Written by IAPMO 9:10 am ASSE, Backflow Prevention

Hospital Backflow Prevention

Today’s complex potable water “production” and distribution systems continue to make significant contributions in helping to sustain the utility and comfort of modern-day Americans. These costly systems provide adequate quantities of essential potable water that satisfies our nation’s economic needs, which include manufacturing, food processing, etc. These same systems also provide ample potable water for our personal safety and physical needs. We use this water for fire protection, heating and cooling, bathing, cooking and, most importantly, drinking.

I ask – because the “production” and distribution of adequate and reliable supplies of essential potable water are such critical, involved and expensive processes – shouldn’t everyone, from the purveyor to the consumer, take responsibility for the protection of this water?

When I refer to “protecting our potable water supply,” I mean that everyone from the purveyor to the consumer must take adequate measures to guarantee that: the purveyor is able to routinely deliver adequate supplies to the consumer; the consumer conserves this water and; most importantly, that we all take the steps necessary to ensure that the water remains potable and is not contaminated in any manner.

This article will review the methods that an internationally recognized hospital is using to protect the public’s potable water distribution system by using our facility’s “containment” program. It will also review the protection provided to our in-house potable water distribution system by using our “isolation” program.

To begin, before a successful backflow prevention program can be implemented, it is important for the purveyor to learn which personnel in the facility to work with when initiating the program. The purveyor must then, while educating the professionals installing, maintaining and utilizing the potable water system, inspire the proper psychological mindset.

Everyone must realize that backflow can occur inside any building and that only educated and concerned people can prevent backflow incidents from happening. It is important to emphasize that the only 100% reliable backflow prevention and cross-connection control program is one that combines a vigorous “containment” program with an equally vigorous “isolation” program.

Because of the rapid technological evolution of the health care industry, the modern hospital is placing more medically related demands on its potable water systems than ever before. Today, not only must the hospital’s potable water system satisfy typical plumbing requirements, but it must also support sophisticated life-supporting medical delivery equipment. As a result of this unique “dual demand,” an absolutely reliable potable water system is a paramount criterion that enables a modern hospital to deliver today’s complex medical care.

Most people can relate to the normal hospital potable water needs and the consequences of the sudden shutdown of the piping system that supports those needs. The patients must have water to drink and bathe with, and of course, to flush toilets. The kitchen obviously needs potable water, the surgeons need it to scrub, and the power house needs it to fill the boilers and cooling towers. The list goes on and on – laundry, dental offices, swimming pools, public restrooms, the morgue …

Those are some of the systems that most people think of when discussing hospital potable water distribution. But what about the medical related processes and equipment that must be protected from the interruption of THEIR potable water supply? These medical processes either need potable water to guarantee their effectiveness and sterility, or they need a guaranteed supply of water to function at all!

These are the processes that place the unique “dual demand” on the hospital’s potable water system. The hospital can not tolerate having any of these medical processes interrupted without notice.

The lack of properly installed and annually tested isolation backflow prevention devices or assemblies could allow backflow contamination to occur inside the building, possibly requiring an immediate shutdown of the entire potable water distribution system. This interruption would terminate these medical processes on little notice and for an indefinite period. The loss of any of these processes would place the safety of the patients in serious jeopardy.

Some of these processes have been around for a while, but have become much more sophisticated, and many others are new on the scene. Automated patient diagnostic laboratory equipment has become much more sophisticated, requiring not only potable water, but distilled and ultra-pure deionized water as well.

Because heart transplant patients are extremely susceptible to bacterial infection, despite new antibiotics available, some may still need ultra-pure bathing water. Autoclaves and washer-sterilizers need water to wash with, make venturi suction seals that create their door seals, and for condensers to condense steam so that it may be drained according to code – or they cannot function at all.

Some patient-life-supporting medical air compressors and medical surgical vacuum pumps need potable water to maintain their impeller seals. Dialysis systems require potable water. The loss of potable water to any of these medical processes or equipment would cause a very unsafe patient environment regarding expected positive patient outcomes.

For the benefit of the hospital patient and all other occupants of the hospital who rely on it, the hospital’s potable water distribution system must be made 100% reliable by protecting it from any detrimental source that may necessitate its immediate and unexpected interruption, such as a backflow incident.

Most hospitals protect the reliability of their potable water systems in various ways. Many hospitals “lock open” and regularly monitor the operation of strategic valves. Other hospitals have developed sophisticated bypass piping systems that provide multiple sources of water for each individual building. All are required to develop and implement policies that provide instantaneous conservation of water in case of an emergency that is beyond their control, such as a break in the municipal water distribution system. This comes from the Joint Commission.

These examples are procedures implemented to attempt to guarantee a constant source of essential potable water to the hospital. However, how many hospitals have become totally committed to protecting their water piping systems from the source of interruptions that present the most serious consequences to everyone in the building; pollution contamination caused by backflow through an unprotected, hazardous cross connection?

The contamination of the potable water system would demand its immediate shutdown, which would be catastrophic to patients using water consuming, life-supporting equipment. Also, serious health consequences could result to anyone inside or outside the building who might drink the contaminated water.

What can be done to prevent contamination or interruption of the potable water system? The answer is the implementation of a complete, approved cross-connection control and backflow prevention program.

This program will include several steps:

  1. A survey of the hospital’s potable water system by a certified surveyor who has competent knowledge of backflow prevention principles, codes and regulations.
  2. The installation and immediate testing (by a certified tester) of approved backflow prevention devices or assemblies where required.
  3. The annual testing of all containment and isolation assemblies with immediate repair and retesting as necessary.
  4. The constant vigilance over the hospitals potable water system by those professionals who are not only knowledgeable about backflow prevention principles, but perhaps more importantly, who are concerned about the serious consequences of a backflow incident and committed to guaranteeing that backflow never happens in their hospital.

The first three components of a backflow program are covered by regulations found in plumbing codes and state or federal regulations. The fourth component is the “key” to the success of the program. This is the component we must be the most aware of. Although the hospital may be forced to comply with governmental codes and regulations, the cross-connection program will not become a complete success until its extreme importance to patient outcomes and safety is instilled into the minds of those responsible for monitoring and maintaining the water distribution system. This knowledge will encourage them to totally commit.

I am referring to the hospitals administration, facilities engineering plumbing supervisors, and the plumbers and maintenance personnel working in the hospital. These people must eagerly work together as a “team” to guarantee the success of the hospital’s backflow prevention program.

The hospital administration, after being made aware of backflow hazards, must acknowledge the dangers of backflow contamination. They must commit funds to train the necessary hospital personnel, and purchase and install the necessary backflow prevention assemblies and devices that are required.

The facilities engineering supervisors must become knowledgeable in backflow prevention principles and pass this knowledge and training to the plumbers and other personnel who may unknowingly cause a potential backflow situation.

They must also ensure that the required annual testing and repair is completed on any existing or future backflow prevention assemblies. It is also important that the hospital personnel are always vigilant to identify and protect the hospital from any still unknown existing cross connections – especially in very old facilities.

Because there are endless possibilities for cross-connection incidents within a facility as large and old (founded 1921) as Cleveland Clinic, we have become totally committed. Currently, my colleagues and I are constantly on guard for potential backflow situations that could cause the contamination of the water system that hundreds (over 1,300) of our patients, many visitors, employees (over 20,000), and countless vital medical related processes and equipment rely on.

Today, our program consists of several hundred containment and isolation assemblies that are tested annually. It is interesting to note that 10-15% of these devices, both containment and isolation, fail in some way and must be repaired.

I want to emphasize the psychological mind-set that water purveyors must help create with whomever they deal with in the hospital. It is easy to mandate backflow programs and to rely on some authority to enforce them under the weight of the law; however, to ensure a totally effective program, the purveyor must encourage the facilities engineering professionals to make their backflow program as flawless as possible.

It is the water purveyor’s responsibility to demand that “containment assemblies” are installed on the water service and the state or local plumbing code’s responsibility to demand that “isolation assemblies” be installed on all known cross-connections.

Once containment assemblies are installed, enforcement of the codes isn’t difficult because the purveyor has records and sends testing notices that are reconciled. Also, these assemblies are generally in the open and cannot be tampered with or eliminated.

Deep inside the building, however, anything can happen after the plumbing inspection. To keep building occupants totally safe, only conscientious professionals can guarantee that isolation assemblies are installed where necessary and annually tested. Also, if renovations are made to the in-house distribution system, these renovations must be protected from contamination as well.

To fully protect the public, I strongly urge both building officials and water purveyors to be fully aware of the need for “isolation” backflow protection and demand that this protection be installed where necessary and tested annually.

As a final thought, it is our responsibility to prioritize the importance of protecting our potable water supply. There are many environmental and safety concerns facing all of us. However, human beings require water to survive and to function. We must guarantee that everyone prioritizes the protection of our drinking water to the number one position when dealing with environmental concerns. Because we are so fortunate to live in one of the few countries where we can open almost any faucet and not be afraid to drink, doesn’t it make sense to protect this privilege the best we know how?

In conclusion, I have stressed the critical roles that we all play in the protection of our nation’s potable water supply. Everyone should now be aware of the importance of combined “containment” and “isolation” backflow prevention programs.

I am pleased to report that because of continually improving backflow prevention programs, there are many knowledgeable and concerned water consumers endlessly striving to guarantee that nothing of negative consequence happens to our nation’s precious potable water supply!

Article by Edward J. Lyczko first appeared in ASSE’s Working Pressure magazine

Last modified: December 19, 2023