Plumbing Design for Healthcare Facilities

By Linda Seigler

The healthcare industry touches the life of every person in the United States, either as a healthcare worker or as a patient. According to the last survey, there are more than 500,000 healthcare facilities throughout the country. These facilities employ more than 12 million providers and practitioners. In a given year, hospitals alone admit upwards of 36 million patients - and everyone depends on the water delivery system.

Hospitals, doctor offices and outpatient care and assisted living facilities -- what we call the institutional market -- all must have reliable connections to the water supply. The common points of contact in the hospital water delivery system are the faucets and components. Because they are heavily used and must often endure harsh chemicals in maintenance and in regular operating procedures, the importance of selecting the right faucets is a decision that should not be taken lightly.

While the healthcare facilities in the institutional market have many needs in common, it is the hospital environment that presents the most unique challenges. Sanitation is a key requirement for the plumbing areas in this environment. Although most healthcare facilities are exempt from water and energy conservation regulations, the faucets and components included in the design should help to conserve water as well as to prevent the spread of disease.

General Requirements

One of the most important considerations in choosing faucets for the healthcare environment is durability. Healthcare facilities use various chemicals in the cleaning and preparation of equipment. In order to provide the best durability in high-use situations, faucets and fixtures should be chromium plated. The chromium plating adds durability, and a longer-lasting faucet means fewer problems for the maintenance department.

Another more immediate maintenance and safety issue is daily cleanup. Water on the floor means more slips and falls anywhere there is a point of contact with the water. Turbulent flow faucets create over-splash and dangerous situations -- particularly for patients with physical handicaps. Laminar flow faucets prevent over-splash and reduce maintenance by the housekeeping staff as well as unnecessary injuries to staff and patients.

Harsh chemicals used in maintenance of the facility and equipment might directly or indirectly connect to potable water systems. This means that there is the possibility for contamination from cross-connections and backflow -- especially since many of these chemicals have some degree of toxicity. Where this is a concern, faucets should be connected to an appropriate check valve or vacuum breaker. All inlets operating below the water line, all faucets with hose adapters and all flush valves should be equipped with vacuum breakers.

Backflow preventers should be installed at all locations where the potable water supply must be protected from contamination. In addition, all faucets and fixtures used in the delivery of potable water should comply with the latest maximum lead content regulations. Water spigots used in lavatories and sinks should have clearances adequate to avoid contaminating utensils.

Facilities for the physically challenged should be in compliance with the Americans with Disabilities Act (ADA) guidelines. In short, valves should be operable without hands (i.e., with wrist blades, foot controls or electronic sensors). Make sure the sizes of wrist blades and handles in patient rooms and common areas comply with all appropriate regulations.

Patient care areas - The patient care area typically includes a restroom with a water closet, a lavatory and either a shower or a tub. Since these areas of the hospital are primary care centers, the faucets should be designed for convenience as well as durability.

• Ceramic cartridges: Because patients in the facility can have a wide range of limitations and physical handicaps, the faucets in the room should be easy to operate. Ceramic cartridges provide exceptional ease-of-use, while maintaining flow rate.
• Lavatory faucet: The faucet in the lavatory area should be a gooseneck spout with wrist blade handles. For more convenience, the design can incorporate electronic or hands-free controls.
• Shower valve: To support safety concerns for most patients, the shower valve should automatically compensate for variations in the water supply pressure and temperature. This will keep patients from being scalded.
• Bedpan washer: These convenient faucets are sometimes placed centrally at the nurse's station, but the patient room could also provide a clinical service sink faucet with a bedpan washer. Bedpan washers are often required by local codes.
  
  

Nurseries - Newborns are precious patients too. Don't overlook the needs of the neo-natal care center. The nursery should have a lavatory with hands-free controls and a high gooseneck spout. This adds both safety and convenience to the neo-natal environment. Other faucets in this area might include filler spouts with separate hand-valve controls.

Food services - Healthcare facilities prepare a large number of food products. These areas also make extensive use of cleansers, disinfectants and pesticides. Like those used in many large restaurants, the faucets used in the hospital food service area should be both durable and convenient.

• Pre-rinse units: Pre-rinse sprayers have proven through the years to be both efficient and durable. The selection of a particular model depends on its intended use. For instance, a spring arm sprayer can provide quick rinsing in a large volume environment.
• Pot and glass fillers: Pot and kettle fillers that swing out over the burners add convenience and timesavings to the kitchen area. Additional pre-rinse units can also be used as pot fillers. Restaurant-style pushback glass fillers also add convenience to any beverage serving station.
• Retractable hose reels and accessories: Retractable hose reels provide convenient access for cleaning in the food service area, yet the hoses are out of the way during food preparation. Several different types of sprayer attachments can provide adjustable streams, from solid to soft spray.
• Hand wash faucets: Because of their extended daily use, faucets used for hand washing in the food services area should be convenient and durable. They should conserve water and reduce the spread of disease. These faucets can be either manual or sensor-operated.

Environmental services - Housekeeping and facility maintenance in a hospital require the use of many different cleaners, disinfectants and treatments. Faucets and components used by the maintenance staff should be durable enough to withstand these harsh conditions.

• Service/mop sink faucets: Typically found in the janitor's closet, the service sink must withstand heavy use and abuse. The faucet receives just as much abuse as the sink itself, but the wall brace helps to maintain durability. Service faucets should provide the highest flow rate to allow for the highest productivity of the maintenance staff.
  
  

Laboratory services - The laboratory provides daily medical and diagnostic testing for the healthcare environment. Consequently, maintaining a sterile environment is the primary concern in the lab, regardless of the size of the healthcare facility. There may be a wide range of disinfecting solutions used in the lab. The faucets and other important accessories should be able to withstand these harsh chemicals.

• Laboratory faucets: Faucets used in the lab should support the diagnostic testing processes by providing controlled flow rates. Serrated tips on the faucets provide for convenient hose attachment.
• Gas cocks with turrets: In most laboratory environments, it is necessary to control the supply of gases and air in testing. The gas cocks and turrets allow for safe control of gas and air to maintain the accuracy of diagnostic results.
• Aspirators: In some testing procedures, it is necessary to mix other fluids with water. Aspirators are used on the end of a faucet spout to create a vacuum and allow other fluids to be introduced into the water stream.
• Fume hood fittings: Fume hoods can be fitted with outlets for gas, air and water. In most instances, the flow of these elements is controlled by a remote valve mounted on the front or inner wall of the fume hood.
  
  

Surgical services -This area includes anesthesia, pre-operative services, surgery and post-anesthesia care. While there are typically no plumbing fixtures in the operating room, there are two rooms immediately adjacent to the operating room where faucet selection is very important.

• Hands-free scrubbing: The scrubbing room usually provides at least two stainless steel scrub sinks, complete with hands-free faucets. A foot/knee pedal or sensor faucet allows medical staff the convenience of hands-free washing while conserving water. This area could also use a tall gooseneck spout for added convenience and laminar flow for safety.
• Workroom faucet: The workroom is designed for the exclusive use of the surgical staff. It is intended to be different from the scrubbing station. This room contains a clinical sink and the appropriate accessories, including a bedpan washer and a separate wall-mounted faucet.
  

Autopsy room - The requirements of the autopsy room may vary, depending upon the needs of the hospital. The plumbing in this room typically provides cold and hot water, with a vacuum breaker or backflow preventer.

It is most important for the plumbing designer to consult with the manufacturer of the autopsy table to determine the requirements for the table. Body flushers and hose reels used in this room need to be designed for pressure control and maintenance. The autopsy room should also be equipped with a stainless steel sink, complete with manual faucet or sensor faucet with a gooseneck spout.

Cross-connection and backflow contamination

Within the hospital water delivery system, there may be points where non-potable water is connected to potable sources. These cross-connections can potentially allow a backflow of non-potable water to contaminate the potable sources.

Backflow often occurs because of increased pressure from a non-potable source. The dangers posed by backflow can be reduced by preventive measures such as installing backflow prevention devices. To prevent future incidents, the healthcare facility should also flush and clean the water distribution system after an incident.

Conclusion

Hospitals provide a wide array of services to the community, including in-patient and outpatient care, emergency and trauma care, laboratories, pathology and many more. The hospital also provides foodservice, maintenance and staff washrooms - in addition to the specific plumbing needs of the patients and families. All of these services must be considered when selecting faucets for the different hospital environments.

Linda Seigler is national sales manager for T&S Brass and Bronze Works Inc., overseeing the domestic sales force for the foodservice and plumbing divisions. She has worked with specifying engineers in the healthcare industry throughout her career. Seigler is invited to comment and advise on various topics related to institutional plumbing, including, but not limited to, T&S Brass products. She can be reached at lseigler@tsbrass.com.