Figure 1: Healthcare Facility Water Use, Source: Practice Greenhealth, "Guide for Healthcare Series," water conservation strategies.

The scale and complexity of hospitals and healthcare facilities, combined with their 24/7 operation, equals significant water and energy use. Depending on size, location and other factors, water use in healthcare facilities can range from 68,750 to 298,013 gallons per year per bed.1 About 25% of a facility’s water use is directed to domestic use and the remaining 75% is used for other operational needs (please see Figure 1).

Reducing water use is not only the socially responsible thing to do, it also makes economic sense for healthcare facilities. Minimizing water consumption lowers expenses related to water use, and there are secondary benefits, including energy cost savings, that multiply the impact of water conservation.

Water-use reduction programs typically reduce water consumption by 20 to 30%, according to the nonprofit organization Practice Greenhealth, formerly Hospitals for a Healthy Environment. In larger hospitals, the savings can be greater than $100,000 per year in water, sewer and energy costs. Further, the U.S. Environmental Protection Agency states that each dollar a hospital saves in energy costs is comparable to generating $20 in new revenues.

Beyond water use, there are a number of other green considerations for healthcare facilities. The high level of cleanliness required to maintain sanitary patient care usually requires using more chemicals. Not only are the cleaning agents themselves part of the “green” equation as far as improving indoor air quality, but the nature of the cleaning necessitates more durable plumbing fixtures and accessories that can stand up to frequent cleaning.

More durable plumbing fixtures with a longer lifecycle keep waste out of landfills. And there is also the issue of recycled and renewable content in the plumbing products specified which can contribute to the facility’s “greenness.”

While the “first” or upfront costs of going green tend to be grossly overestimated, the actual costs can be as little as two percent. The EPA estimates that a $4 investment (per square foot) in green buildings nets a $58 benefit (per square foot) over 20 years. Clearly, the lifecycle costs of going green far outweigh the investment. (For other financial benefits of green building, see Table 1)

Start With A Plan

The first step in any successful water efficiency program is to have a plan. Prioritizing water-saving measures as part of the planning process is critical to meeting water-conservation goals. Is going for the U.S. Green Building Council’s Leadership in Energy and Environmental Design (LEED) certification a consideration? Or is the objective to cost-effectively retrofit an existing facility to reduce operating costs? The answers will impact the types of products selected, the documentation needed and many steps along the way.

Either way, a good first step is to conduct a baseline assessment, and determine the cost of opportunities and the potential return on investment. The new Energy Star benchmarking tool at can be helpful for tracking water consumption, as well as energy performance. The tool allows users to track multiple water meters, benchmark facilities relative to past performance, monitor water costs and regularly evaluate progress.

Using ultra-low-flow toilets and waterless urinals are an option to meet LEED water-saving requirements.

LEED For Healthcare

At the project level, “green” building continues to gain momentum, but there is confusion among industry professionals about LEED. The USGBC certifies projects, not products. Rather, environmentally friendly products such as low-VOC paint, under-floor air systems, waterless urinals and light-activated lavatory systems can help meet LEED criteria. 

To achieve LEED certification, a facility must meet minimum standards in six areas of building design: sustainable sites, water efficiency, energy and atmosphere, material and resources, indoor environmental quality, and innovation and design process. A minimum of 26 out of a possible 69 points across these categories must be met for LEED certification. Additional points add up to a higher level of certification.

The LEED for Healthcare Green Building Rating System has developed a series of healthcare specific guidelines to meet the unique needs of the market. The system, for example, provides up to five credits for water efficiency:
Prerequisite: No potable water use for medical equipment cooling (required).

1. Water-efficient landscaping (1 point).

2. Portable water-use reduction:
  • measurement and verification (1 point).
  • process water and building system equipment (1-2 points).
  • domestic water (1 point).
Under the guidelines, facilities may not use potable water for medical equipment cooling, and instead must use air-cooled or closed-loop cooling water for equipment cooling. To eliminate the use of potable water for landscaping or irrigation, drought-tolerant vegetation must be planted, or only greywater or captured rainwater may be used for irrigation. The measurement and verification requirement calls for metering for various operations.

There are one or two points that can be earned for reducing or eliminating the use of potable water for nonpotable process use in building system equipment. These requirements assess the processed water equipment needs for the project, including specifics for the cooling towers, water recycling units and vacuum pumps used in the building system.

Table 1. Financial Benefits Of Green Buildings In The United States

Reducing Domestic Water Use

There are a number of potential strategies for reducing domestic water use. Replacing toilets that use as much as 4.5 gallons per flush and specifying low-volume toilets that use 1.6 gpf or less can save an estimated 14% in total water use. For high-performance healthcare facilities, ultra low-flow toilets and waterless urinals are an option to meet LEED requirements for the water-use reduction credits. Additional water savings can be achieved by installing sensor-activated flush meters that control the water used during peak times.

Water use requirements for faucets and lavatory systems vary from 2.5 gallons per minute to 2.2 gpm, depending on the plumbing or building code; generally, lavatories in public restrooms should use just 0.5 gpm. Several manufacturers offer both low-flow lavatory faucets and low-flow showers. Install flow reducers (less than 2.5 gpm) and aerators on applicable plumbing fixtures for greater savings.

Another popular water-saving option is to specify infrared sensors on faucets to ensure that water is running only while someone is washing their hands. The flow rate limit for metered faucets is 0.25 gallons per cycle, which is the amount of water used during the time the faucet is activated. Innovative new touchless faucets feature capacitive-sensing technology that eliminates vandal-prone infrared sensor windows. The entire spout is an omni-directional detection zone that detects a user’s presence from any angle of approach.

Product And Material Specification

Choosing products with a longer lifecycle and/or made from environmentally responsible materials is an important aspect of restroom design that goes hand-in-hand with water conservation. Selecting patient care units and lavatory systems with solid-surface countertops helps ensure long-term durability and ease of cleaning. An integrated bowl eliminates crevices for microbes to hide, and solid surface materials are naturally resistant to bacteria. Newer sinks and countertops are also designed to keep water in the bowl, instead of running onto the floor, which poses a slip hazard.

Increasingly, product manufacturers are introducing products for the restroom that are greener by incorporating post-consumer recycled content. Solid plastic toilet partitions made from 100% post-consumer recycled high-density polyethylene plastic is one example. The solid plastic material is ideal for heavy usage, and can help a facility earn LEED credit for recycled materials.

Accessories also play an important role in conservation. Although some people prefer paper towels to hand dryers because they are faster, there are significant opportunities for cost-savings in choosing the dryer over towels. New, more powerful hand dryers are capable of drying hands in 10 seconds or less, closing the gap and making the hand dryer nearly as efficient as paper towels.

Reducing the amount of paper products used in the restroom will help cut the nearly 2 billion pounds of paper and cardboard waste from U.S. healthcare facilities each year. Avoiding hand towel clutter is also more sanitary for healthcare settings.

We have only touched on some of the strategies for greening healthcare plumbing and choosing more environmentally conscious fixtures and materials for restrooms. Continue to educate yourself about best practices and consider becoming a LEED-accredited professional - it is a sound investment in your future and helps make you a valuable business partner. The greening of healthcare and virtually every part of society is not a trend that will go away. It is up to you to make the most of this new plumbing opportunity, and in turn, help others make healthy business choices.