Every Construction Project Creates a Water Management Challenge

Why Every Renovation Should Include a Water Management Plan

When most people think about construction projects in healthcare facilities, they focus on timelines, budgets, and minimizing disruptions to patient care.

Few stop to consider what may be happening inside the building's plumbing system.

Whether it's a small clinic renovation, a new patient tower, or the replacement of a single wing, nearly every construction project changes how water moves through a facility. Those changes can create conditions that allow biofilm to develop, disinfectant residuals to decline, and opportunistic waterborne pathogens, including Legionella, to multiply.

Construction doesn't just change a building. It changes the water system.

Legionnaires' disease remains a significant public health concern. According to the Centers for Disease Control and Prevention (CDC), an estimated 8,000 to 18,000 people are hospitalized with Legionnaires' disease each year in the United States. Because hospitals and long-term care facilities serve older adults and immunocompromised patients, they must be especially vigilant in managing water quality.

Water Systems Are Designed Around Movement

A healthy potable water system depends on consistent flow.

As water moves through pipes, it helps maintain disinfectant residuals, minimizes stagnation, and reduces the opportunity for biofilm to establish itself.

Construction projects often interrupt that balance.

A wing may be temporarily closed for renovation. New plumbing may be installed but remain unused for weeks or months. Existing piping may be isolated while contractors complete tie-ins. Occupancy may shift from one area of the building to another, changing water demand throughout the system.

Each of these changes affects water quality.

Water age is one of the most important factors influencing water quality. As water remains stagnant within a plumbing system, disinfectant residuals naturally decline while conditions become increasingly favorable for biofilm development. Construction activities often accelerate this process by creating temporary low-flow or no-flow conditions throughout portions of the building.

Common Construction Activities That Increase Risk

Research has shown that construction and renovation activities can increase the risk of exposure to waterborne pathogens if water systems are not properly managed before, during, and after the project. Changes in water demand, temporary shutdowns, and plumbing modifications all influence the conditions that affect microbial growth.

Temporary Building Shutdowns

Closing portions of a facility often leads to little or no water use in those areas. As water sits stagnant, disinfectant levels begin to decrease while water age increases, creating favorable conditions for microbial growth.

New Plumbing Installations

New piping is not automatically "clean" simply because it is new.

Construction debris, manufacturing residues, pressure testing, and extended periods before occupancy can all influence water quality. Newly installed plumbing should be properly disinfected, flushed, and evaluated before being placed into service.

Pipe Tie-Ins

Connecting new plumbing to an existing system can disturb accumulated scale and biofilm that has remained relatively stable for years.

Without proper planning and flushing, these disturbances may affect water quality well beyond the construction zone.

Temporary Dead Legs

Construction frequently creates sections of pipe that are installed but not immediately used.

Even temporary dead legs can become areas of prolonged stagnation if they are not incorporated into flushing plans.

Changes in Water Demand

Moving patients, relocating departments, or temporarily closing portions of a building changes how water flows through the entire plumbing system.

Areas that previously experienced regular water use may suddenly become low-use locations, increasing water age and reducing disinfectant residuals.

Construction and Water Management Must Work Together

Too often, construction teams and water management teams operate independently.

The project may be completed exactly as designed while the facility's water management program struggles to address new hydraulic conditions that were never considered during planning.

Recognizing this risk, ASHRAE Standard 188 and the newer ASHRAE Standard 514 emphasize that water management should be considered throughout the entire life cycle of a building, including design, construction, renovations, commissioning, occupancy, and future modifications. Water safety should never be viewed as something that begins only after construction is complete.

The most successful healthcare projects involve collaboration before construction begins, not after occupancy.

Questions worth asking include:

• Which fixtures or piping will be out of service?

• How long will areas remain inactive?

• Will flushing be required during construction?

• Will temporary water quality monitoring be needed?

• When should disinfection and verification testing occur before reopening?

• Has the Water Management Program been updated to reflect the changes?

Planning for these questions early can significantly reduce risk later.

Reopening Requires More Than Turning the Water Back On

One of the most common mistakes is assuming that a renovated area is ready for patients as soon as construction is complete.

The CDC's Toolkit for Developing a Water Management Program recommends evaluating buildings after prolonged shutdowns or significant plumbing changes before they return to normal operation. Flushing, verification of disinfectant residuals, and confirmation that control measures are functioning as intended are all important steps before patients return to the space.

Before reopening, facilities should verify that water quality has been restored through flushing, appropriate disinfection when necessary, and water quality testing in accordance with their Water Management Program and applicable guidance.

Returning a building to service safely requires more than completing the construction checklist.

It requires confirming that the water system is ready as well.

Construction Is Temporary. Water Quality Impacts May Not Be.

Every construction project eventually comes to an end.

The changes made to the plumbing system, however, may influence water movement for years to come.

New branches are added, piping layouts change, occupancy patterns shift, and water demand evolves. Those changes become part of the building's long-term hydraulic behavior.

The most successful healthcare organizations recognize that construction is not simply a facilities project. It is also a patient safety initiative. By integrating construction planning with a proactive water management program, facilities can reduce risk, protect vulnerable patients, and ensure that every newly renovated space is truly ready for occupancy.

As the old saying goes, "Measure twice, cut once." The same principle applies to healthcare water systems.

Plan the water before you open the doors.

Closing Thought

"Every wall you move has the potential to change how water moves. Every change in water movement has the potential to change patient risk."