Why PFAS Matter in Healthcare Water Management

For decades, healthcare water safety programs have focused on microbial risks such as Legionella, Pseudomonas, and other opportunistic pathogens. While these threats remain critical, another category of concern is gaining attention across the water industry: PFAS.

PFAS, or per- and polyfluoroalkyl substances, are often referred to as “forever chemicals.” These compounds have been widely used in industrial manufacturing and consumer products since the 1940s because of their resistance to heat, oil, grease, and water. Unfortunately, that same chemical stability makes them extremely persistent in the environment and in water systems.

As regulatory agencies and healthcare organizations begin paying closer attention to PFAS contamination in drinking water, facilities managers are asking an important question: What does this mean for hospital water systems?

Understanding PFAS, and how it interacts with existing water quality and microbial risks, is becoming an important part of modern water management planning.

What Exactly Are PFAS?

PFAS represent a large group of synthetic fluorinated compounds that include substances such as:

• Perfluorooctanoic acid (PFOA)

• Perfluorooctane sulfonate (PFOS)

• GenX chemicals

• Hundreds of related fluorinated compounds

These chemicals were historically used in products such as nonstick cookware, firefighting foams, stain resistant fabrics, food packaging, and industrial coatings.

Because the carbon fluorine bond is one of the strongest in chemistry, PFAS molecules break down extremely slowly. In many cases they persist for decades in groundwater and municipal water systems.

The U.S. Environmental Protection Agency has identified PFAS exposure as a potential risk factor for several health concerns including:

• Immune system effects

• Thyroid disruption

• Increased cholesterol levels

• Developmental issues in children

• Increased risk of certain cancers

In response, the EPA has proposed strict drinking water limits for several PFAS compounds measured in parts per trillion, an incredibly small concentration that highlights just how persistent and biologically active these compounds can be.

How PFAS Enter Building Water Systems

Most facilities do not introduce PFAS directly into their plumbing systems. Instead, these compounds typically enter buildings through municipal water supplies.

Sources may include:

• Industrial manufacturing discharge

• Fire training facilities that used PFAS firefighting foam

• Landfill leachate entering groundwater

• Contaminated municipal wells

Once PFAS enter the municipal supply, they can move into hospitals, long term care facilities, and other large buildings through standard incoming water lines.

Unlike chlorine or other disinfectants, PFAS are not easily removed by conventional municipal treatment processes, meaning they may already be present before water ever enters the building.

Why PFAS Matter in Healthcare Water Management

At first glance, PFAS might seem unrelated to microbial pathogens like Legionella. However, they intersect with healthcare water safety in several important ways.

1. Water Chemistry and System Health

The chemistry of incoming water directly affects corrosion, scale formation, and microbial growth inside building plumbing.

Changes in water treatment strategies aimed at removing PFAS may alter:

• Chlorine residual levels

• Oxidation reduction potential (ORP)

• Biofilm formation dynamics

Facilities that do not monitor these changes may see unexpected shifts in water system conditions.

2. Biofilm Interactions

Biofilm is the slimy microbial matrix that forms on pipe walls, tanks, and fixtures. It serves as a protective environment for bacteria such as Legionella.

Research has shown that certain contaminants can accumulate within biofilm layers. While PFAS research in plumbing biofilms is still developing, early studies suggest that persistent compounds may bind within these microbial communities.

This reinforces an important point: a healthy water system requires both chemical monitoring and microbial control.

3. Regulatory Pressure on Healthcare Facilities

Healthcare organizations already operate under strict water management requirements from organizations such as:

• The Joint Commission

• CMS (Centers for Medicare and Medicaid Services)• ASHRAE Standard 188

• CDC water safety guidance

As PFAS regulations expand at the federal and state level, healthcare facilities may soon face additional expectations for water monitoring and documentation.

Facilities with established water management programs are far better positioned to adapt to these emerging requirements.

Monitoring the Overall Health of Your Water System

The most effective water management programs look beyond a single contaminant and evaluate the overall condition of the water system.

At Legionella Specialties, we often use multiple indicators to evaluate water health, including:

Oxidation Reduction Potential (ORP)

ORP measures the water’s ability to oxidize contaminants and control microbial activity. It provides a real time indicator of whether disinfectants in the water system are active and effective.

If ORP levels fall too low, bacteria and biofilm can begin to thrive inside plumbing systems.

ATP Testing

ATP testing measures the amount of biological activity present in water samples. ATP, or adenosine triphosphate, is the energy molecule found in all living cells.

High ATP readings indicate elevated microbial activity and potential biofilm development, even before specific pathogens are detected.

Legionella Culture Testing

Ultimately, laboratory culture testing remains the gold standard for confirming whether Legionella bacteria are present in a system.

Together, these measurements provide a comprehensive picture of water quality, allowing facilities to identify risks before they become outbreaks.

Why a Strong Water Management Program Matters More Than Ever

Emerging contaminants like PFAS are a reminder that water safety is not a single issue but a complex system involving chemistry, microbiology, infrastructure, and operational practices.

Facilities that rely on outdated monitoring or minimal testing may miss early warning signs that their water system is becoming unstable.

A modern Water Management Program should include:

• System wide risk assessment

• Routine monitoring of disinfectant levels

• ORP and ATP testing for system health

• Routine Legionella culture testing

• Biofilm control strategies

• Corrective actions when control limits are exceeded

When these components work together, facilities can maintain safe water conditions even as regulations and water chemistry continue to evolve.

How Legionella Specialties Helps Healthcare Facilities Stay Ahead

At Legionella Specialties, our goal is simple: help healthcare facilities maintain safe, compliant, and biologically stable water systems.

Our team works directly with hospitals, long term care facilities, and complex buildings to provide:

• Water Management Program development and support

• Legionella risk assessments

• ORP and ATP water quality testing

• Routine laboratory testing for pathogens

• Targeted treatment strategies such as AquaGuard MO

• Ongoing monitoring and compliance support

By combining scientific testing, proactive treatment, and expert oversight, facilities can significantly reduce the risk of waterborne pathogens while maintaining the overall health of their water systems.

In an environment where new contaminants and regulations continue to emerge, proactive water management is no longer optional. It is essential.