Sustainability Roadmap for Hospitals

• The amount of water used per flush can be reduced by 63 percent by upgrading an existing 3.5 gpf (gallons per flush) toilet to one of today’s most efficient 1.25 gpf models.
• The amount of water used per flush can be reduced by 87 percent by upgrading a 1.0 gpf urinal to one of today’s most efficient 0.125 gpf (pint flush) models.

• Cost benefits: Upgrading to more efficient fixtures reduces water, sewer, and energy costs by reducing potable water consumption.
• Environmental benefits: Reduced water consumption decreases the amount of water withdrawn from natural water bodies, protects the natural water cycle and decreases the strain on the municipal water supply. Energy use and emissions associated with treating, supplying, and heating potable water are reduced.
• Social benefits: Newer low-flow toilets can increase flushing capacity and reduce associated flushing noise. Upgraded controls can include touch-free options, which reduce the risk of spreading infection.
• Quality and Outcomes:Upgrading to touch-free control options can help prevent the spread of infection.   

• Toilets: Replace existing toilets with flush valves that use greater than 1.6 gpf with toilets and flush valves that use a maximum 1.6 gpf (1.25 is recommended). Evaluate toilet and flush valve combinations for desired flow, noise, and operational characteristics.
• Urinals: Replace existing urinals that use flush valves with 1.0 or greater gpf with urinals and flush valves that use a maximum of 0.5 gpf. 0.125 gpf, or pint flush, is recommended. Evaluate urinal fixture and flush valve combinations for desired maintenance and operational characteristics.
• When evaluating low-flow fixtures ensure consideration is taken on the possible municipal infrastructure affects. Will the water flow from the facility be impacted, which could possible require lift station?

Complete a fixture and flow inventory for all fixtures to identify upgrades that will provide the best return on investment.

• Toilets
  • Replace existing toilets with flush valves that use greater than 1.6 gpf with toilets and flush valves that use a maximum 1.6 gpf (1.25 is recommended). Evaluate toilet and flush valve combinations for desired flow, noise, and operational characteristics.
  • When using a flush valve bedpan washer, confirm the water consumption rate and functionality with the manufacturer. Consider dual flush 1.6/1.1 gpf valves for this application.
  • Consider installing low-flow flush valves in high-use public and staff toilet areas first, then in lower-use private toilet rooms.
  • Low-consumption flush valves are most effective with high-efficiency water closets. The reduction in water flow may not as effectively clean an older bowl not designed to be used with low-consumption flush valves.
  • When replacing both the toilet and the flush valve, consider purchasing both from the same manufacturer. Since manufacturers often test their low-flow components as a system, the efficiency of an overall system with parts from the same manufacturer may be greater than the sum of individual components from multiple manufacturers. Also, buying a complete package from the same manufacturer may increase the warranty of the individual components.
  • Reducing water flow in fixtures and connected piping can result in slower flow velocities, which in turn may impact scouring effectiveness. Evaluate and select waste pipe sizing to maintain an appropriate scouring effect. Lower water flow is more likely to affect the scouring effectiveness of fixtures connected at the end of a waste pipe branch line. With fixtures connected downstream from numerous other fixtures, the waste stream from the upstream fixtures can mitigate the impact of lower flow.
• Urinals
  • Replace existing urinals that use flush valves with 1.0 or greater gpf with urinals and flush valves that use a maximum of 0.5 gpf. 0.125 gpf, or pint flush, is recommended. Evaluate urinal fixture and flush valve combinations for desired maintenance and operational characteristics.
  • Low consumption flush valves are most effective with high-efficiency urinals. The reduction in water flow may not effectively clean an older urinal that was not specifically designed for low-consumption flush valves. When replacing both the fixture and the flush valve, consider purchasing both from the same manufacturer. Since manufacturers often test their low-flow components as a system, the efficiency of the overall system may be greater than the sum of individual components from multiple manufacturers. Also, in some cases, buying a complete package will increase the warranty of the individual components.
  • Waterless urinals require special maintenance procedures. If they are selected, staff members must be trained accordingly. Waterless urinals are recommended primarily for new construction as they can result in issues such as scouring efficiency and uric acid build up in retrofits.
  • Reducing water flow in fixtures and connected piping can result in slower flow velocities, which in turn may impact scouring effectiveness. Evaluate and select waste pipe sizing to maintain appropriate scouring effects.

• Zurn has a free ROI-calculator tool available on its website with a number of fixture upgrades, including urinals and toilets.

If you have an ROI tool, calculator, or other similar resources to share, please contact us or participate in the discussion below.

Dartmouth-Hitchcock Medical Center, Lebanon, N.H.

• Key Points
  • The facility conducted an extensive water conservation retrofit program, including fixture upgrades and retrofits.
  • The total cost of the program (retrofit, consulting fees, and fixture and hardware costs) was $350,000.
  • An annual savings of $100,000 is realized from water, sewer, and energy cost reductions.

Veteran Affairs Medical Center, Portland, Ore.

• Key Points
  • A range of fixture upgrades were implemented.
  • Costs and savings were documented.

• Local regulatory agencies may have a requirement for high-efficiency toilets or sensor-operated flush valves. Check your local regulations.
• Due to the urgency of water conservation in California, the state leads the way in terms of related regulations. Reference documents include the Water Conservation Act of 2009 and the 20x2020 Water Conservation Plan.

• LEED for Existing Buildings: Operations + Maintenance
  • Water Efficiency Prerequisite 1: Minimum Indoor Plumbing Fixture and Fitting Efficiency
  • Water Efficiency Credit 2: Additional Indoor Plumbing Fixture and Fitting Efficiency
• LEED for Healthcare: New Construction and Major Renovations
  • Water Efficiency Prerequisite 1: Water Use Reduction
  • Water Efficiency Credit 3: Water Use Reduction
• LEED for New Construction and Major Renovations
  • Water Efficiency Prerequisite 1: Water Use Reduction
  • Water Efficiency Credit 3: Water Use Reduction

• Operations: Facilities Management FM Prerequisite 4: Minimum Indoor Plumbing Fixture and Fitting Efficiency
• Operations: Facilities Management Credit FM 2.1-2.5: Potable Water Use Reduction: Total Building Reduction

If you have sample environmentally preferable purchasing language for products or contracted services to share, or other related resources, please contact us or participate in the discussion below. 

• Optimize fixture water flows.
• Establish baseline for current water consumption.

If you have any information or resources to contribute, please contact us or participate in the discussion below.

• Continuing Education Center, Precious Water: Sustainable Indoor Water Systems
• Alliance for Water Efficiency, general information on water conservation
• FacilityManagement.com
• • The Greener Side of Restroom Design, an article on low-flow fixtures and controls
  • Transition to Green Plumbing in Healthcare
• Healthcare Environmental Resource Center, Facilities Management - Water Conservation
• North Carolina Department of Environmental and Natural Resources, Water Efficiency Manual for Commercial, Industrial and Institutional Facilities
• Plumbing Efficiency Research Coalition, Drainline Transport of Solid Waste in Buildings
• U.S. Environmental Protection Agency (EPA), WaterSense Program