Plumbing Fixture Selection for Health Care Facilities
By John A. Clark, P.E., Sr. Quality Assurance Engineer
Karges-Faulconbridge, Inc.
Our engineering firm was recently hired to upgrade and add space to an existing hospital/clinic facility constructed in 1999. As part of our design process, we prepared a recommended list of plumbing fixtures to be used within the new and remodeled building. Rather than just provide what has "always been done," we proceeded to review all of the current standards and changing code requirements. We met with the client to review what had been the hospital standard and discussed the new requirements for Americans with Disabilities Act (ADA) accessibility, as well as the current recommendations listed in the 2006 edition of "Guidelines for Design and Construction of Hospital and Health Care Facilities."
The discussion topics began with what is currently being required for ADA accessibility, the new International Plumbing Codes and the latest American Institute of Architects (AIA) Design Guidelines. Client goals such as touchless and paperless operation and the avoidance of recontamination were also covered.
Economics are also important; therefore, after all the discussions with the client, vendors and professional plumbing society members, the basic "sink" fixture selection for material, style type, faucet and spout trim was broken down into good, better and best choices.
Basic handwashing stations
Good: A vitreous china 20 x 18-inch wall sink with 4-inch wrist blade handles on 8-inch centers, a 5-inch spout with 2.2 gallons per minute (gpm) laminar flow outlet and a grid strainer. Advantage: There is continued use of standard-durable wrist blade faucet parts. Disadvantages: Two hands are needed to achieve mixed water temperature. There is no point-of-use scald protection.
Better: A vitreous china 20 x 18-inch wall sink with a single hole-center single lever (minimum 4 inches long), a 4 3/4-inch spout with 2.2 gpm laminar flow outlet and a grid strainer. Advantages: Flow quantity and water temperature can be adjusted with one hand. The unit contains a high limit adjustable water temperature stop for scald protection.
Best: A vitreous china 20 x 18-inch wall sink with a single hole-center sensor, a standard spout with 2.2 gpm laminar flow outlet, external water temperature adjustment and a grid strainer. Advantage: This unit provides touchless operation. Disadvantage: The unit costs about 20% more than the other faucet choices.
Note: Alternatives to a wall-hung china sink are an oval self-rimming 20 x 17-inch china sink or a 20 x 17-inch single bowl, 18 gauge, 304 stainless steel sink. Avoid using 0.5 gpm flow outlets; field feedback indicates that there is not enough water flow to clear the sink of soap. Have the architect call the handwashing station a "sink" vs. calling it a lavatory; a sink requires a 1 1/2-inch trap and a lavatory only requires a 1-1/4-inch trap. Trap size relates to drainage time, which is also relative to water flow time, so the size does make a difference. A rose spray outlet is also acceptable, instead of the laminar flow unit. For infection control, soft flow outlets are not allowed in the sinks. Vitreous china sinks that use grid strainers do not have to have an overflow; the overflow hole is a possible source of contamination.
Clinic sinks for handwashing, instrument washing and carafe filling.
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| Hand-washing sink with 3" radius gooseneck faucet and wrist blades. |
These sinks should have the same features as those described above, except that they should have a gooseneck spout, which should be about 10 inches high and have about a 5-inch radius. The height allows clearance adequate to avoid contaminating utensils and the contents of carafes. The 5-inch radius helps reduce splashing on the back ledge of sinks.
Water closets
These units should be vitreous china with an elongated bowl and 1.6 gpm siphon jet flush, and should be wall hung for ease of cleaning. The wall-hung units should have a floor- mounted closet carrier that has three- or four-bolt anchors into the floor slab to prevent the fixture from pulling away from the wall. Most wall-hung units use a top spud for the exposed flush valve unit. Rear spud units are selected for concealed piping arrangements (high security).
Floor-set units may also be used. Rear outlet floor-set units are used in facilities with precast or post tension slab construction. It should be noted that rear outlet units require a higher water pressure to successfully flush the fixture (35 pounds per square inch (psi) vs. 25 psi).
Bedpan lugs are available for both tank units and flush valve units. Bedpan washers are available as part of a flush valve assembly or as a wall-mounted hose unit with a wall- mounted pedal valve. If a hose arrangement is selected, provide a wall-mounted atmospheric vacuum breaker.
The flush handle mounting height should be coordinated with the mounting height of the wall-mounted grab bars. Dual flush handles (liquid and solid) and sensor flush valves are also an option. The flush handle must be on the wide side of any ADA stall arrangement.
The toilet seat should be white, open front, without a cover, a standard commercial class with a stainless steel self-sustaining check hinge.
Clinic/Laboratory work sinks
The self-rimming unit is a 22 x 19-1/2 x 7-1/2-inch single compartment, 18 gauge, 304 stainless steel sink. A 22 x 19-1/2 x 10-inch unit is also available for washing larger pieces of equipment. The front to rear 19-1/2-inch dimension fits within most casework countertops.
If a double compartment sink is required, select a 33 x 19-1/2 x 7-1/2-inch unit for standard use. If a deep wash sink is desired, select a 33 x 22 x 10-1/8-inch unit. Verify, however, that the width of the counter can accommodate the 22-inch front to rear sink dimension.
Faucet trim must include a gooseneck with a laminar flow outlet. The gooseneck for single compartment sinks can be rigidly connected in the center of the sink; the gooseneck for the two-compartment units must be a swivel arrangement. The faucet blades are now referred to as elbow units and must be six inches long. The single lever units also must have a 6-inch long lever. The drain is a basket strainer type.
For a touchless configuration, a single casework foot pedal or a wall-mounted foot pedal can also be included. The faucet handle is used only to adjust flow quantity and temperature. If using a wall-mounted foot valve, mount the unit on a wall bracket so that the pedal is out far enough to reach from below the countertop. Mount the countertop at ADA height and, for ADA acceptance, use the side approach choice rather than selecting a 5 3/8-inch sink depth. Side approach units do not require offset drains and pipe insulation.
Flushing rim service sinks
Flushing rim sink fixtures are available in wall-mounted (25 x 20-inch) or floor- mounted (27 x 20-inch) types. The front and sides of the rim have stainless steel rim guards. The flushometer mechanism is mounted above the hose end spout, with elbow blade handles on the faucet trim.
The flushometer activation may be either a handle or a sensor operation. A bedpan washer is available as part of the flush valve assembly or as a wall-mounted hose unit with a wall-mounted pedal valve. A laminar flow outlet should be provided rather than a hose end thread, which requires a hose and an atmospheric vacuum breaker.
Safety eyewash units
These units are usually mounted on the countertop adjacent to a stainless steel clinic sink and are activated by a stainless steel push handle. Be aware that, when the eyewash is turned in toward the sink, a conflict may arise between the eyewash and the gooseneck. In order to avoid taking up counter space near the sink, wall- mounted hose units are also used; however, these units look unprofessional. Units with a pullout hose integral with the sink's faucet spout are currently available. This integrated type uses the least amount of work space and counter space. A tempered water supply must be provided to the hose connection. The tempered water supply can be from a safety-tempering valve or from a 15-minute storage tank located nearby.
Plaster sinks
Plaster sinks have the same choices of features as clinic work sinks. The only addition to these sinks is a solids interceptor (plaster trap). For exposed locations, use a white PVC unit. When the trap is contained in a base cabinet, the unit can be acid-resistant coated fabricated steel.
Instrument-cleaning work stations
A countertop instrument-cleaning unit requires a supply of 140 F hot water for thermal sanitation. The units do not use much water; therefore the 140 F water source must be immediate. The solution is to provide a point of use water heater below the countertop. The water heater may be in a base cabinet. Select a unit that does not have a pressure and temperature (P&T) relief valve, because units with a P&T valve will require a floor drain to accept the relief from the valve.
Hydrotherapy whirlpool tanks
These units require a fill system, a drain system and a spillage drain. The fill system and the drain system should be sized as large as possible to reduce the turnaround time required for fill, drain and cleaning. Time is money in the health care industry. The spillage drain should have a deep seal trap, a trap primer or a trap assembly to minimize the problem of the trap drying out.
Foot pedal controls
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Clinic sink with single-lever faucet and foot pedal. |
Use a wall-mounted foot pedal or a toe space unit only to turn the water on and off. Use a single lever faucet piped-in series to adjust the flow and temperature of the supply. Mount the wall-mounted foot pedal on a wall bracket to extend the pedal to a location right below the edge of the countertop. Use the toe space unit in a base cabinet with only the pedal showing under the base cabinet door. This arrangement avoids the foot pedal "tap dance" in order to achieve a comfortable water temperature.
Patient rooms
Patient rooms require a handwashing station in the patient toilet and a clinic sink for the medical staff in the bed space. A trend in patient room design is to make the rooms more homelike. A combination unit provided in the bed space integrates a toilet and a handwashing/clinic class sink (longer handle and gooseneck) that can be used by the patient and the staff.
Bathing units
Tubs and showers all require pressure balance control valves, traditional outlet spouts and handheld hose shower units. Tubs with the handheld shower also require a vacuum breaker on the hose supply. The designer must coordinate the handheld shower holder with the grab bars that are also required.
Sitz baths
These units use a thermostatic mixing valve with a wall-mounted thermometer to show the mixed supply water temperature.
Soap systems
It has recently been discovered that refillable soap systems can become contaminated. Therefore, all soap systems in the infection control areas of medical and dental facilities must be in disposable containers.
Cross flow between hot and cold service lines
Verify that every mixing faucet has integral check valves or that check valves have been added to the service lines. A common faucet at fault for cross flow is one with hose end valves, often used in mop sinks and flushing rim service sinks.
Touchless, paperless or standard facilities
Touchless design uses sensor activation of all the fixtures, soap and paper towel dispensers or high velocity hand dryers. It also has the facility's exit door swing outward or uses a "Z," no door entrance/exit.
The paperless concept uses high velocity hand dryers. Consider providing touchless paper towel dispensers, however, in unisex restrooms that contain diaper changing stations.
To avoid recontamination of the hands, a standard facility should have paper towels available to use on the exit door hardware. Locate a paper towel trash container near the exit door to accept the paper used on the door hardware.
Conclusion
This article notes many little things that make the difference between a good design and what has always been done. To get a feeling of the real "value" of wrist blades and elbow blades, have a conversation with the health care infection control staff of your client. I have almost always (95% of the time) been informed that the infection control procedure is to wash your hands, take a paper towel to dry your hands and then grab the faucet handles with the paper towel to close them. So much for wrist and elbow actions. Better technologies are the single levers, foot pedals and, ultimately, sensor units. The design selection process should pay close attention to handle lengths, specify laminar flow outlets rather than soft flow aerators, have no overflow outlets in china sinks, select the 5-inch gooseneck radius to reduce splashing during hand washing and use disposable soap systems.
John A. Clark. P.E. is a Sr. Quality Assurance Engineer with Karges-Faulconbridge, Inc. (KFI) in Saint Paul, MN. John has more than 40 years of experience in a broad range of hospital, clinic, and institutional and industrial projects. His experience includes design and selection of HVAC, plumbing and fire protection systems for the leading health care facilities across the United States. Mr. Clark can be reached at jaclark@kfi-eng.com