In healthcare, infection control and patient safety are non-negotiable priorities. While effectively managing water safety is critical to reducing infection risks, balancing this responsibility with financial constraints and operational efficiency remains an ongoing challenge for both healthcare engineering and estate management personnel, and others with responsibility for the safety of the water system in hospitals and other healthcare facilities.
Reducing costs and emissions is a long-term journey for the NHS, but small, impactful changes can improve efficiencies now. By adopting innovative solutions from manufacturers, and ensuring their effective and consistent implementation, the benefits can be realised in the shorter term. One area where the balance between maintaining the healthcare facility’s water system in a safe and hygienic condition, and the need to operate within tight financial constraints is particularly evident is with water delivery and management systems, where the pressure to maintain safety standards while controlling costs has led to the emergence of more efficient solutions.
PBVs — ‘an increasingly attractive option’
Among these, Pressure Balance Valves (PBVs) are becoming an increasingly attractive option within the UK healthcare sector in suitable environments, especially when compared with the more traditional thermostatic mixing valves (TMVs). While TMVs have long been the gold standard for maintaining safe water temperatures and preventing scalding, They offer a simpler, more cost-effective alternative for suitably risk-assessed environments such as non-critical care settings. PBVs offer advantages in terms of installation and maintenance, making them a valuable tool when seeking to balance safety with the ever-growing demands for cost savings.
In a setting where patient safety is paramount, but cost and sustainability demands are also high, any modifications to standardised and accepted systems must be carefully considered. PBVs are not a direct replacement for TMVs, but serve as an alternative in specific situations.
Infection control must be a priority from the early design and construction stage of new facilities. Everyone involved must have a clear understanding of what infection control and risk assessment mean in relation to their role. The earlier that knowledge sharing begins, the better the specification process — which in turn assists in optimising budget use during construction, and provides long-term savings. The relationship between healthcare personnel and manufacturers is therefore critical to finding solutions that balance patient safety, cost-efficiency, and sustainability, and manufacturers like Armitage Shanks are working closely with the NHS to develop products that meet the specific needs of healthcare environments.
For example, in the case of PBVs, this collaboration has resulted in Armitage Shanks’ latest design, which simplifies installation and reduces ongoing maintenance, while also ensuring that the water system continues to meet required safety standards. By understanding the needs of healthcare professionals, manufacturers can foster strong cross-disciplinary relationships and develop practical solutions.
The right tool for the job
The core difference between PBVs and TMVs lies in the technology behind each system. PBVs use a ceramic sleeve and shuttle system to balance pressure. When water pressure fluctuates, the shuttle moves within the sleeve to adjust hot and cold water flow, maintaining a steady outlet temperature. This is a relatively straightforward system, which makes it simpler to operate and maintain.
In contrast, TMVs are more complex. These systems regulate water temperature by mixing hot and cold water using a thermostatic element. While they offer more precise temperature control, their more intricate mechanics mean that they require regular checks and ongoing maintenance. This level of precision makes TMVs critical in high-risk areas like operating theatres or intensive care units, where patient safety is paramount.
While TMVs remain essential in high-risk settings, PBVs present a more cost-effective and low-maintenance alternative in non-critical care areas such as patient washrooms, staff facilities, and certain wards. One of the most significant advantages of PBVs is their lower maintenance requirements. Although all taps and mixers in healthcare environments require periodic checks, TMVs demand more frequent maintenance due to their complexity. PBVs, classified as manual taps, are not subject to the same level of scrutiny under NHS guidelines such as HTM 04-01: D08 Supplement, yet they still meet the anticipated changes in HBN 00-10 Part C (expected this year). This difference reduces both maintenance time and costs, allowing valuable funds and staff time to be spent elsewhere.
The sequential mixing design of PBVs allows hot and cold water supplies to flow smoothly, and prevents stagnation, helping to maintain cleanliness, and minimising the risk of infection. In high-risk environments, where the likelihood of infections is much greater, TMVs are still the right choice, but PBVs provide a viable solution in lower-risk areas.
Complementary roles
While PBVs and TMVs serve different primary functions, they complement each other in maintaining a safe and efficient water system, and clever specification can make it simple to minimise costs while complying with healthcare regulations.
Standards guiding this specification have been continuously updated. The British Standards Institution (BSI) recently introduced BS8580-2, a new standard for risk assessments related to Pseudomonas aeruginosa and other waterborne pathogens. This standard offers healthcare providers a crucial framework for managing bacterial risks that pose significant health threats in hospitals and other medical settings.
Effectively controlling Pseudomonas aeruginosa requires well-designed, carefully specified equipment that allows healthcare providers to maintain a balance between patient safety, cost efficiency, and sustainability.
For healthcare estates, lowering maintenance costs is essential for financial sustainability. With ongoing funding challenges and labour shortages in the care sector, reducing maintenance demands can free up both time for overstretched maintenance staff and budget resources, allowing healthcare facilities to focus more on patient care. As the availability of skilled professionals to manage complex plumbing and heating systems declines, solutions that minimise maintenance requirements are becoming increasingly valuable. PBVs provide a practical advantage by simplifying routine checks, and also reduce the need for specialist intervention, making them an effective choice for healthcare settings.
The advantages of specifying PBV mixers go beyond immediate cost and maintenance savings. With the growing demand for care services, many providers are expanding facilities or upgrading infrastructure to meet the needs of an ageing population. Future-proofing these spaces calls for flexible solutions that can adapt to evolving regulations and operational requirements. PBVs provide a scalable, long-term option that seamlessly integrates into both new developments and refurbishment projects, ensuring that healthcare facilities remain efficient and compliant in the years to come.
Design considerations for ease of installation and use
In addition to their operational and cost benefits, some PBVs are designed with ease of installation in mind. Armitage Shanks has streamlined the process by ensuring that its non-thermostatic Markwik 21+ Comfort SQ PBV mixer can quickly, easily, and cost-effectively, replace an existing Markwik 21+ TMV fitting, by simply swapping out the tap body and reusing the Markwik 21+ TMV spout and handle (for more information see https://youtu.be/I1PxQVsrABY?si=fnOT-eBkNM5EbyT3).
This ‘plug-and-play’ compatibility means healthcare providers can adopt PBVs without overhauling their entire water system, minimising disruption, and reducing installation costs.
This approach allows the NHS to make the switch to PBVs with minimal effort and expense. The compatibility of PBVs with existing systems is particularly valuable for facilities looking to reduce both installation time and costs while still achieving the benefits of a more efficient water safety solution. It also provides a smooth transition for Maintenance teams, who are already familiar with the existing fixtures and fittings.
Furthermore, many PBVs are exclusively tested using air, as recommended in the latest healthcare bulletin for HTM 04-01. By testing products using air only, they are free from any potential bacterial infection, further simplifying the switch to PBVs.
In the ongoing effort to balance patient safety with cost-efficiency, PBVs offer a practical solution for non-critical care settings where TMVs may be overly complex and expensive. These low-maintenance, cost-effective systems help healthcare estates teams streamline their operations and reduce overheads, allowing valuable resources to be allocated where they are most needed.
For the NHS, adopting PBVs where appropriate is a strategic step toward greater financial and operational efficiency. They enable healthcare facilities to maintain high standards of infection control without the need for frequent and costly maintenance. By integrating these smarter solutions into existing infrastructure, the NHS can help drive sustainability and reduce its carbon footprint while still prioritising patient safety.
Pressure-balanced valves are also highly compatible with modern, energy-efficient heating systems, helping to reduce unnecessary water heating. By maintaining consistent water temperatures, they prevent sudden fluctuations that would otherwise force water systems to work harder to compensate for drops in temperature.
Enhanced stability
Enhanced system stability also means fewer unexpected failures in healthcare environments, reducing the frequency and cost of emergency maintenance. Additionally, by minimising strain on water heaters and plumbing infrastructure, pressure-balanced valves contribute to the longevity of these systems, delaying the need for costly replacements, and ensuring more efficient long-term operation.
As the healthcare sector continues to evolve, PBVs are likely to play an increasingly important role in delivering efficient, safe, and sustainable water management solutions in suitably risk assessed healthcare environments. With the right products in place, healthcare estates can navigate the complexities of modern care environments, ensuring that both patient safety and cost-efficiency are achieved without compromise.
Anil Madan and Ideal Standard
Anil Madan joined Ideal Standard, part of the Villeroy & Boch Group, in 2017 as a Product manager, and is now UK Non-Residential Marketing manager for Ideal Standard and Armitage Shanks. With over 25 years’ B2B marketing experience, and over 15 years working in the commercial sanitaryware sector, he has a broad understanding of the needs of healthcare professionals, installers, and end-users. In his role, he manages the Armitage Shanks brand range of specialist healthcare and commercial fittings and sanitaryware.
Ideal Standard International describes itself as ‘a world-leading manufacturer of high-quality residential, commercial, and healthcare bathroom solutions’. The Brussels-headquartered company employs over 7,000 people, operating at eight manufacturing sites, and serving over 100 countries across Europe, the Middle East, and Africa.