By Mackenna Moralez, Associate Editor

Editor’s note: This is the first part of a three-part article.  

Water is an essential part of hospitals and other healthcare facilities. It is used for cleaning purposes, infection control, food preparation and is a pivotal part of the patient experience. Without it, patients and residents would be unable to receive the care they need. However, these types of facilities aren’t immune to outages or outbreaks – it's just that when it happens, lives are on the line. 

Late last year, Franciscan Children’s Hospital in Brighton, Massachusetts was forced to restrict the use of its tap water after discovering the presence of Burkholderia cepacia – a harmful bacteria that is often resistant to common antibiotics. Staff were told to limit the use of water for bathing and consumption and were also advised to sanitize their hands after washing them in the sink. While the bacteria was present, the hospital did not accept transfers of patients with lung transplants.  

What happened at Franciscan Children’s Hospital is not uncommon, and because of this, water should be looked at like any other material that enters a building to ensure it meets quality requirements. Once it is within the healthcare facility, water should be kept outside the Legionella growth temperature range of 68 to 120 degrees Fahrenheit. In addition, the facility should make sure the water is continuously flowing to maintain an oxidant residual carried throughout the entire facility.  

“What facilities can do to ensure the quality and safety of water within their hospital building is to really understand the components of a water management program, which then leads them to develop and implement that program based on the site-specific conditions in their building,” says Missy Cain, vice president of technology at Phigenics.  

One way that facilities can achieve better water quality is by adhering to ANSI ASHRAE standard 188, which calls out several key elements of a risk management process so that facilities and owners can program in place.  

“Once those control measures are chosen, then you really move into an implementation mindset in which you consider how you will monitor the control measure and what corrective actions you will take if those control measures are found to be outside of limits,” says Cain. “That is the understanding that a really successful program will have.” 

Having a proper water maintenance program will also help mitigate the risk of any bacteria in the building water systems. Whether it’s an existing, new or renovated building, hospitals and other healthcare facilities can take several steps to maintain or even improve water quality. Four initial moves facilities managers can make include: 

• Teams perform a water risk assessment. This assessment can identify potential water-related risks associated with the facility, allowing team members to set water-related goals and organize response procedures to mitigate risks. 
• Review, update and implement a new or revised water management plan. Having a plan in place can identify potentially hazardous water conditions and outline processes to better minimize the growth and transmission of waterborne pathogens in facility water systems. 
• Install high efficiency water treatment solutions. This can include water softeners, reverse osmosis, deionized water, ultraviolet disinfection and ultrafiltration systems. Hospitals and other healthcare facilities should adhere to recommended maintenance of water treatment solutions and water supply systems by performing preventative maintenance.  Teams can also execute regularly scheduled water testing protocols by analyzing water samples for contaminants and other water parameters at different points upstream and downstream of the water system. 
• Contract with an engineering firm that can perform building commissioning. By performing building commissioning, engineers are able to review the water system design, perform quality control inspections of installed equipment, execute functional testing to verify optimal efficiency and performance of equipment, coordinate operational trainings and provide system manuals that detail manufacturer recommended maintenance procedures and schedules.  

“By prioritizing these steps, hospitals and healthcare facilities can reduce the risk of poor-quality water,” says Kevin Albrecht, field engineer II, FST Technical Services. “These steps provide protections and assurances for quality parameters such as, water temperature and pressure meeting owner specifications and working with equipment as designed. In addition, lower-quality water can lead to poor equipment performance causing issues for mechanical heating and cooling systems and plumbing systems that can affect the overall comfort and well-being of patients and staff in the facility.” 

Water is considered a utility within a commercial building, but it is still something that people consume in their bodies. There’s a quality and safety side to it, as well as efficiency. If water is compromised with bacteria, it can not only shut down an entire facility, but a patient’s life could be at stake. Knowing what could be at risk, municipalities treat water with disinfectants that kill certain types of pathogens before being supplied to healthcare facilities. However, if proper protocols and procedures are not implemented and followed, there are several factors that may encourage the growth of Legionella once water is supplied to a facility.  

“Legionella is known to grow in areas of stagnant water, particularly when the disinfectant residual is low, and the temperature is within the growth temperature range,” says Michael Conrad, senior technical manager, NSF. “Thus, any facility that meets these criteria, regardless of whether it is a hospital or healthcare facility, is at risk. The increased risk for healthcare arises because of the people found within the buildings. These can be the elderly and others that may have compounding factors such as lowered immune systems. The risks from Legionella can be mitigated by completing a risk assessment and developing a comprehensive water management plan outlining control, monitoring and validation measures for the specific site.” 

To continue reading part two, please click here.  

Mackenna Moralez is the associate editor for the facilities market.