U.S. hospitals are water hogs, using an average of 570 gallons of water per staffed bed, per day. To put this figure into perspective, consider that the average American citizen uses around 150 gallons of water per day; the average Briton, 44 gallons; the average African, just 5 gallons. 

Water shortages and droughts are more common, and increased demand is being placed on already stressed municipal water supply and treatment systems. While hospital water use supports a number of vital functions—including the HVAC system, process cooling, sterilization, and sanitation—there’s much room for improvement. 

Though hospitals across the country have begun to address energy use and increase their energy efficiency, few hospitals have considered implementing water efficiency—yet. This is due primarily to the historically low cost of water in the United States and the perception that water is an inexhaustible resource. 

Yet with water and sewer rates rising between 5 and 10 percent every year in many parts of the country, investments in hospital water efficiency programs can provide attractive returns.

Water conservation is also an emerging risk-management strategy, as facilities are increasingly challenged to forecast operating costs and communities are expecting their neighboring facilities to be good water stewards in times of drought. Perhaps most important, tackling water consumption and quality is a way to fulfill healthcare facilities’ role to promote and maintain human health, which is inextricably linked to the health of the environment. 

To start working on water efficiency, healthcare facilities can apply many of the lessons learned from managing energy. A successful water-reduction strategy starts by collecting and analyzing available data, choosing the right metrics, then considering the return on investment (ROI) of potential solutions. This allows the development of a water-savings strategy that begins with the most cost-effective solutions and progresses over time to more complex solutions.

Virtually all facilities can make some improvements in water efficiency, although the opportunities are perhaps greatest for the most water-hungry hospitals.

Know what you use, and where
Finding out how much water your hospital consumes on an aggregate level is straightforward: your water utility can provide overall consumption data, or you can pull data directly from your utility bills. For facilities just beginning to look at water efficiency, this is a good starting point.

The Environmental Protection Agency’s Energy Star Portfolio Manager has a water module to which facilities can link their water consumption data and track progress over time, much like the tool does for energy. To understand your starting point in relation to other similar facilities, there are other emerging tools that can help (see author bio). 

Much more challenging is verifying the water consumption of specific buildings, equipment, and functions. Reasonable assumptions can be made in a high-level water audit that considers the types of systems, processes, and age of equipment and fixtures in the facility. However, available industry data describing actual water use (beyond equipment ratings and specifications) for specific systems, fixtures, and equipment is scant.

As facilities increasingly commit to their water-efficiency strategies, they may consider employing selective mobile or fixed water sub-meters to build a verifiable data set and support future initiatives. Wisely placed sub-meters can also assist in preventive maintenance and leak detection. 

Once you’ve gathered as much information as you can about your past water consumption (three years’ data is a good starting point), the next step is to analyze the most effective water conservation measures for your facility. A thorough water audit will consider cost ranges of various measures, both water and energy savings benefits, and the resulting return on investment. 

Water conservation measures should include both operational projects, like fixing leaks, and capital projects, such as installing low-flow plumbing fixtures.

Do the easy work first
A successful water conservation strategy at any hospital has to start saving money quickly and easily in order to gain widespread support. Tackling the low-cost measures first—fixing leaks, for example—allows you to save water and money nearly immediately, which then builds support among hospital staff to continue with your water conservation measures. The savings gained from low-cost measures can also be used to create a fund to support future measures. 

By analyzing each measure and coming up with an ROI for each one, you can plan within your budget for what happens immediately, what happens over the next months, and what you may do over years.

In addition, look at implementing water conservation measures as part of ongoing or planned renovation projects—this can reduce the initial cost and save money on the back end.

Plan big over the long term
Once your strategy has been embedded in your ongoing operations, you can plan for longer-term, more forward-thinking projects. These projects require that facilities fundamentally rethink their water and wastewater systems in ways that today may be considered unusual in a North American healthcare setting, but are becoming more commonplace elsewhere. 

These strategies include matching your water source to the quality of water you need in your facility, and re-using water to the extent possible. For example, hospitals are currently flushing toilets and irrigating landscapes with potable drinking water, which is expensive and wasteful.

Systems are now available to collect rainwater, treat it, and supply it to functions such as cooling tower makeup, toilet flushing, and irrigation. Using rainwater for non-potable functions not only saves the cost of purchasing potable water but also saves the stormwater discharge costs from the diverted rainwater. 

Non-potable systems can also be served by high-quality process water that is recycled within the facility. For example, reusing rinse water for sterilizers, or collecting condensate from air handler cooling coils and reusing it for cooling tower or boiler makeup. 

While healthcare building codes can be a barrier to reuse where water could potentially contact patients and staff, code organizations are beginning to grapple with the reuse of greywater in healthcare facilities as water shortages become an issue nationwide. Onsite blackwater treatment and reuse in hospitals is an emerging field still in its early research stage. 

Whether you’re looking at developing a basic water conservation plan or thinking big about water reuse, understanding your current water use and planning over the long-term for reduction is the key to maximizing cost savings. Water will have a bigger impact on healthcare operational costs as it becomes a more scarce (and expensive) resource, and those hospitals that begin to design a strategy for water reduction today will reap the biggest savings tomorrow. 

Christy Love is a senior designer and environmental performance analyst at Mazzetti Nash Lipsey Burch. Mazzetti recently completed development of a free online database and benchmarking tool for healthcare water consumption. The tool can be explored at www.mazzetti.com/watermark.

SIDEBAR: Case Study—Providence St. Peter Hospital
An illustration of the types of projects that a hospital can pursue can be found at Providence St. Peter Hospital, a 390-bed hospital in Olympia, Wash., which has sp
ent more than a decade implementing water-savings measures.

Despite growth on its campus and increasing patient days, Providence St. Peter was able to save more than 31 million gallons of water and $1.5 million over nine years by implementing a water conservation strategy.

Measures implemented included:

• Water audit and benchmarking
   
• Leak detection and repair
   
• Replacement of single-pass, water-cooled equipment with air-cooled or central-chilled water
   
• Upgraded vacuum sterilizers
   
• Dual-flush retrofits and fixture upgrades
   
• Pint urinals
   
• High-efficiency showerheads
   
• Lavatory faucet flow control
   
• Xeriscaping, drip irrigation, and rain sensors
   
• Optimized cooling tower and boiler cycles of concentration
   
• Efficient dishwasher
   
• Waterless medical vacuum pumps.