self- sufficiency while they result in many benefits in the electric grid. Taking into account that hospitals
require large amounts of heat energy for space heating and hot water production the use of co- generation systems could cover a significant part of their heat and electricity requirements. For
financing the required energy investments hospitals could utilize new financial tools including third
party financing and public private partnerships. An energy saving company (ESCO) could design,
finance and implement the energy investments resulting in benefits both to the hospital and to the
ESCO. The distributed generation systems which could be used in hospitals depend on the availability
of the energy source and the fuel, the maturity and the cost of the energy technologies and the
possibility of achieving support by public subsidies. The sustainable energy systems which could be
used in hospitals include:
a) Renewable energy systems like solar-PV, solar thermal power systems, small wind turbine
systems and systems based in biogas, and
b) High efficiency energy systems like heat and power co-generation systems, heat, cooling and
power tri-generation systems and fuel cells using conventional fuels like natural gas. Their
overall efficiency in heat and power generation is in the range of 80-90 %. The co-generated
heat and cooling could be also used in the hospital.
The distributed electricity generation systems which could be used in hospitals are presented in table
3.
Table 3. Distributed electricity generation systems which could be used in hospitals
Energy source Technology used Intermittent or
continuous
energy
generation
Generated energy
Solar energy Photovoltaic panels Intermittent Electricity
Solar energy Parabolic trough or disc
solar collectors and steam to
power engines
Intermittent Electricity and heat
Solar energy Hybrid PV- solar thermal Intermittent Electricity and heat
Wind energy Wind turbines Intermittent Electricity
Hydro energy Hydroelectric turbines continuous Electricity
Biogas biogas burning and steam to
power engines
continuous Electricity and heat
Natural gas, Hydrogen Electrochemical generation continuous Electricity and heat
Natural gas Gas engines or other
technologies
continuous Electricity and heat
Natural gas Gas engines and absorption
chillers
continuous Electricity, heat and
cooling
Source: Own estimations
6 Discussion
Our results indicate that various distributed generation technologies could be used for electricity
generation in hospitals while some of them co-generate also heat which could be used in them.
Various renewable energy sources are included among the fuels used in these systems. Some systems
are mature, reliable, cost-effective and they are already used in various hospitals. Our results indicate
that the use of these systems could increase the environmental sustainability in hospitals substituting
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the use of polluting fossil fuels with green fuels and energy efficient technologies. However the current
work does not indicate which distributed electricity generation systems are cost-effective and
profitable in order to be used in health care buildings. Support of the installation cost of these energy
technologies, which currently are not cost-effective, with public subsidies is required for their
promotion in hospitals.
7 Conclusions
The application of distributed electricity generation in hospitals has been investigated. Various
distributed energy generation systems are already used in industry, agriculture and in large buildings.
Health care buildings require large amounts of energy for covering their annual electricity and heat
requirements while they usually consume grid electricity and fossil fuels having a high carbon
footprint. Their annual energy consumption varies between 254.9 KWh/m2 and 738.5 KWh/m2
.
Various distributed electricity generation systems could be used in hospitals reducing their fossil fuels
consumption as well as their impact to climate change. Some of them, including the use of biogas and
small hydro power, could be used only if the energy source and the fuel are available on-site. The
majority of these systems utilize either renewable energies or natural gas while some of them co- generate heat and power. Their use should be promoted in the future due to the resulted economic
and environmental benefits. Further research should be focused in the investigation of renewable
energy systems which could be used for heat generation in hospitals, like solar thermal energy and
solid biomass burning systems, as well as in the investigation of using very efficient heat pumps for
their air-conditioning. Additionally, research should be focused in the profitability assessment of the
application of these novel energy technologies in hospitals implementing various case studies.
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