The Green Guide for Health Care (GGHC) is a sustainable buildings program, developed for the healthcare industry and built on the framework established by the Leadership in Energy and Environmental Design (LEED) certification program. With the GGHC program, a building can receive up to 94 construction points and 32 operation points.

Unlike the LEED program, which uses points to establish achievement rankings, the GGHC points system is designed to provide a baseline, or benchmark, for healthcare facilities to use as they track their own performance on an ongoing basis. In essence, the program serves as a voluntary educational guide, promoting sustainable design, construction, and operations practices.

One of the core components of the GGHC guidelines is the promotion of the efficient use of potable (i.e., drinkable) water in medical facilities so that they can maintain adequate water supplies while helping to conserve the earth's supply of fresh water. Although efficient use of water is a primary goal of green and sustainable buildings, it is also a necessity in large areas of the United States. Currently, parts of California, Arizona, New Mexico, Texas, Florida, and a number of states in the Midwest are experiencing moderate to exceptional (the highest category) drought conditions with little relief in sight.

Water credits

To encourage healthcare facilities to follow construction and operating practices that conserve water, GGHC provides medical facilities with several credits or points that emphasize water efficiency, such as:

Potable water use for equipment cooling. Unlike LEED, which does not provide points for reductions of potable water use for process purposes such as cooling hospital equipment, GGHC awards this credit when medical facilities restrict the use of potable water for once-through cooling of any equipment. In many medical facilities, domestic water is connected directly to equipment that needs cooling. To earn this point, facilities can incorporate an alternative design that connects equipment to the building's closed-loop cooling system, helping to minimize water use significantly.

Water-efficient landscaping. Two credits are offered in this category: one point is provided for reducing landscaping water by 50% or more, and another for using no potable water for irrigation. This is similar to the LEED landscaping points and usually requires the coordination of project planners, architects, landscaping professionals, and landscape maintenance personnel. One way this can be accomplished is by selecting vegetation that requires very little irrigation. Another solution is to develop a system that captures rainwater from roof drains. The rainwater is then stored and used for irrigation, helping to minimize or eliminate the need for potable water usage.

Incorporating wastewater technologies. Although it may be difficult for a healthcare facility to earn this credit because of the type of contamination likely to be found in hospitals and other medical facilities, this point is obtained by a reduction of at least 50% of the wastewater from a facility by using low-flow plumbing fixtures or—taking it a significant step further—by installing no-water fixtures such as waterless urinals. As an alternative, medical facilities can earn this credit by treating 100% of their wastewater on-site.

Reduction of potable water use. Two points can be earned by reducing potable water usage by at least 20%, with an additional point earned when water use is reduced by 30% or more. Although water used for scrub sinks and other clinical use is exempt, many medical facilities can earn this point by simply checking and repairing plumbing leaks and by installing low-flow restroom fixtures, showerheads, and waterless urinal systems. Additionally, a new technology, dual-flush toilets, is becoming more popular. With this system, 1.6 gallons of water can be selected for removing solid waste from the bowl, while a second option, which uses less water, allows the removal of liquid waste.

Measuring water use reduction.GGHC awards one point for developing a system for ongoing accountability of water consumption in the facility. Water measurement devices are installed in different areas of the building, allowing operations staff to monitor water use throughout the facility. This system also helps catch leaks and detect why some areas of a facility may be using significantly more water than others.

Process water use reduction. Similar to the credit earned for reducing water use to cool equipment, the intent of this point is to reduce water usage for the process cooling of not only hospital equipment but also the facility's compressors and cooling towers. At least 10%, or a minimum of 100,000 gallons of water, must be reduced annually to earn this credit.

Water-saving restroom fixtures

Among all the GGHC guidelines, one that can achieve the most significant results helping to save water in a medical facility, as well as its related costs, is ensuring that plumbing and fixtures are operating correctly, and that low-flow/no-flow fixtures are installed.

The amount of water wasted in patient bathrooms or restrooms in a large medical facility can be quite astonishing. For instance, just one leaking toilet can waste as much as 50 gallons of water per day, while a dripping faucet or showerhead can waste as much as 1,000 gallons of water every week.

Often overlooked or ignored, these fixtures must be repaired as soon as they are discovered. Additionally, of all bathroom fixtures, showerheads most frequently wear out, usually because they become clogged with lime deposits. When this happens, they generally work poorly. This is the perfect time to replace the head with a newer, low-flow model. These low-water-volume showerheads use less than two gallons of water per minute, compared to three or more with older showerheads.

Outdated toilets, which are still found in many older facilities because of their long lifecycle, use about 4.5 gallons of water per flush. Newer systems use 1.6 gallons of water per flush. Even this amount is being reduced as the result of new technologies and the dual-flush systems mentioned earlier. Instead of repairing older toilets, facility managers should replace them with those that use less water. Studies indicate that installing low-flow toilets can save hospitals as much as 7% of their annual water use—helping them take a significant step toward earning one or more GGHC credits.

In addition to toilets, urinals can be very big water users in most medical facilities. Many facility professionals are unaware that a conventional urinal can use more than 40,000 gallons of water per year. Older units use as much as five gallons of water per flush whereas newer units use about one gallon of water, an 80% reduction.

As suggested in the GGHC guidelines, medical facilities can save even more by installing urinals that use no water at all. These systems operate without flush handles or sensors. Instead, traps or cylinders are placed at the base of the urinal and are filled with a “blocking” fluid. Urine drains into the traps and eventually into a drainpipe, as with a conventional urinal. The blocking fluid keeps odors from being released. Additionally, because the urinals stay dry, they have been found to be more hygienic as well.

Cash savings

Although the task of meeting some of the GGHC guidelines may seem daunting, it can be done, and the rewards are significant. Among them is a reduction in the cost of delivering and removing water from a facility, as well as sewer charges.

For instance, one hospital installed low-flow fixtures in all patient- and exam-room sinks. The stream from older faucets was measured at five gallons of water per minute. After retrofitting with the low-flow units, the stream was reduced to 1.5 to 3.5 gallons of water per minute. It was determined that each new faucet was saving the facility 88 gallons of water per day and 32,000 gallons of heated water per year, for a combined water and energy savings of $280 annually per sink. Multiply that by all of the sinks in the facility and you have significant savings. A nonmedical facility, used 220 days per year, reported that after installing 50 waterless urinals used by an average of 500 men, three times per day, there was a savings of 1,170,000 gallons of water per year. This facility estimated that with water and sewer charges set at $5.50 per 1,000 gallons used, they were saving approximately $6,435.00 annually.

It appears that what is good for the planet is good for the pocket book, as well.

Klaus Reichardt is managing partner of Waterless Co., LLC, a leading manufacturer of no-water urinals and related products.

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