Main image: Dr George Mukhari Hospital after the upgrade which included the HCU and ICU.

Leading consulting engineering and infrastructure advisory firm Zutari has registered the first Green Star-rated hospital in South Africa, namely the Cintocare Hospital. “With regard to sustainability and healthcare, we have an excellent track record. In terms of green buildings, we have over 100 registrations to date,” comments Mechanical Building Services Associate Willie Kotze.

Assisting with the upgrade

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, KwaZulu-Natal. 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.

Refurbishment challenges during hard lockdown

At Livingstone Hospital, the installation was undertaken in an active Covid-19 ICU ward during hard lockdown. In contrast, at Dr George Mukhari Hospital the ICU wards could be handed over for complete refurbishment.

Zutari collaborated with SM Maré & Associates Quantity Surveyors and principal agent, Osmond Lange Architects + Planners, at Dr George Mukhari Hospital. Its scope of work was structural, electrical, electronics, wet services, fire engineering and HVAC.

The timeframe was from 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.

Leon Esterhuizen, Technical Director, Zutari.

Refurbishment requirements

The 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.

Vincent Gieselbach, Civil Engineer, Zutari.

Other requirements were special lighting to allow medical staff to visually identify a patient’s condition, such as a blueish colour indicating oxygen deprivation. The facility also had to remain fully functional, even during power disruptions.

The civil engineer, Vincent Gieselbach, comments that the refurbishment elevated a public-sector hospital to a private-sector level. Zutari quickly ascertained that the existing sewer and water mains required additional repairs.

Engineering challenges

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.

Aging infrastructure obstacles

OJ Ojayi, Structural Engineer, Zutari.

There were various challenges in terms of the wet services installation due to the age of the existing infrastructure. To ensure that the 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.

The wet services engineering team coordinated with the other disciplines’ engineering teams to ensure that there were no clashes. Another major challenge was the decades-old external reticulation, for which no as-built information was available, thus requiring a detailed assessment before work could commence.

The structural engineer, OJ Ojayi, highlights that the main challenge was that the hospital remained “live” during the refurbishment. Close attention was paid to the location of existing services to avoid disrupting it.

Reuse of existing materials

They tried to use as much of the existing materials as possible. Instead of breaking down the entire structure and rebuilding it from the bottom up, Zutari added external fins for the lateral reinforcement of the brick walls. 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,” adds Kotze. “No water cooling was opted for, and no ozone-depleting refrigerants were used, while heat pumps were selected as opposed to resistance heating.”

Simplified long-term maintenance

Coordination between the extensive number of services was critical to provide easy access for future maintenance. In addition, robust new systems provide simplified maintenance over the long term. Despite the pandemic being over, Kotze says that the healthcare sector presents major opportunities for Zutari’s specialised multidisciplinary skillset, especially in HCU and ICU facilities.

For more information, contact Zutari:
Tel: +27 12 427 2000

For more projects like these, subscribe to our free magazine on Sign up for our newsletter: or join other discussions on, and

Subscribe to our Community👇

Stay Inspired, Stay Educated, Stay Informed.

This is how people in the built environment do it!

By subscribing you agree to receive our promotional marketing materials. You may unsubscribe at any time. We keep your data private.