Healthcare facilities are tasked with preventing the spread of healthcare-associated infections (HAIs), and the intricacies of plumbing design and material selection play a significant role in this effort. The role of biofilm in promoting bacteria and pathogens in healthcare water systems including drains and the link between drinking water outbreaks like Legionella to biofilm in plumbing systems, and the importance of selecting the right materials for supply lines are all pivotal in curbing the risk of HAIs.
The role of plumbing in infection control
Understanding the interaction between plumbing materials and microbial growth is imperative for Infection Preventionists (IPs). Making informed choices during construction and renovation allows for the selection of materials that not only minimize infection risks but also ensure compliance with health and safety standards. By collaborating effectively with facility management, IPs can significantly contribute to joint infection control initiatives, ensuring that plumbing systems do not become a source of infection.
Key plumbing terms to understand
Infection prevention requires a firm grasp of key plumbing concepts that impact patient safety. Understanding terms such as leaching, corrosion, and biofilms enriches an IP’s toolkit, allowing for better mitigation of risks associated with waterborne infections.
Leaching
The process by which materials, such as metals or chemicals, dissolve or are washed out from the pipe material into the water due to contact with the water over time. In healthcare settings, leaching can introduce potentially harmful substances into the water supply, affecting water quality and patient safety.
Corrosion
The gradual destruction or deterioration of materials (metals, alloys, plastics, etc.) caused by chemical reactions with their environment. In pipes, corrosion can lead to reduced water flow, leaks, and the release of metals into the water, which can serve as nutrients for microbial growth, including biofilms.
Biofilm
A complex aggregation of microorganisms, including bacteria, fungi, and protozoa, that adhere to each other and surfaces, encased in a protective and adhesive matrix. Biofilms in plumbing systems can harbor pathogens, making them resistant to disinfection and posing a significant risk for HAIs.
Types of lines: Supply, return, drain, waste
Plumbing systems consist of multiple types of lines, each with a distinct function. Here, we explore supply lines, return lines, drain lines, and waste lines. Grasping the role of each type is vital for maintaining an efficient, safe, and reliable plumbing system.
Supply lines
The integrity of plumbing supply lines is critical in delivering safe, potable water for drinking, handwashing, and patient care activities. Materials like copper, PEX, and CPVC are chosen for their durability and reliability.
Flexible water supply pipes offer installation ease and adaptability, making them an excellent choice for connecting water supplies to fixtures in constrained spaces. Their construction from materials like stainless steel, PVC, or braided nylon offers durability and resistance to corrosion, ensuring reliable performance over time.
Return lines
Equally important are the plumbing return lines, which ensure the efficient operation and delivery of potable water systems. They contribute to patient comfort and infection control by reducing water age and stagnant conditions, preventing sediment accumulation, and ensuring temperature and disinfectant residuals.
Drain and waste lines
Proper sanitation in healthcare facilities hinges on effectively removing wastewater and materials through well-designed drain and waste lines. Choosing the right materials, such as PVC or cast iron, and ensuring their correct installation and maintenance are key factors in preventing backflows and the spread of pathogens.
Types of plumbing material and their impact on patient safety
Exploring the benefits and potential risks associated with commonly used plumbing materials—including copper, stainless steel, cast iron, galvanized steel, and various plastics such as PVC, CPVC, and PEX—helps IPs make informed decisions.
PVC, CPVC, and PEX are generally not used in healthcare plumbing due to their susceptibility to biofilm formation and potential chemical leaching. These materials can create environments conducive to microbial growth, posing significant infection risks in healthcare settings. Additionally, their lower thermal tolerance and potential for chemical degradation under high-temperature water systems make them less suitable for the stringent plumbing requirements in healthcare facilities.
Each material has its advantages, such as antimicrobial properties or corrosion resistance, but also considerations like the need for regular maintenance to prevent contamination.
Copper
Copper is favored for healthcare plumbing because of its antimicrobial qualities and durability. It lowers microbial levels in water systems and keeps water quality high with a lower risk of contamination, however over time, it can lose these properties due to scale and sediment accumulation. Used in drinkable water lines, both hot and cold, copper helps reduce infections associated with healthcare. Regular checks and maintenance are needed to avoid bacterial contamination from damaged pipes. Despite its initial cost, copper’s health advantages and long-term use can make it a cost-effective choice.
Stainless steel
Stainless steel is favored in healthcare for its corrosion resistance, hygiene, and durability. Its non-porous surface helps reduce bacterial growth and biofilm, promoting a cleaner water supply and helping prevent HAIs. Despite higher initial costs, its longevity and minimal replacement needs make it a cost-effective choice. Regular maintenance, including inspections and proper cleaning, is crucial for its long-term use. Stainless steel plays a vital role in maintaining patient safety in healthcare settings.
Cast iron
Cast iron pipes, commonly used for underground plumbing due to their durability and sound-dampening qualities, are mainly used in drainage and vent systems. Over time, these pipes may corrode, risking water contamination and health hazards. Therefore, regular checks and upkeep are crucial. Despite potential risks, when well-maintained, cast iron pipes remain a good choice for healthcare facilities, offering high crush strength and noise reduction, which is important for patient comfort. Prioritizing patient safety in healthcare plumbing material selection is key.
Galvanized steel
Once popular for their corrosion resistance, galvanized steel pipes can degrade over time. The zinc coating may wear off, leading to rust and bacterial growth. In healthcare settings, these pipes are unsuitable for drinking water systems due to potential water quality issues and health risks. Modern facilities prefer safer materials to reduce risks. Regular maintenance, including corrosion checks, water tests for heavy metals, and planning for replacements with safer materials, is crucial for patient safety.
PVC
PVC pipes are cost-effective and durable, but not often used in healthcare for potable water systems. They resist chemicals and corrosion, ideal for non-potable water, wastewater, and vent lines. PVC is non-toxic and safe within its operational limits but requires regular checks to maintain integrity and careful installation to avoid leaks and infection risks. While PVC is reliable for plumbing, avoid using it where hot water could release chemicals.
CPVC
CPVC is favored for healthcare facility plumbing due to its chemical and heat resistance. It outperforms PVC in resisting chemicals and handling high temperatures, making it ideal for hot water lines. CPVC pipes are durable and don’t corrode, rust, or scale, minimizing bacterial growth and contamination risks. Yet, it’s crucial to ensure proper installation and regular joint inspections to avoid leaks and contamination. CPVC is not often used in healthcare settings.
PEX
PEX pipes are an excellent choice for plumbing thanks to their flexibility and easy installation, reducing connections and leak points. They resist corrosion, avoiding leaks and water contamination. The smooth interior prevents biofilm, making PEX good for both hot and cold-water systems, including drinking water and radiant heating. PEX is not often used in healthcare settings.
Combating biofilm
Potable water systems are a critical focal point in the fight against HAIs, harboring potential sources of infection. IPs must be vigilant in implementing strategies to mitigate biofilm buildup, from water management strategies, routine flushing programs, supplemental disinfection systems, and routine cleaning to employing chemical or enzymatic solutions. Understanding the risks associated with potable water systems and implementing comprehensive strategies to manage these risks is paramount for maintaining a safe environment.
Implementing plumbing 201 insights
The battle against HAIs requires a proactive approach to water management and plumbing hygiene, encompassing regular testing and evaluations, selecting appropriate materials, and maintaining an efficient water system. IPs play a crucial role in fostering an environment that prioritizes patient safety by understanding and addressing the complexities of plumbing systems in healthcare settings.
In summary, effective infection prevention extends into the realm of plumbing within healthcare facilities. With the right knowledge and collaboration, IPs can influence plumbing decisions to significantly reduce the risk of HAIs, safeguarding the health and well-being of both patients and staff.
In-depth group training on plumbing
Interested in learning more about plumbing and how you can play a part in keeping your facility water safe and reducing healthcare-associated infections? Request a group training session for your team or organization here.
