Water Treatment and Air Quality Management for Healthcare Facilities

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What’s the difference between HVAC systems in regular buildings and in healthcare facilities?

In a regular building, heating, cooling, and humidification levels are essential to any building, but when it comes to healthcare facilities they are vital.

Hospitals and healthcare facilities are breeding grounds for bacteria. When patients seek treatment at these institutions, they bring a host of airborne microbes, threatening the health of the staff and, worse, other patients.

As we’ve heard every day for the past couple of months, healthcare patients are at higher risk for contracting pathogens, and that includes water-borne pathogens that grow in HVAC systems when the environment allows.

The Dangers of Legionella and Other Pathogens in Hospitals and Healthcare Facilities

Take Legionella, for instance. In the past 5 years, about 1 in every 3 outbreaks of Legionella happened in hospitals, with mortality rates over 10%.

Legionella is a bacteria commonly found in the atmosphere and harmless in low counts. However, it can rapidly grow in parts of building water systems that are constantly wet, becoming dangerous. When the contaminated water is spread via water droplets released through aerosolization, everyone in the building becomes susceptible to contract a pneumonia-like disease called Legionnaire’s.

HVAC examples that could potentially spread Legionella and other bacteria include water heaters, expansion tanks, humidifiers, cooling towers, and pipes, valves, and fittings.

Even though municipalities treat their water with disinfectants that kill Legionella and pathogens such as Pseudomonas, Acinetobacter, Burkholderia, Stenotrophomonas, nontuberculous mycobacteria, and fungi, other factors allow them to enter a building’s water distribution system, such as:

  • Vibrations and water pressure changes that can dislodge biofilm and release bacteria into the flow
  • Water main breaks that can introduce dirt and other materials into the water, using all of the available disinfectants,
  • Changes in municipal water quality or in the type of disinfectant used that can result in more sediment and turbidity, lower disinfectant levels, and/or unbalanced pH

In addition, other factors within building water systems promote bacteria growth, including:

  • Biofilm, scale, and sediment
  • Water temperature fluctuation
  • Improper disinfectant levels
  • Water stagnation

Take Control of Your Building With an Efficient Water Management Program

These are the reasons why establishing and maintaining a program to inhibit bacterial growth in building water systems is so important, especially if we are talking about healthcare facilities.

Water management programs can identify hazardous conditions and help you take steps to minimize the growth and spread of Legionella and other waterborne pathogens in water systems.

In general, any effective water management, either chemical or non-chemical, include:

  • Maintaining water temperatures outside the ideal range for bacteria growth
  • Preventing water stagnation
  • Ensuring adequate disinfection
  • Maintaining premise plumbing, equipment, and fixtures to prevent scale, corrosion, and biofilm growth

Healthcare facilities are mandated by the CMS to establish and maintain a water treatment program, therefore required to regularly monitor and immediately respond to correct hazardous conditions if or when they are identified.

In fact, there are seven activities involving an efficient water management program:

  • Creating a water management program team, with assigned responsibilities
  • Describing the building water system in details with diagrams and a complete written description
  • Identifying the hotspots where Legionella could potentially grow and spread
  • Determining what control measures should be applied, where they should be placed, and how to monitor each of them
  • Establishing how to intervene when the preestablished control limits are not met
  • Making sure the program is working as designed
  • Documenting and communicating all the activities

How HVAC Systems Affect Air Indoor Quality in Healthcare Buildings

But water is not the only concern healthcare facilities should have. Air exchange, humidity, pressure, and temperature are also required to be precise in hospitals and healthcare facilities in order to minimize the risk of infection for patients.

And that’s when the real challenge begins:  the HVAC system of any building, including healthcare facilities, performs several activities on a daily basis, such as filtering, cooling, heating, humidifying, dehumidifying, pressurizing, and exhausting. ALL of these tasks impact indoor air quality.

How? Let’s look at some examples.

First, if the incom­ing air is not properly filtered, dust and other particulates from the outdoors are brought into the building. Second, if the supplied air is not either cooled or heated as it should, occupants experience discomfort. Third, if the supplied air is not dehumidified properly, increased humidity levels lead to biological growth. Forth, if isolation rooms are not properly pressurized, airborne transmis­sion of pathogenic bacteria may occur. Last, when airborne chemicals are not properly exhausted from laboratories, they tend to migrate into other spaces.

Achieve High Air Indoor Quality in With These 4 Tips

So how can you achieve and maintain high IAQ in a healthcare facility?

1. Ensure that all HVAC equipment is performing as designed

If HVAC routinely tasks can affect indoor quality, the first thing you need to worry about is accuracy. Is your HVAC system performing as it should? Inspect all the main pieces of equipment and also your piping for answers.

The tendency is to focus on the airside of the mechanical system, but the hydronic side is not less important. Cooling towers, chillers, water source heat pumps, hydronic pumps, etc. also play a huge role in IAQ and you may not have thought about it.

2. Invest in technologies such as ionization to improve IAQ

Active ionization is a technology with high antibacterial power, proven to be active against the harm of pollen, dust, mold, viruses, bacteria, and other contaminants that damage organs if they enter the human body.

The technology deactivates and neutralizes harmful organisms and can be mounted in the air conditioner, where the existing system fan will deliver the virus killing ions, sterilizing the air inside a building. The technology is extremely efficient and is proven at removing 98-99% of:

  • Airborne bacteria, such as Micrococcus luteus;
  • Yeast, such as Rhodotorula rubra;
  • Bacillus Anthracis;
  • Mold and germs present in the natural spectrum of air.
  • Maintain humidity levels

The first cases of legionellosis were attributed to airborne substances containing bacteria from cooling towers, evaporative condensers or humidification sections of the air handling units of AC systems.

Bacteria and viruses cause infections to thrive in extremely high and extremely low humidity environments. During summer, humidity levels tend to increase, and mold spores, dust mites, and other allergens survive best in high humidity environments, which also increase the levels of noxious chemicals in the air, including ozone and formaldehyde.

The majority of the negative health risks caused by humidity can be lowered by keeping indoor levels between 40 and 60%. ASHRAE recommends temperature ranges of 68°F to 78°F at 50% relative humidity in most buildings, but healthcare facilities have more specific requirements.

3. Keep ducts clean

Even though some hospitals count on ductless heating and cooling systems to provide different rooms and zones with the proper temperature, most facilities still require elaborate ductwork to meet the needs of different hospital areas, such as ICU, pediatric, geriatric and maternity units, among others. 

When dirt accumulates in duct systems, it enters the building and decreases the air quality. Leaks in ducts also lead to mold, and mold has spores that contribute to respiratory attacks and infections.

Believe it or not, there’s also the danger of pests in facilities duct systems. Mice hair, insects, and pest droppings can be blown into the air in any building, but in healthcare facilities, they are more likely to cause harm than anywhere else.

What Role Will Your HVAC System Play?

In the end, HVAC systems help these facilities run smoothly...or become the source of more health problems. They can either protect the health and safety of the people inside or make things worse.

HVAC design and maintenance of healthcare facilities is a delicate job. Buildings are usually big, with hundreds of rooms, requiring the system to be designed around all these spaces’ unique needs and also with strict building codes. In addition, HVAC maintenance is critical. Regular cleaning and monitoring are vital to prevent issues. And downtime is simply not an option.


That’s why you need to work with a team of experienced specialists who can design and maintain your facility out of trouble.

FAS and Vertical Systems are the only partners you’ll need for proper water management and indoor air quality plan for your healthcare facility. We have experience in designing and servicing full energy systems, from cooling towers to chillers, to air handling units, and more. Contact us today to start the process of ensuring your healthcare facility is safe and your system is performing at optimum energy efficiency.