8 Tips for Healthcare Fixture Selection that Reduce the Spread of Infectious Diseases and Increase Patient Safety

Spread of COVID-19 and Legionaries’ disease can be reduced with better fixture selection 

By James Dipping

Hospitals, outpatient centers, senior living facilities and medical offices are at an increased risk for spreading viruses like COVID-19 and bacteria that can lead to illnesses like Legionaries’ disease. 

Transmitted through a building’s water stream, these bacteria can result in major liability when immuno-compromised patients like the elderly and young children are exposed. The result is increased costs and claims for healthcare facility owners and operators who have a responsibility to eliminate or reduce the possibility of bacteria growth in their facilities.  

Fixture selection is a critical piece of prevention and maintaining patient safety. Consider the following tips for fixture selection in all healthcare care facilities.

1. Keep faucet selection simple. Choose heavy-duty, chrome-plated faucets made by the same manufacturer when possible to streamline maintenance and repairs. Because patients can’t be in a room when you’re fixing a faucet, stocking one brand of components can minimize disruption and maximize revenue. Keep faucets – especially those in heavy traffic areas – as simple as possible. Applications that employ photovoltaic technology or mini turbines to recharge batteries while water flows through the control box have more delicate features with the potential to break down the line. An outpatient facility can have as many as 50-60 faucets and without a dedicated plumber or facilities professional to conduct daily repairs, sinks can be left out-of-order for too long.
   
2. Coordinate faucet and sink size. To minimize splashing that leaves water on countertops and sends droplets into the air, specify faucets that amply cover the sink, sending water into a straight line in the sink. Consider angled surfaces, the shape of the countertop and faucet dimensions during design and construction. When selecting faucets, select the sink bowl at the same time to make sure splashing can be controlled effectively. Work with the architect and patient room designer to make sure this is coordinated. There are plenty of stories of poorly coordinated faucet discharge that led to patient staph infections because of bacteria growing on a sink countertop.
3. Eliminate aerators. When water is infected with bacteria and then mixed with air at a point-of-use aerator, bacteria can easily spread into the air and onto the sink. By design, aerators have a screen at the spout, which pulls air in, mixing it with the water stream in order to make users feel like they’re receiving more water. This process of mixing air with water also creates a greater chance for bacteria growth because the screen at the outlet of the faucet retains water when not in use.  Infectious disease control teams across the country are eliminating aerators from their design standard and instead selecting laminar flow faucets that have a plain spout that will dry completely after each use. A dry surface doesn’t support the growth of bacteria. In a laminar flow fixture, the flow control device that limits the amount of water coming out of the faucet is in the base of the faucet and it doesn’t mix air with the water stream, effectively reducing the possibility of bacteria growth in the fixture spout. Eliminating aerators reduces the ability for bacteria to grow in the fixture.
4. Staff sinks. While still mandated by most local codes, staff sinks in patient rooms often go unused. The need for the staff sink is eliminated as most healthcare facilities utilize anti-microbial gel dispensers in each room. When in-room staff sinks aren’t used, it causes water stagnation at the faucet, which can lead to bacterial growth in the piping system and faucet spout. Challenge the local authority having jurisdiction to reconsider their position and eliminate the requirement for staff sinks in patient rooms. This will similarly eliminate additional capital costs for the hospital and further reduce the spread of bacteria.
5. Consider wall-hung vs. floor-mounted toilets. To meet the needs of an ncreasing number of bariatric patients, hospitals and outpatient facilities are looking to specify a more heavy-duty toilet for their bathrooms. Traditional vitreous china wall-hung toilets are rated for 500 pounds to meet ASME A112.19.2-2005/CSA B4 5.1-05. A wall-hung bariatric toilet rated to hold 1,000 pounds is made of stainless steel and must be paired with an appropriately rated in-wall support system. Because stainless-steel, wall-mounted bariatric toilets are extremely costly, more  healthcare facilities are considering floor-mounted vitreous china applications rated by manufactures for the same 1,000 pounds. While wall-hung fixtures are easier to clean, many healthcare facilities are turning to floor-mounted toilets in vitreous china to reduce costs.
6. Specify anti-microbial materials. Whether it’s water closet seats or vitreous china fixtures, select elements with anti-microbial agents to serve as another firewall to kill bacteria. An anti-microbial finish can be found on just about any vitreous china product, including wall-hung lavatories, toilet seats, countertops, some copper sink bowls and more.
7. Optimize patient room drain locations. To minimize water ponding and patient slippage, specify linear drains in patient bathrooms. Linear drains, which are often 3-feet long by 2-inches wide, are typically found in high-end bathrooms and can be constructed using a kit to precisely pitch the floor. Pitching the floor in a circular shape is hard to do effectively, as it must be done by hand. For this reason, many hospitals have made linear drains their go-to standard. While they are more costly, linear drains virtually eliminate pooling water around the drain and therefore, the likelihood of patient slipping.
8. Coordinate emergency eye and face wash equipment. In outpatient facilities or in pharmacies, emergency eye and face wash equipment fixtures are required by the ANSI Z358.1 standard to be tested weekly. It is important to be diligent when specifying these fixtures because of the way they operate – they either swing down or across the sink. When installed, they should discharge over the sink and not the countertop and floor. If not specified and installed correctly, they can cause unnecessary pooling of water on the floor and someone can easily slip and fall, making a mess when in use and preventing required testing. 

Start preventing the spread of bacteria early on
There’s more to preventive healthcare than wearing a mask and washing hands. Avoiding the spread of infection starts as early as the design phase of a healthcare facility and continues through construction. Specifying the proper fixtures is the first step. 

James Dipping, P.E., CPD, GPD, LEED AP BD+C, ARCSA AP, is ESD’s plumbing technical director.