The crisis facing water supplies in the UK is acute, with a potential drought on the horizon. All organisations are under pressure to use less water whenever possible, and this includes the NHS, which uses approximately 50 billion cubic metres of water per year,1 making it one of the UK’s largest water consumers. Using less water not only helps to preserve vital water supplies, but also has an additional benefit in terms of lower carbon emissions. Each m3 of water saved can equate to a carbon reduction of between 21 and 560g.2 Thus any organisation that is serious about reducing its environmental impact needs an effective water management strategy
A good water management strategy can help an organisation reduce the impact of its water use in three ways – firstly by identifying opportunities to use less water in the first place; secondly by detecting and reducing water wastage, and thirdly by facilitating the recycling and re-use of grey water and stormwater run-off wherever possible. This is as true in healthcare as it is in any other sector, as the NHS recognises.
Obligations on the NHS
The NHS is committed to cutting the amount of water it uses3 through both reducing wastage – for example from leaks, and improving the efficiency of its water use. The introduction of the Health and Care Act in 2022 also placed an obligation on the NHS to contribute towards a UK-wide Net Zero emissions target – NHS emissions are currently equivalent to 4% of the total carbon footprint of England.4 From April 2023, the NHS has required all suppliers for contracts above £5 m per annum, to publish a Carbon Reduction Plan.5 All this means that the importance of using less water across healthcare estates is widely recognised – indeed each NHS Trust should now have a Water Management Team set up; however Estates managers in healthcare face a particular set of additional challenges when it comes to effectively managing their water use
Firstly, any water management strategy designed to cut water use across a healthcare estate needs to take into account the stringent hygiene and water safety regulations to which healthcare facilities are subject.6 Any water-saving technologies need to be specifically designed with the requirements of the healthcare environment in mind. For example, medical taps must comply with strict regulations and testing to ensure water hygiene, and so any low-flow taps installed with a view to reducing water use must also meet these standards.
Age and diversity of buildings
Healthcare providers often face challenges associated with the age and diversity of both their buildings and their pipes and waste service. For example, data recently released by NHS Scotland showed that almost 200 sewage leaks were recorded between 2019 and 2023, largely attributed to ageing pipework.7 Engineering teams often have to work with a wide variety of types of pipework, and address other challenges – such as extreme lengths of pipework or deadlegs not removed during past building works, presenting the ideal environment for stagnation.7 Old thermostatic mixing valves can be hidden behind new wall structures, making their day-to-day maintenance extremely challenging. Sensor taps and digital showers can reduce water use by up to 70%, while improving patient safety.
Ecoprod has installed CONTI+ sensor taps into many healthcare environments. Many CONTI+ taps are designed specifically for healthcare, and have both infection control and patient safety at the heart of their design. For example, smooth internal components mean that water flows continuously through the tap without restriction. Water does not even pass through the tap’s solenoid, so no bacteria can breed. Larger particles of water debris can pass through the tap’s filter point, which has larger than average filtration holes, so no biofilm gathering point is created within the tap. Any materials to which germs could adhere are simply flushed away
The sensor controls of a touch-free tap are ideal for patients who may struggle to grip and turn the controls on a traditional tap. Temperatures can be preset to an optimum level, which cannot then be changed by individual users, thus eliminating the risk of scalding. These taps are also designed to be easily accessible to maintenance teams, who need to be able to quickly remove components for cleaning or replacement as part of the PPM process
A regular hygiene flush removes any stagnant water, and areas where risk is increased – for example empty patient rooms, can quickly be identified. The Estates team can activate a 12-, 24-, or 48-hour hygienic flush by using a simple stop/start button.
Water and liquid hygiene product dispensing
Ecoprod’s range of sensor taps also includes miscea taps, which can dispense both water and liquid hand hygiene products from the same unit completely touch-free, making them ideal for surgeries and other medical settings. Only one product needs to be installed, with no separate soap or disinfectant dispensers needed, therefore reducing any infection control problems. Whether in a surgical setting, medical area, or public space, the surfaces around the tap and washbasin area can be kept as clean and clutter-free as possible.
Digital showers enable the length of time for which the shower runs, and the maximum temperature at which it can run, to be set remotely. This means significantly less water is used, and patient safety is improved, as the risk of scalding is removed. The shower can also be set to shut off automatically if the cold water supply fails, providing further anti-scald protection. Such showers have other safety features relevant in a healthcare environment. The shower panel is made from AVW plastic, which is 100% antibacterial, meaning that no bacteria can grow on the surface of the shower panel itself. Each shower can be programmed to flush automatically, and every component has been tested at up to 80 °C, so the shower can be flushed at a temperature guaranteed to kill every single bacterium without any risk to the shower itself. The hot and cold water pipework are rinsed separately. This almost totally eliminates microbiological contamination of the shower water.
‘Smart’ water management systems reduce maintenance costs
Effective water management is critical when it comes to preventing Legionella, Pseudomonas, and other similar infections. Smart water management systems such as the CONTI+ CNX enable the complete management of up to 150 connected products such as taps, urinals, and showers, on one system, and multiple networks can be combined for a large hospital site. Hygienic flushing and thermal disinfection can all be programmed, automated, and controlled, remotely. The system automatically controls and logs all safety routines and function checks, providing both reassurance to users of the quality management of the water system, and a full audit trail of safety reports.
Automatic logging of flushes and other safety routines provides an audit trail, as well as reassuring users that water safety is taken seriously. All activities on the water system are logged, and the stored data provides a complete record of all operational uses of each component – whether by staff, patients, or visitors. This can then be used to evidence underused water-connected products wherever they are in the estate, so action can be taken to further improve hygiene, such as more regular thermal flushes to avoid stagnation in patient rooms or other locations to identify sentinel points that are not being used.
The automation of flush routines removes the possibility of human error, which the Health & Safety Executive identifies as a significant contributory factor in many Legionella outbreaks. A manual process is only as good as the people who are implementing it. Relying on maintenance staff to patrol around premises flushing devices one by one means that there is always a risk that they do not flush for long enough, or at the correct temperature, or that they miss a device altogether. Additionally, a water management system such as the CNX reduces the amount of travel to remote sites that maintenance staff are required to undertake, further improving operational efficiency, and reducing the organisation’s carbon footprint.
A smart water management system such as CNX takes away any uncertainty associated with a manual process, and removes the risk of human error. Facilities managers know precisely which taps were run, when, for how long, and at what temperature. The settings for flush duration, interval, and water run-on time for every tap installed in the system can be set via a mobile device or PC.
Advanced wireless management
The CONTI+ Service App also offers advanced, wireless management of CONTI+ electronic fittings on site. Each fitting can be managed remotely through the app, including scheduling programme sanitary rinses, checking and setting water running times, optimising sensor ranges, checking usage data of each fitting, and much more. This enables Facilities managers and engineers to maintain each fitting more effectively, ensuring that hygiene is not compromised.
Waterless urinals, meanwhile, can save 100,000 litres of water per urinal per year. Switching to waterless urinals saves a huge amount of water compared with traditional flushing urinals. At Ecoprod we have installed many thousands of URIMAT waterless urinals across many different types of organisations. Typically, each URIMAT urinal saves up to 100,000 litres of water per year. As a guide, this equates to between £250 and £600 per urinal per year, just in water savings alone (depending on the regional cost of water).
URIMAT urinals are designed to be much easier and quicker to clean than traditional urinals, thus offering greater hygiene levels. The urinal bowl is made of a super-smooth polycarbonate or ceramic material which deposits cannot stick to, and is specially moulded, with no pipes, awkward corners, or sharp edges to clean, or in which bacteria can become established. Cleaners need only spray the inside of the bowl with MB Active Cleaner, a microbiological cleaner, which then breaks the urine down organically.
There is no need for scrubbing and scouring, so cleaning time is reduced, and effectiveness increased
Smart water temperature monitoring
The HSE requires that hot water be stored at temperatures above 60 °C, and cold water at temperatures below 20 °C, to reduce the risk of Legionella. 8 Manual monitoring of this can be timeconsuming, as well as subject to error. Automated temperature monitoring systems such as those provided by Aguardio can provide constant recording of hot and cold water temperatures at each point of use. An alert can be sent out if these parameters are breached so that problems can be identified and investigated as soon as they occur
One of the most effective ways of reducing water use is to identify and stop leaks. Watersafe estimates the cost of a single leaking toilet to be between £300 and £6,000 per year.9 Just one leaking toilet can waste between 215 and 400 litres of what would otherwise be clean drinking water each day. Leaking toilets are notoriously hard to spot, meaning that leaks can continue undetected for months or years, wasting huge amounts of water, and ultimately impacting upon an organisation’s bottom line, as all that wasted water needs to be paid for
Smart detectors such as the Aguardio temperature monitor mentioned above can also be used very effectively for leak detection. The monitor is clamped to the toilet inlet, and continuously monitors the temperature of water flowing through the pipe. A significant change in temperature – for example caused by cold water running continuously through a pipe, can indicate a leak, and thus triggers an automatic alert, enabling the identification of leaks that could easily be otherwise missed by staff
Rainwater harvesting and sustainable drainage solutions
A key part of any water management strategy is not only reducing water usage and wastage, but also identifying opportunities to reuse water whenever possible. Indeed, since 2015 all new developments are legally required to install sustainable drainage solutions, for example by harvesting rainfall and reusing it sustainably. In hospitals, rainwater harvesting is commonly used for irrigation and watering of gardens, and several hospitals in the UK have won awards for gardens and courtyards designed in this way.10 The benefits of such systems are numerous, and should not be overlooked as part of the development of any hospital’s water management strategy. A professionally designed and installed rainwater harvesting system should deliver water quality that will be more than sufficient for non-potable applications such as WC flushing, laundry, and so on.
Specialist expertise required
Installing water-saving products in healthcare environments does, however, require specialist expertise. Infection control needs to be at the forefront of all decision-making throughout the healthcare supply chain – from the commissioner of the system to the installer of the products. This means that contractors working on healthcare water systems need specialist knowledge and experience. For example, the tools should be cleaned between jobs to enhance hygiene and support tight infection control processes. Effective, clean water systems require specialist knowledge to operate and keep in good order to avoid stagnation and the hygiene problems this can cause.
At Ecoprod we have many years’ experience helping hospitals and other healthcare organisations install watersaving technologies specifically designed to address these challenges. There are many measures that hospitals can take to safely reduce water consumption while maximising hygiene. An effective Water Safety Plan can identify where savings can be made, and which products are best suited to the requirements of a particular hospital.
A senior manager in a healthcare organisation once told me that ‘Health buildings require more water, not less, in order to keep them healthy’. Modern technological advances mean that view is increasingly outdated. Using less water definitely does not mean compromising on hygiene. Quite the opposite in fact. Modern water-saving technology offers opportunities to further enhance hygiene and patient safety, while also enabling healthcare organisations to significantly reduce their water use and carbon footprint, supporting the move towards Net Zero.
Paul Musgrove, Sales director at Ecoprod, has worked on healthcare projects both in the UK and internationally since the early 1990s. Since 2007 he has specialised in washroom-related products, with a preference for sustainable experience. He believes in delivering correct solutions for customers in an ethical and consultative manner. He has been Sales director at Ecoprod for the past two years, helping a range of clients from the healthcare and other sectors to use less water, and save and recycle more.
1 Merriman D. Efficient water delivery is vital for healthcare climate resilience [Internet]. Hospital Times. 20 December 2021. https://tinyurl.com/4tjd4yru
2 Sowby RB, Capener A. Reducing carbon emissions through water conservation: An analysis of 10 major U.S. cities. Energy Nexus. 2022 Jun; 100094.
3 To become more water efficient. Our Pledge [Internet]. NHS Property Services. https://tinyurl.com/3rstef8y
4 THE NHS: Carbon Footprint. Sources of NHS carbon emissions (England). Faculty of Public Health Special Interest Group – Sustainable Development. https://tinyurl. com/3dc9ccbv
5 Carbon reduction plan requirements for the procurement of NHS goods, services and works [Internet]. NHS England. 14 February 2023. https://tinyurl. com/2p9yd6b4
6 Health Technical Memorandum 04-01: Safe water in healthcare premises. Part B: Operational management. Department of Health & Social Care. 2016. https://tinyurl. com/mwhdzxwk
7 Green C. Scotland’s ageing hospitals hit by hundreds of sewage leaks [Internet]. inews.co.uk. 12 April 2023. https://tinyurl. com/fd96864d
8 Legionnaires’ disease – Risk systems – Hot and cold water systems [Internet]. Health & Safety Executive. 2014. https://tinyurl. com/2bbcuzf5
9 Why should we care about leaky loos? Rand R. Thames Water. WaterSafe plumbers advice – leaking toilets waste water and money [Internet]. https:// tinyurl.com/332p6k2c
11 Reimagining rainwater in hospitals [Internet]. Mayor of London. https:// tinyurl.com/2rndvtz8