11.1 Health Care & Related Facilities (SPS 382.50)

Why health care is different

Patients are vulnerable to scalding, waterborne pathogens such as Legionella, and cross-contamination. SPS 382.50 adds requirements on top of the general code for "health care and related facilities." Health care plumbing is reviewed only by the department. Table 382.20-1 line 1 sends all new work, additions and alterations in hospitals, nursing homes, ambulatory surgery centers, renal dialysis centers, CBRFs and inpatient hospices to DSPS regardless of fixture count. Line 5 adds the testable backflow assemblies serving these facilities.

Fixtures and equipment (SPS 382.50 (2))

Table 382.50-1 assigns spout and action types room by room (nursing, nursery, surgical and other departments). Psychiatric-care areas where gooseneck spouts endanger patients are exempt from the spout rules.

Water supply (SPS 382.50 (3))

Hospitals must have at least 2 water services, connected to different water mains where more than one is available. Each must be able to supply the total building demand (non-essential additions excepted). A code note warns that two services or a private main may require a check valve under NR 811.

All health care facilities must provide hot and cold water to patient-accessible sinks:

• Hot water initiated and stored at 140 degrees F minimum.
• Maximum temperature at patient-accessible outlets 115 degrees F.

Hospitals, CBRFs, inpatient hospices and nursing homes must also meet these requirements:

Disinfection methods (one is required):

1. Thermal: storage and circulation initiated at 140 degrees F or more with a return of at least 124 degrees F.
2. 0.5 mg/L residual chlorine.
3. Chloramine.
4. Chlorine dioxide.
5. Another department-approved method, or municipal disinfectant with an approved residual and site approval.

Hot water piping is labeled with the disinfection method:

• At the injection point.
• Within 5 feet of it.
• Every 25 feet within the mechanical room.
• On the inside of each mechanical room door.

Lettering is at least 1/2 inch high.

Water management plans are required in facilities with more than 250 occupants. They cover:

• Emergency water contingencies
• Pathogen control
• Routine and emergency disinfection
• The person responsible for water quality
• Periodic flushing
• The hot water balancing valve report

Adult day care centers are also limited to 115 degrees F at participant-accessible outlets.

Related provisions elsewhere

• Dialysis: a dialysis machine's indirect waste may discharge to a water closet or lavatory in a single-occupancy patient toilet room through a 1-inch air gap (SPS 382.33 (8) (d) 9.). A dialysis box in a patient room must be lockable, with its receptor sealed when not in use. A hose outlet for a portable dialysis machine in a lockable box is not a cross connection.
• Sterilizer rooms: a room containing recessed or concealed sterilizer parts needs a floor drain serving the whole floor (SPS 382.30 (11) (b) 3. b.).
• Air admittance valves may not be used in health care facilities (SPS 382.31 (17m)).
• Health care appliances must meet the drain, vent, supply and backflow rules of SPS 382 (SPS 384.15).

Worked example

A nursing home renovation adds 10 patient rooms (2 beds each) and a therapy tub room.

• Plans go to DSPS, not an agent municipality.
• Valving: no more than 4 rooms per control valve.
• The therapy tub gets a combination pressure-balanced and thermostatic valve set for 110 to 115 degrees F with high-temperature flow cutback.
• The loop is designed for thermal disinfection at 140 degrees F with a 124 degrees F return, so uncirculated branches stay at 3 feet or less.
• Every patient sink spout discharges at least 5 inches above the rim.
• Handles are wrist blades of 4-1/2 inches or less.