In June, NHS Property Services (NHSPS) launched their Green Plan, a three-year plan to decarbonise their estates with the ultimate goal of achieving carbon net zero by 2040 in England, and all UK estates by 2050
The plan acknowledges that generating hot water is a major contributor, so improving water efficiency and managing consumption will play a key role in reducing emissions.
Carole Armstrong, marketing manager at Delabie UK Ltd, looks at how estate teams can deliver efficient water management within healthcare facilities while maintaining system hygiene and user safety.
NHSPS was created in 2013 to identify areas for improving water efficiency, including reducing waste water and investigating technologies to reduce use across its estates. Health Technical Memorandum (HTM 07-04), also published in 2013, provides best practice for sustainable water management in healthcare estates. Key to understanding water usage patterns, and therefore identifying areas of waste, is having an accurate system schematic and metering to monitor use, particularly in sensitive areas such as clinical, public and/or service areas. There are two areas of waste that can be easily addressed; leaks and inappropriate use of equipment.
Timely maintenance and regular servicing prevent leaks which can be costly to repair especially if they lead to structural damage to buildings. Ensuring appropriate water pressure in the system will also reduce leaks by preventing excessive wear and tear within the network and avoiding unnecessarily high flow rates through appliances. Fittings that are specifically designed for intensive use in public buildings with technology, that adapts to system conditions and to meet user needs, will minimise waste.
NHSPS identified that domestic appliances consume the most water, and are the most cost-effective area to deliver water efficiency in hospitals and healthcare facilities. “Domestic” appliances include WCs, urinals, taps, baths and showers. The challenge is for estates teams to identify technologies that will reduce water waste, while the onus is on manufacturers to develop new water-efficient technologies that use less water/energy to deliver an equivalent performance, such as dual flush WCs, low-flow taps, and automatic urinal control systems.
Equally important is educating users, to change consumption patterns, supported by appropriate equipment. This will encourage more efficient use of water, for example electronic controls or self-closing water controls in public areas. Metering will allow new practices to be monitored, ensuring good practice is identified and upheld.
HTM 07-04 estimates that leaking toilets account for up to 30% of water consumption in healthcare facilities, with a small leak accounting for 6 litres per hour. A leaking WC cistern often goes undetected as water seeps silently past the mechanism and into the bowl. Concealed by the overflow, users may not be aware of leaks and rarely report them. To prevent over-consumption, seals need to be checked regularly, cleaned and replaced where necessary.
WC cisterns store up to 9 litres of water at room temperature, providing ideal conditions for Legionella bacteria to develop. Direct flush mechanisms remove the need for cisterns by harnessing the system pressure to flush the toilet. Any leaks are immediately obvious and can be instantly addressed.
Dual flush technology has become more prevalent in recent years and NHS Property Services recommend upgrading toilets with cisterns to dual flush systems.
Most mechanisms deliver a 3/6 litre dual flush, which can be adjusted according to the WC pan size and system pressure, with a 2/4 litre flush option to meets environmental targets such as BREEAM. However, it’s not always evident which button activates the shorter or longer flush. Delabie’s Tempomatic Dual Control electronic flush has an intelligent rinse function which distinguishes between the need for a short rinse (2 or 3 litres) or a longer flush (4 or 6 litres) and flushes accordingly. This avoids user mistakes and guarantees the bowl is rinsed even if the user forgets to flush to maintain hygiene.
Urinals are not routinely installed in healthcare settings. Typically, they have an automatic flush system to rinse the bowl, prevent urine crystallisation and avoid blockages in the pipework. However, they consume significant volumes of water. According to HTM 07-04, an automatic urinal system will flush between 7.5 and 12 litres of water every 20 minutes, consuming up to 900 litres per day.
A user-activated urinal flush, either a manual flush or by presence detection, will reduce consumption significantly and remove the need for continuous flushing. However, manual flushing relies on the user to actively flush, whereas sensor-controlled urinals guarantee an automated flush. A sensor-controlled urinal can reduce water consumption by up to 60% according to HTM 07-04.
Delabie’s Tempomatic 4 intelligent urinal can be programmed to flush according to urinal type and usage patterns, taking into account busy periods and reducing unnecessary pre- and post-use flushes. See table 1. Delabie’s electronic urinals also feature anti-blocking to prevent misuse and minimise waste, and the flow rate can be adjusted to suit the installation.
Tempomatic 4 urinal adapts to usage patterns to optimise flushing
In healthcare settings, HTM 07-04 estimates that taps typically consume 400 litres per day and a leaking tap may waste approximately 15 litres per day. The guidance recommends monitoring taps to identify, report and, ultimately, repair leaks. Durable mechanisms will withstand more intensive use and experience less component fatigue; this minimises leaks and prevents water wastage.
Solid brass taps, with robust mechanisms require less servicing and will tolerate intensive and heavy-handed use. However, even the most durable mechanisms require maintenance when used intensively. Timely maintenance extends the tap’s lifespan and reduces the risk of leaks.
Restricting flow rates is not a universal solution for reducing water consumption. Regulators are more effective as they adapt to the system pressure to deliver a constant flow rate despite any pressure fluctuations. Consumption will be controlled if the regulator is suitable for the intended use, delivering an appropriate flow rate.
Non-concussive (self-closing) or sensor taps can also contribute significantly to reducing consumption and encouraging good water management as they support the notion of fractional use. One of the NHS Property Services’ top tips on hand washing recommends only turning on the tap when wetting and rinsing hands.
Traditional basin taps typically consume 9 litres per minute (lpm)⁴. If hand washing takes 32 seconds (see table 2), including wetting, soaping and rinsing, and the tap runs throughout, total consumption is 4.8 litres per use. Over an 8-hour period this equates to 115 litres, assuming a conservative 3 hand washing events an hour. By splitting the water delivery, significant savings can be made through fractional use.
With Delabie taps, the valve closes automatically after 7 seconds (time flow models) or after removing hands from the detection zone (sensor-controlled models), and the flow rate is limited to 3 lpm at 3 bar. The user can, therefore, wet their hands, apply soap and rinse without the tap running continuously. A Delabie electronic tap can reduce consumption to 0.6 litres per use, a drop of almost 90% (see table 2). Delabie taps also prevent Legionella development by activating a duty flush every 24 hours after the last use to prevent stagnation. HTM 07-04 advocates the use of sensor (non-touch) taps in certain applications, as they reduce water consumption and reduce the risk of infection.
The concept of fractional use applies equally to showers, so installing a self-closing shower will also reduce water consumption and the energy bill, since less hot water is required. Ideally, the shower should be equipped with a TMV3 approved point-of-use thermostatic mixing valve (TMV) to ensure anti-scalding safety. This will also improve efficiency since there is no wastage while the mixed water reaches the desired temperature.
Installation design should ensure that there are no cold water dead legs; under-utilised showers should be removed; and low-use outlets should be installed upstream of frequently used outlets (or electronic controls) to maintain regular flow through the pipework.
Estates teams play a vital role in ensuring the efficient use of water by the use of appropriate technology that does not impact essential use or compromise patient and user welfare. Reducing water consumption need not place vulnerable users at risk, since new technologies allow estate teams to offer efficiencies and still provide anti-scalding safety and infection control. Effective maintenance and service coupled with water monitoring will identify leaks early and minimise waste. Installing water efficient WCs, urinals, taps and showers that are appropriate for the area of use will deliver sustainable water management.
The TEMPOMATIC 4 urinal valve has 3 rinsing programmes according to the type of urinal
1. To become more water efficient - NHS Property Services Published by NHS property services
2. HM Government: The Buildings Regulations 2010. Approved Document G - Sanitation, hot water safety and water efficiency. Ed. 2015 with 2016 amendments
3. Department of Health: Environment and sustainability Health Technical Memorandum 07-04: Water management and water efficiency – best practice advice for the healthcare sector. Published 2013.
4. Health & Safety Executive: HSG274 Part 2 Legionnaires' disease Technical guidance. Part 2: The control of legionella bacteria in hot and cold water systems. Published 2014.