Health care continues to be an important and growing market for the plumbing industry and for the construction sector as a whole. Even when the market for other building types suffered through dips and drops, health care was one of the first markets to lead the way back out of the recession.
“Health care is a growth market,” said John Aykroyd, vice president of New Business Development at Sloan Valve. “There is plenty of data on that, and you also have to factor in baby boomers who are retiring. During the downturn, construction was put off. The Affordable Care Act added to the delays and right now we do not have enough facilities to go around.”
All of that means a growing demand for new and upgraded health care facilities. By their very nature, these kinds of projects carry a different set of requirements than other building types. Chief among the concerns of owners and administrators of health care facilities is the old adage, “do no harm.” Every effort must be made to ensure that patients coming into the building don’t leave in worse shape than when they entered.
“Patient safety and preventing infections are top priorities,” explained Will Haas, product manager of lavatory systems at Bradley Corporation. “The health care industry wants products that are easy to clean. So, no sharp corners or crevices, and surfaces should be seamless and without joints. Best are materials and products that have a non-porous surface, which can limit microbe growth.”
“Every plumbing product is a health care product in that they are designed to protect public health,” said Gunnar Baldwin, water efficiency specialist at TOTO USA. “As such, the performance of a product relates to how well it will protect the health of a population. If a toilet doesn’t work well, it exposes waste to the air, and indirectly to people. The obvious example is a faucet that doesn’t do a good job washing your hands and may lead to contamination.”
“Patient care is critical in all health care facilities. Mitigating infections is critical. That underlies all our product development for health care,” said John Fitzgerald, vice president of marketing at Chicago Faucets. “There are challenges in any market, and those challenges can vary even within a specific market like health care. For example, in an ER setting, the faucet may be asked to perform differently than in a patient room. Understanding the delicate dynamic of patient care and user needs is essential.”
“Whether it be storing hot water at 140°F to help control Legionella and then using a master mixer to send a safer, tempered water to the domestic hot water system, or tempering water at a surgeon’s sink, healthcare applications can be very critical in nature,” said Peter Gobis III, national sales manager at Leonard Valve Company. “In developing products, Leonard wants to fully understand the prevailing codes for the applications, along with new lead free requirements. Obtaining the details and/or rationale for special requirements on top of prevailing codes is a must. There are many sound products on the market, but some may be more desirable than others for certain applications. Early involvement by the manufacturer benefits everyone.”
“Working with our health care partners, we see that one size does not fit all,” said Jeff Dryfhout, global director of Marketing at AeraMax Air Treatment. “Every facility and marketplace has unique needs and solutions. For example, indoor air quality is a primary concern in the health care market. Often, the plumbing contractor and engineer, while focused on water, needs to widen his or her observations to see the enormous consequences of not only water, but the air.”
Along with concern for surface contamination, health care facilities need to mitigate the transmission of airborne bacteria, viruses and other contaminants.
“Indoor air can be up to five times more polluted than outdoor air,” Dryfhout said. “It has an impact on our overall wellbeing. For example, a restroom has a higher source of contaminants than other rooms. Just imagine what happens to the air when a toilet is flushed. Designing and building health care facilities with clean indoor air as a priority is an emerging opportunity for the health care market.”
“The key component for any health care product is how it helps prevent disease,” Aykroyd said.
He pointed out that according to the most recent Center for Disease Control (CDC) health care associated infection survey, one in 15 hospital patients has at least one health care related infection.
“That’s per day,” Aykroyd said. “We’re focused on how our products can help prevent disease.”
As an example, Aykroyd explained how Sloan developed the “line purge” feature in their products, which flushes the line when inactive based on end user requirements.
“We want to help reduce such liability to the end user customer,” Aykroyd said.
“The health care marketplace is heavily regulated by codes, the U.S. Food and Drug Administration (FDA), the CDC and others,” Baldwin explained. “Challenges arise in the literal interpretation of the codes.”
Baldwin used a sensor activated faucet as an example as it relates to handwashing.
“The health codes say you should wash your hands for 15 to 20 seconds, depending on the state requirements and the authority having jurisdiction,” Baldwin explained. “The health code does not say the water should be running all that time; in fact, our observations indicate one only needs 3 or 4 seconds of water to wet the hands and 7 or 8 seconds to rinse the soap off for a CDC recommended hand wash. The 20 seconds of handwashing required by the health code includes the lathering process, during which running water is not needed.”
Because the codes don’t clarify the particulars of handwashing, this can lead to confusion.
“The plumbing codes were not written around the volume of water used but to satisfy the need to meet the health code,” Baldwin continued. “It’s a waste to let water run straight from the spout to the drain, and it represents a dilemma to all manufacturers of sensor faucets to design a faucet to stay on for 20 seconds when there is really no need for them to stay running for more than the 7or 8 seconds it takes to rinse.”
Minimizing the transmission of illness and infection in a place filled with them is no easy task, particularly when in the case of some older facilities, the building itself can be your enemy.
“The emergence of Sick Building Syndrome has become a real issue due to building design or occupant activities that can result in negative health implications,” Dryfhout said. “ASHRAE has stated that ‘many infectious diseases are transmitted through the inhalation of airborne infectious particles, which can be disseminated through building ventilation systems.’”
The prevention of infection is one major area of focus for health care, but there are others as well.
“All health care facilities service a diverse population in terms of accessibility and mobility,” Haas said. “Accessibility issues can affect product design. Are the products designed for all users to operate easily? Can a disabled person use the product? Can a small child use the product? What about seniors with limited mobility?”
Indeed, mobility is a big factor behind the idea of universal design, which aims for products designed in such a way that they can be used by people with a wide range of physical abilities.
“Patients who are less mobile may also be vulnerable to things like water on the floor that can create a slipping hazard,” Haas continued. “And patients who are obese are not only less mobile, but special considerations are required so that products will structurally support them.”
While there are many concerns to be addressed in an operation as complex as a health care facility, there are no hard, fast rules about how to approach these concerns and how to rank them. That can vary from facility to facility, and that can make the job of a contractor, designer or product manufacturer challenging.
“I think the biggest challenge [with health care projects] is knowing who is the ultimate decision maker at the facility,” Aykroyd said. “Is it the infection control authority? Is it the sustainability director? Is it the mechanical engineer? Who is it? Many times, there are contradictions in terms of the requirements of each of the disciplines, so our job is to build a consensus. That is not always easy.”
Still, there are things anyone can do to better equip themselves for work on health care jobs.
“Certainly, it is important to know the Americans with Disabilities Act (ADA) guidelines and all local codes and should be aware of the principles of Universal Design so that all users can be accommodated,” Haas suggested. “In a health care application where everything runs 24/7, it is essential that products are durable and as maintenance free as possible. It is not only disruptive to patients, but also very costly to the facility to have a patient room unavailable if needed.”
“Controlling Legionella should prevail over energy management,” Gobis suggested. “We have seen designs that incorporate timing devices to turn off the recirculation pump during the evening hours. By doing so, there is no circulation and thus this allows stagnant water to sit at prevailing ambient temperatures, and with the growth range for Legionella is 68-122°F, turning off the recirc pump during evening hours mitigates the recirculation process. Knowing that running some circulators can cost only $35 per year, it would seem rather easy to justify that controlling the growth of Legionella and potential infection should prevail over the minimal cost savings for the recirc circulator.”
“For engineering and contracting professionals, I would say to work with companies who have a history with the health care market,” Fitzgerald said. “While cost is certainly important in every decision, a short-sighted cost decision may not be in the best interest of the customer’s overall strategy. It’s important that facilities incorporate products made in the U.S. – not just from an economic patriotism point of view, but from a practical, availability point of view.”
When dealing with projects as complex as health care facilities, Aykroyd emphasized the importance of keeping a close eye on the details.
“I’m sure [contractors and engineers] keep good records, but I’m talking about even more details, from production specification to installation to maintenance and warranty,” Aykroyd said. “Having those records is a must these days because it isn’t a matter of if a problem will arise, it’s when.”