Proper plumbing system design and placement can meet sustainable objectives while reducing germ transmission.

Hygiene and cleanliness are naturally top considerations when designing plumbing systems for hospitals or other medical facilities.

With the green movement gaining momentum in the healthcare market, professionals realize that their facilities can save money on water and energy with their plumbing systems, while gaining additional benefits that align with their overall objectives: Sustainable healthcare strategies can help promote healthier, more hygienic environments for patients and staff.

There are many areas of healthcare facilities - and functions involving plumbing systems within each - that could achieve greater water efficiency. The type and flow rate of faucets to specify, for one, warrants a close look.

According to the Centers for Disease Control and Prevention, hygienic hand-washing is the single-most effective measure for preventing the spread of pathogens that can cause everything from the common cold to more serious, even life-threatening, diseases. Proper hand-washing is critical to reduce the transmission of pathogens to food, water, other people and inanimate objects, such as hand railings and other surfaces.

Select electronic faucets use a visible LED that lights up for the duration of the recommended hand-washing cycle. This prompt serves as a simple tool for encouraging healthcare professionals to comply with proper hand-washing procedures.

A 2.2 gpm flow rate is necessary in foodservice areas, nurses’ stations and patient rooms, for example, where employees are washing foods, filling containers or rinsing equipment. Additionally, laminar flow spray heads that typically operate at 2.2 gpm are suitable for critical care applications in healthcare, such as for surgical scrub sinks.

Unlike “aerated”-type flow controls, laminar flow does not draw ambient room air into the water stream, avoiding any possible introduction of airborne bacteria. Flow control in some models is located in the base of the faucet, which totally eliminates the introduction of airborne particulate, as well as the need to periodically clean the flow control.

But a much lower, yet effective flow rate can be chosen for faucets serving the public or other basic hand-washing needs. The U.S. Green Building Council, among other industry sources, specifically recommends lavatory faucets with 0.5 gpm aerators for public restrooms and other general hand-washing stations. (See sidebar “LEED For Healthcare Draft May Promote Greater Efficiencies” for more information.) Low-flow faucets offer an easy way to cut water consumption, while allowing users to properly clean their hands and reduce germ transmission, which is especially critical in healthcare environments.

Low-flow, sensor-operated faucets are available with tempered or hot/cold water operation. Although most sensor-operated faucets are powered by batteries or plug-in transformers, new solar-powered, 0.5 gpm faucets that run off any natural or artificial restroom light source enable facilities to save both water and energy.

Facilities also have a wide range of toilet and urinal technology choices, which run the gamut from the standard 1.6 gpf water closet models to dual-flush technologies to waterless urinals. High-efficiency toilets and high-efficiency urinals are becoming more popular as professionals increasingly recognize how much they have to gain by using less water.

Some of these water-efficient options, such as pressure-assist toilets and waterless urinals, do call for complete fixture changeovers, whereas dual-flush technologies, sensor-operated flushing and lower-consumption flushometers may be available as retrofit kits for converting existing manual fixtures.

Touch-Free Operation

It just makes sense that the more convenient a product is to use, the more often people are apt to use it. This, too, can be said of placement and design of sinks in encouraging healthcare professionals to wash their hands.

A study published in Journal Watch found that 80 percent of healthcare workers reported that easy access to sinks and availability of hand-washing facilities led to increased hand-washing compliance. Similarly, research conducted by the Virginia Commonwealth University's Department of Internal Medicine found that easily accessible waterless antiseptic dispensers significantly improved hand-washing rates among healthcare workers than infection-control education alone. The compliance rate rose from 19 percent after education about the need to wash to 41 percent after installing one dispenser for every four patient beds.

It’s not just placement of hand-washing devices that leads to lower nosocomial, or hospital-acquired infection, rates; design of the hand-washing system also plays a key role. As published in Infection Control and Hospital Epidemiology, researchers comparing contamination rates of sensor-operated vs. manual faucets in an Australian hospital concluded that sensor-operated faucets prevent contact transmission of nosocomial pathogens.

Thus, healthcare facility planners can benefit by combining the advantages of touch-free plumbing with the sustainable benefits of systems that are specifically engineered for low-consumption applications. Sensor-operated faucets, for example, can offer greater water savings by not only being low-flow, but also by automatically turning water on only when needed and then promptly turning off when users’ hands leave the sensor range.

Germs and bacteria can easily reside on restroom surfaces for many hours. Sensor-operated faucets, soap dispensers and hand dryers keep the hand-washing process as hygienic as possible, while reducing opportunities for cross-contamination, which occurs when people touch a dirty surface right after washing. These surfaces include manual faucet handles, the push buttons on manual hand dryers and restroom doors.

Design of other plumbing fixtures and fittings can also reduce germ and bacteria transmission. Installing electronic, touchless water closet and urinal flushometers cuts down on the number of contaminated touchpoints in the restroom at which users can leave or pick up various sorts of germs. Energy-efficient, sensor-operated hand dryers use about 80 percent less energy than conventional models, while offering the hygienic benefit of operating automatically. Plus, these dryers completely dry hands in seconds, which is important because wet hands pick up more germs than dry hands.

Careful planning can give professionals interested in achieving sustainable healthcare facilities the best of both worlds: plumbing systems that reduce costly and wasteful water and energy usage, while providing healthier, more hygienic environments.

LEED For Healthcare Draft May Promote Greater Efficiencies

Four years in the making, LEED for Healthcare will make its debut later this year. Based on LEED for New Construction Version 2.2 and the Green Guide for Healthcare Version 2.2, LEED-HC will address the distinctive needs of the healthcare market. The rating system will apply to inpatient care facilities, licensed outpatient care facilities and licensed long-term care facilities, as well as to medical offices, assisted-living facilities, and medical education and research centers.

Five new health-based credits to the LEED rating system are included in the LEED-HC draft as it currently stands. The Water Efficiency section, for example, has been extensively modified to reflect the prevalence of potable water used in healthcare facilities for mechanical systems and medical equipment processes.

The number of points awarded by the section has not altered from LEED-NC. Instead, points have been reallocated across two new credits and two modified credits. This is particularly demonstrated with WE Credit 3: Potable Water Use Reduction: Domestic Water, where only one point is given to maximize potable water efficiency.

The requirements of this credit are two-fold and very specific. First, it calls for sensor-operated faucets on all hand-washing sinks, but excludes compounding sinks, housekeeping sinks and sinks in inpatient bedroom toilet rooms.

Second, Water Efficiency Credit 3 requires the use of high-efficiency plumbing fixtures and fittings or fixture flow controls to keep plumbing water consumption within these levels: lavatories should use no more than 1.5 gpm; showers, 2 gpm; urinal flushometers, 0.5 gpf; and water closet flushometers or pressure-assist single-flush toilets, 1.28 gpf. This can be achieved through the use of high-efficiency fixtures such as waterless urinals to reduce potable water demand.

There are a number of high-efficiency toilets (HET) that flush at or below the HET maximum of 1.28 gallons per flush, including pressure-assist toilets and flushometer toilets. Flushometer high-efficiency toilets are recommended for healthcare applications.

Water-efficient showerheads are available that require less than the 2.5 gpm maximum set by EPAct, and lavatory faucets can be effective with water-saving faucet aerators that use as little as 0.5 gpm.