Written by Jeff Cichonski and Jim Norton

Connecticut Children’s Hospital Patient Tower | Hartford, Connecticut

Hospitals are often judged by what happens inside their walls – but the systems behind those walls determine whether care is possible at all. For Connecticut Children’s, the only hospital in the state dedicated exclusively to pediatric care, the need to expand was not simply a matter of growth. It was a matter of resilience.

Like many hospitals across the country, Connecticut Children’s was facing aging infrastructure. Its existing facility – nearly 30 years old – was operating with systems at or beyond capacity, limited redundancy, and equipment approaching the end of its useful life. Renovation options were increasingly constrained, and the hospital was running out of ways to modernize critical services while continuing to care for patients.

At the same time, demand for pediatric care was growing. Families across Connecticut were traveling long distances to access specialized services that the hospital aspired to provide closer to home. The organization’s vision was clear: expand access to advanced pediatric care, consolidate services, and create a modern, healing environment that could support patients, families, and clinicians – today and for decades to come.

The result is a new eight-story patient tower in downtown Hartford, designed to nearly double the hospital’s size and significantly expand clinical capacity, including much-needed NICU beds and critical care services. Behind the scenes, however, the project represents something even more transformative: a fundamental rethinking of how hospital infrastructure can be designed for uninterrupted care, adaptability, and long-term resilience.

Salas O’Brien served as the mechanical, electrical, plumbing, fire protection, medical gas, and technology engineer for the project, partnering closely with Connecticut Children’s, CannonDesign, DPR Construction, and design-assist trade partners to deliver a facility where no single system failure can compromise patient care.

Designing for zero downtime

From the outset, reliability was the project’s north star.

In the existing facility, a single failure could take out core services and directly impact patients. That reality shaped the new tower’s approach: full redundancy across all critical systems.

Power, air handling, medical gas, and life-safety systems were engineered so that maintenance, equipment failure, or external events would not interrupt operations. Electrically, the tower is fed by two new utility services connected to double-ended switchgear, creating a robust primary backbone. Emergency power is supported by N+1 generation and fully automated controls that allow generators to engage seamlessly during outages.

In a dense urban environment like downtown Hartford – where flooding risk, utility coordination, and limited site access add complexity – critical infrastructure required careful placement and protection. Emergency generators were elevated to mitigate flood risk, and utility upgrades were coordinated directly with city agencies to create reliability on a scale.

For a hospital, power consistency is not optional; it is fundamental to life safety.

Mechanical Systems Built for Resilience and Efficiency

The mechanical systems were designed with the same philosophy: no single point of failure, paired with long-term efficiency and adaptability.

Rather than relying on traditional high-temperature steam, the tower operates entirely on low-temperature hot water. Salas O’Brien engineered a new boiler plant and a chiller plant with year-round heat recovery, creating a system that is more efficient today and better aligned with the hospital’s future decarbonization goals.

Heat recovery chillers capture waste heat from cooling operations and reuse it for heating, allowing the building to heat and cool simultaneously while maintaining the precise environmental conditions required in pediatric and neonatal care. High-efficiency gas boilers with fuel-oil backup provide reliability without sacrificing performance, while operating temperatures remain compatible with future electrification strategies.

Water efficiency was also integrated into the system design. A condensate recovery system captures water from air-handling units and reuses it as cooling-tower makeup, supplying approximately 60 percent of demand in a high-use clinical environment.

Air Systems Built for Infection Control and Adaptability

In pediatric care, air quality and infection control are inseparable from patient safety.

The clinical space within the patient tower is served by three custom air-handling units, each capable of maintaining operations even if one unit is unavailable. Fully redundant air-handling systems support critical spaces, including C-section and fetal surgery operating rooms, infant resuscitation areas, and the sterile compounding pharmacy suite.

Patient rooms were designed to adapt as conditions change. In the event of an airborne infectious outbreak, acuity-adaptable rooms can automatically switch to full exhaust mode with some relatively simple control modifications, supporting isolation protocols without invasive renovations or operational disruption.

Medical gas systems were also engineered to support surge ventilator demand, allowing rooms to accommodate additional equipment during emergencies. The building was intentionally designed with a pandemic response mode, capable of supporting more patients, more ventilators, and higher-acuity care when it matters most.

Solving Complex Challenges in a Constrained Urban Site

Delivering this level of redundancy on a landlocked urban site required creative problem-solving.

One major challenge was locating the bulk oxygen system within tight spatial and code constraints. Through close coordination with fire marshals, city officials, and civil engineers, the team developed a compliant solution for the new tower that can backfeed the existing hospital, strengthening resilience across the entire campus.

Plumbing design required equal precision. Below-grade kitchen operations required pumped grease waste systems to reach street-level interceptors – another example of adapting infrastructure to site realities without compromising safety or performance.

Structural coordination was equally demanding. The new tower connects directly to the existing hospital, requiring alignment with floor-to-floor heights never intended for modern hospital systems. Early coordination and extensive prefabrication enabled major beam penetrations to be designed with large ductwork and piping in mind, reducing field conflicts and maintaining the overall construction schedule.

Delivering at Speed Without Compromising Quality

Time was a defining pressure.

Patient demand already exceeded capacity, with beds placed in temporary locations throughout the existing facility. Compounding the challenge, the project was launched amid post-pandemic supply-chain disruptions, with lead times for major electrical equipment stretching beyond 100 weeks.

To maintain momentum, Salas O’Brien worked closely with DPR Construction and trade partners to identify long-lead equipment early and release it before design documents were complete. This approach required rigorous risk assessment and clear communication, but it allowed procurement to move forward without sacrificing performance or reliability.

Releasing equipment mid-design is rarely comfortable for engineers. It succeeded here because risks were shared, decisions were aligned, and the team moved forward together.

Collaboration as a Design Strategy

That collaborative mindset defined the project.

Rather than a traditional top-down delivery model, the team adopted design-assist, bringing trade partners into the process early. Engineers, contractors, architects, clinicians, and facilities staff worked together in a “big room” environment, sometimes with dozens of stakeholders collaborating in real time.

Connecticut Children’s intentionally included voices from across the organization, from infection control teams to frontline nurses. While this approach added complexity, it made sure decisions reflected real operational needs.

Salas O’Brien’s long-standing relationship with the hospital strengthened this collaboration. Beginning with a mechanical and electrical infrastructure study in 2018, the firm brought institutional knowledge that helped define clear goals for redundancy, serviceability, and future readiness from day one.

A Healing Environment for Children and Families

While much of the project’s complexity lies behind walls and ceilings, its impact is deeply human.

The new tower reshapes the hospital’s presence in downtown Hartford, creating a welcoming main entrance on Washington Street with improved valet access, clearer wayfinding, and a more intuitive arrival experience. Inside, themed environments, natural light, and thoughtful finishes help reduce anxiety for children and families alike.

During construction, a nurse paused to look at the nearly completed tower and shared that what was being built would fundamentally change how she could do her job. The moment captured the project’s purpose more clearly than any technical metric.

Strengthening the Community

Beyond the hospital walls, the project has made a meaningful impact on the Hartford community.

The tower expands the hospital’s campus by approximately 40 percent, consolidating NICU and specialty services that were previously spread across multiple buildings. Families who once traveled out of state can now access advanced pediatric care closer to home.

The hospital partnered with the City of Hartford to improve Washington Street, committed to planting 100 trees in the Frog Hollow neighborhood, and coordinated parking solutions that benefit both hospital staff and local residents. Job fairs held with DPR Construction connected city residents to employment opportunities during and after construction.

Engineering for What Matters Most

At its core, the Connecticut Children’s patient tower demonstrates what’s possible when engineering excellence is aligned with purpose.

From redundant power and adaptable air systems to efficient mechanical design and collaborative delivery, every decision was guided by a single principle: children come first. The result is a facility built not just to operate, but to endure, adapt, and support care through whatever challenges the future brings.

For Salas O’Brien, the project reflects more than technical success. It represents a commitment to partnership, rigor, and designing systems that quietly – but powerfully – enable healing.

Jeff Cichonski is a mechanical engineer with over 25 years of design and management experience. He is known for building long‑term client relationships through responsiveness, clear communication, and a balanced approach to design and project leadership. His work spans hospital expansions, complex renovations, and major infrastructure upgrade projects. Jeff serves as a Principal at Salas O’Brien.

Jim Norton has nearly two decades of design and leadership experience in the healthcare sector, contributing deep technical expertise and a collaborative approach to every project. His work spans master planning, new construction, and highly intricate renovation projects across diverse healthcare environments. Jim leads an MEP studio of 16 design professionals and serves as a Senior Vice President at Salas O’Brien.