z317.1 plumbing 09

Z317.1-09

Special requirements for plumbing installations in health care facilities

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Z317.1-09

CSA Standards Update Service

Z317.1-09March 2009

Title: Special requirements for plumbing installations in health care facilitiesPagination: 38 pages (vii preliminary and 31 text), each dated March 2009

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ASSOCIATION CANADIENNE DENORMALISATIONBUREAU CENTRAL DE L’INFORMATION5060, SPECTRUM WAY, BUREAU 100MISSISSAUGA ON L4W 5N6CANADA

CANADIAN STANDARDSASSOCIATIONCONSOLIDATED MAILING LIST5060 SPECTRUM WAY, SUITE 100MISSISSAUGA ON L4W 5N6CANADA

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Published in March 2009 by Canadian Standards AssociationA not-for-profit private sector organization

5060 Spectrum Way, Suite 100, Mississauga, Ontario, Canada L4W 5N61-800-463-6727 • 416-747-4044

Visit our Online Store at www.ShopCSA.ca

Z317.1-09Special requirements for plumbing

installations in health care facilities

CSA Standard

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100%

ISBN 978-1-55491-116-5Technical Editor: Grace Rylett

© Canadian Standards Association — 2009

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March 2009 iii

Contents

© Canadian Standards AssociationSpecial requirements for plumbing


Technical Committee on Health Care Facility Engineering and Physical Plant v

Subcommittee on Plumbing in Health Care Facilities vi

Preface vii

1 Scope 1

2 Reference publications 2

3 Definitions 3

4 General requirements 74.1 Codes and regulatory requirements 74.2 Alarms 74.3 Materials 74.4 Operations and maintenance program 74.4.1 General 74.4.2 Frequency 74.4.3 Infection control in plumbing installations 84.4.4 Risk management 94.5 Commissioning 9

5 Hydraulic fire protection systems 9

6 Water systems 106.1 General 106.2 Potable water supply 106.2.1 General 106.2.2 Alternative water supply 106.2.3 Initial system treatment 106.2.4 Testing of potable water systems 116.3 Potable water distribution systems 116.3.1 General 116.3.2 Design and construction 116.3.3 Pressure-booster systems 126.3.4 Hot water systems 136.3.5 Water storage tanks 146.4 Distilled, demineralized, pure, or treated water systems 156.4.1 General 156.4.2 Deionization 166.4.3 Distillation 166.4.4 Reverse osmosis 166.5 Steam and condensate 17

7 Drainage systems 177.1 General 177.2 Application 177.3 Foreign objects 177.4 Insulation 177.5 Storm drainage systems 17

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Z317.1-09 © Canadian Standards Association

iv March 2009

7.5.1 Discharge 177.5.2 Sump pumps 187.6 Sanitary drainage systems 187.6.1 Sewage pumps 187.6.2 Design 187.6.3 Hazardous waste 19

8 Plumbing fixtures and fittings 208.1 General 208.2 Sanitary fixtures 218.3 Lavatories and sinks 228.3.1 Patient lavatories 228.3.2 Other lavatory locations 238.3.3 Surgeon scrub-sinks 238.3.4 Flushing-rim-type sinks (hoppers) 238.3.5 Janitor or soiled utility sinks 238.4 Bathtubs and showers 238.4.1 Class C facilities 238.4.2 General 248.4.3 Bathtubs 248.4.4 Showers 258.5 Floor drains 25

AnnexesA (informative) — Additional considerations for plumbing installations in health care facilities 27B (informative) — Health care facility examples according to class 29C (informative) — Cleaning cooling towers and related equipment with sodium hypochlorite or calcium

hypochlorite 31

Tables1 — Hot water temperatures, °C 26

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March 2009 v

Technical Committee on Health Care Facility Engineering and Physical PlantM. Keen St. Michael’s Hospital,

Toronto, OntarioChair

G. Burrill Teegor Consulting Inc.,Fredericton, New Brunswick

Vice-Chair

R.J. Belanger R.J. Burnside and Associates Ltd.,Wasaga Beach, Ontario

W.D. Carson The Mitchell Partnership Inc.,Toronto, Ontario

L. Ellinas R Tec Consulting,Toronto, Ontario

M. Fontaine Alberta Infrastructure,Calgary, Alberta

G. Granek Toronto, Ontario

C. Harvey Ontario Ministry of Health and Long-Term Care,Toronto, Ontario

J. Kruse Public Health Agency of Canada,Ottawa, Ontario

G. Kuzmenko Carillion Canada,Toronto, Ontario

P. Langford South Shore District Health Authority,Lunenburg, Nova Scotia

M. O’Reilly QuadraTec Inc.,St. John’s, Newfoundland and Labrador

P.E. Paasche University of New Brunswick,Fredericton, New Brunswick

L. Shea Manitoba Health and Healthy Living,Winnipeg, Manitoba

N. Stark H.H. Angus & Associates Ltd.,Toronto, Ontario

R. Nayyar Canadian Standards Association,Mississauga, Ontario

Project Manager

The Technical Committee would like to acknowledge the visionary leadership of Ain Allas, who passed away in January 2009. His dedication to the development of this and other standards will remain a valuable contribution to the field of standardization.

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vi March 2009

Subcommittee on Plumbing in Health Care Facilities

W.D. Carson The Mitchell Partnership Inc.,Toronto, Ontario

Chair

R.J. Belanger R.J. Burnside and Associates Ltd.,Wasaga Beach, Ontario

G. Granek Toronto, Ontario

G. Kuzmenko Carillion Canada,Toronto, Ontario

S. MacMillan Travelers Guarantee Company of Canada,Toronto, Ontario

P.E. Paasche University of New Brunswick,Fredericton, New Brunswick

R. Watson New Brunswick Department of Supply and Services,Fredericton, New Brunswick

R. Nayyar Canadian Standards Association,Mississauga, Ontario

Project Manager

G. Rylett Canadian Standards Association,Mississauga, Ontario

Project Manager

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March 2009 vii

Preface

This is the fourth edition of CSA Z317.1, Special requirements for plumbing installations in health care facilities. It supersedes the previous editions, published in 1999, 1988, and 1978. This Standard is one of a series of Standards related to health care facility engineering.

This Standard is intended to assist health care facilities to reduce the environmental impact of and manage the risks associated with plumbing installation and maintenance.

The following have been updated for this edition:(a) the definitions (Clause 3);(b) requirements on infection control, risk management, and commissioning (Clause 4); (c) requirements on initial water system treatment, testing of potable water, and water conservation

strategies (Clause 6); and(d) requirements on plumbing fixtures and fittings (Clause 8).

This Standard was prepared by the Subcommittee on Plumbing in Health Care Facilities, under the jurisdiction of the Technical Committee on Health Care Facility Engineering and Physical Plant and the Strategic Steering Committee on Health Care Technology, and has been formally approved by the Technical Committee. It will be submitted to the Standards Council of Canada for approval as a National Standard of Canada.

March 2009

Notes: (1) Use of the singular does not exclude the plural (and vice versa) when the sense allows.(2) Although the intended primary application of this Standard is stated in its Scope, it is important to note that it remains

the responsibility of the users of the Standard to judge its suitability for their particular purpose.(3) This publication was developed by consensus, which is defined by CSA Policy governing standardization — Code of

good practice for standardization as “substantial agreement. Consensus implies much more than a simple majority, but not necessarily unanimity”. It is consistent with this definition that a member may be included in the Technical Committee list and yet not be in full agreement with all clauses of this publication.

(4) CSA Standards are subject to periodic review, and suggestions for their improvement will be referred to the appropriate committee.

(5) All enquiries regarding this Standard, including requests for interpretation, should be addressed to Canadian Standards Association, 5060 Spectrum Way, Suite 100, Mississauga, Ontario, Canada L4W 5N6.Requests for interpretation should

(a) define the problem, making reference to the specific clause, and, where appropriate, include an illustrative sketch;(b) provide an explanation of circumstances surrounding the actual field condition; and(c) be phrased where possible to permit a specific “yes” or “no” answer.Committee interpretations are processed in accordance with the CSA Directives and guidelines governing

standardization and are published in CSA’s periodical Info Update, which is available on the CSA Web site at www.csa.ca.

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March 2009 1

Z317.1-09Special requirements for plumbing installations in health care facilities

1 Scope

1.1This Standard specifies requirements for the following in health care facilities:(a) hydraulic fire protection systems;(b) pure water systems;(c) drainage systems; and(d) plumbing fixtures and fittings.Note: See CAN/CSA-Z7396.1 for design, installation, certification, and maintenance requirements for non-flammable medical gas piping systems.

1.2This Standard specifies minimum design, construction, installation, operations, and maintenance requirements in addition to the applicable requirements specified in(a) the National Building Code of Canada; (b) the National Plumbing Code of Canada;(c) the CAN/CSA-B45 Series;(d) the CAN/CSA-B64 Series;(e) ASME A112.18.1/CAN/CSA-B125.1;(f) ASME A112.18.2/CAN/CSA-B125.2; and(g) CAN/CSA-B125.3.

1.3This Standard is not intended to preclude the use of design concepts and the adoption of construction, installation, operations, and maintenance procedures more stringent than those specified in this Standard and in the documents listed in Clause 1.2.Note: Water quality and conservation efforts involve protection of public health and the rational use of water from intake to tap. Such efforts include educating the consumer, appropriate water treatment, verification of drinking water quality, and appropriate operation and maintenance of storage and distribution systems. Optimal plumbing design and installation can help health care facilities adopt water protection and water quality strategies that preserve natural resources and the ecosystem as a whole.

1.4This Standard applies to Class A-1, A-2, B, and C health care facilities. Note: Some requirements may be waived for smaller Class C health care facilities as determined by the application of engineering principles and in consultation with the administrator and the authority having jurisdiction.

1.5The requirements of this Standard apply to the retrofitting of existing systems when (a) an existing health care facility is

(i) extended; or (ii) subject to material alteration or repair; and

(b) the plumbing in existing facilities is adversely affected.

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2 March 2009

1.6In CSA Standards, “shall” is used to express a requirement, i.e., a provision that the user is obliged to satisfy in order to comply with the standard; “should” is used to express a recommendation or that which is advised but not required; “may” is used to express an option or that which is permissible within the limits of the standard; and “can” is used to express possibility or capability. Notes accompanying clauses do not include requirements or alternative requirements; the purpose of a note accompanying a clause is to separate from the text explanatory or informative material. Notes to tables and figures are considered part of the table or figure and may be written as requirements. Annexes are designated normative (mandatory) or informative (non-mandatory) to define their application.

2 Reference publicationsThis Standard refers to the following publications, and where such reference is made, it shall be to the edition listed below, including all amendments published thereto.

CSA (Canadian Standards Association)CAN/CSA-B45 Series-02 (R2008)Plumbing fixtures

CAN/CSA-B64 Series-07Backflow preventers and vacuum breakers

ASME A112.18.1-05/CAN/CSA-B125.1-05Plumbing supply fittings

ASME A112.18.2-05/CAN/CSA-B125.2-05Plumbing waste fittings

CAN/CSA B125.3-05Plumbing fittings

CAN/CSA-B651-04Accessible design for the built environment

C22.1-09Canadian Electrical Code, Part I

CAN/CSA-C22.2 No. 0-M91 (R2006)General Requirements — Canadian Electrical Code, Part II

CAN/CSA-C22.2 No. 218.1-M89 (R2006)Spas, hot tubs and associated equipment

C22.2 No. 218.2-93 (R2008)Hydromassage bathtub appliances

N292.3-08Management of low- and intermediate-level radioactive waste

Z32-04Electrical safety and essential electrical systems in health care facilities

Z317.10-09Handling of waste materials in health care facilities and veterinary health care facilities

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March 2009 3

CAN/CSA-Z317.13-07Infection control during construction, renovation, and maintenance of health care facilities

Z318.0-05Commissioning of health care facilities

CAN/CSA-Z7396.1-06Medical gas pipeline systems — Part 1: Pipelines for medical gases and vacuum

CDC/HICPAC (Centers for Disease Control and Prevention/Healthcare Infection Control Practices Advisory Committee)Guidelines for Environmental Infection Control in Health-Care Facilities, 2003

Guidelines for Preventing Health-Care–Associated Pneumonia, 2003

Health CanadaGuidelines for Canadian Drinking Water Quality — Summary Table, 2008

NFPA (National Fire Protection Association)13 (2007)Standard for the Installation of Sprinkler Systems

NRCC (National Research Council Canada)National Building Code of Canada, 2005

National Fire Code of Canada, 2005

National Plumbing Code of Canada, 2005

Ontario Ministry of Municipal Affairs and HousingOntario Building Code, 2006

Public Health Agency of CanadaConstruction-related Nosocomial Infections in Patients in Health Care Facilities: Decreasing the Risk of Aspergillus, Legionella and Other Infections, 2001 (http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/01pdf/27s2e.pdf)

3 DefinitionsThe following definitions shall apply in this Standard:

Accessible — access to a fixture connection, plumbing appliance, valve, cleanout, or other equipment, possibly requiring the removal of an access panel, door, or obstruction, but not requiring the cutting or breaking of materials.Note: This definition is consistent with that of the Ontario Building Code.

Administrator — the person or designate responsible for the operation of a health care facility.

Bariatric — concerned with the treatment of obesity.

Barrier-free — the characteristic of an area or facility that can be approached, entered, and used by all persons, including those with physical or sensory disabilities.

Biohazard — material that can be contaminated with viable micro-organisms (including prion protein material) or toxins that under certain circumstances can cause disease or illness.

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4 March 2009

Building drain — the horizontal piping, including any vertical offset, that conveys sewage, clear water, waste, or stormwater to a building sewer.

Building sanitary drain — a building drain that conveys sewage.

Building storm drain — a building drain that conveys stormwater.

Chemical waste — waste that contains one or a mixture of chemical compounds and is classified as hazardous or non-hazardous.

Clear water waste — waste water with impurity levels that are not harmful to health. Notes: (1) Clear waste water includes

(a) cooling water and condensate drainage from refrigeration and air-conditioning equipment; and (b) cooled condensate from steam heating systems.

(2) Clear waste water does not include stormwater.

Combined sluice hopper/clinical service disposal sink — a large standing or wall-hung sink that (a) has the following:

(i) a faucet and blade handles; (ii) hot and cold water; (iii) a vacuum breaker spout; (iv) a flush valve with a handle on the front; (v) a flushing rim; and (vi) a combined waste soil pipe;

(b) is located in a soiled utility room; and(c) is used to dispose of body fluids.

Continuously supervised location — a location that is monitored 7 days per week, 24 hours per day, by a person with authority to react to unexpected and emergency situations.

Dead leg — a pipe, or other plumbing component or system, that has contained, currently contains, orlikely will contain stagnant water.

Distilled, demineralized, pure, or treated water system — a system designed to deliver water of a quality determined by user needs that meets the requirements of specific Standards developed by technical societies such as the Canadian Standards Association (CSA), the Association for the Advancement of Medical Instrumentation (AAMI), the American Society for Testing Materials (ASTM), and the National Sanitation Foundation (NSF).

Drainage system — an assembly of pipes, fittings, fixtures, traps, and appurtenances that is used to convey sewage, clear water waste, or stormwater to a public sewer or a private sewage disposal system.Note: Drainage systems do not include subsoil drainage pipes.

Fixture — a receptacle, appliance, apparatus, or other device that discharges sewage or clear water waste. Note: Fixtures include floor drains.

Grey water — untreated waste water from the bath, shower, bathroom wash basin, kitchen sink, dishwasher, clothes washing machine, and laundry trough. Note: Grey water does not come into contact with toilet waste (black water).

Grey water reuse — the use of grey water in a beneficial application. Note: Reuse does not include disposal at a depth that would not benefit plants and gardens.

Grey water systems — grey water diversion, treatment, storage, and distribution systems that reuse grey water for garden irrigation.

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March 2009 5

Hands-free operation — operation of devices without the use of the hands. Note: Hands-free operation includes elbow, knee, foot, or electronic operation.

Hazardous waste — a material or substance that, if handled improperly, has the potential to harm people, property, or the environment.

Health care facility (HCF) — a set of physical infrastructure elements supporting the delivery of health-related services.Note: For examples of different health care facilities by class, see Annex B.

Class A-1 HCF — a facility in which patients are (a) accommodated on the basis of medical need; (b) provided with continuing medical care; and(c) provided with supporting diagnostic and therapeutic services that can be extended beyond

12 h. Note: Class A-1 HCFs typically provide trauma and emergency services, have surgical operating rooms, and are referred to as “active treatment” or “acute care” institutions.

Class A-1 HCFs fall into one of the following categories:

Category 1 — health care facilities designated by the authority having jurisdiction as a mission critical facility, including facilities designated as essential in infectious diseases outbreak management.

Category 2 — health care facilities that meet two of the following conditions:(a) the HCF is an academic centre providing tertiary or quaternary services such as

transplantation, oncology, or trauma services;(b) the HCF provides regional programs such as oncological, trauma, cardiac, dialysis,

pediatric, maternal, or newborn services;(c) the expected travel time to a Class A-2 facility exceeds 1.0 h under normal driving

conditions; and(d) the HCF is the sole provider of acute care health services to populations in excess of

500 000 people.

Category 3 — health care facilities that meet one of the requirements listed in Category 2 and(a) provide programs or services that are not generally provided by other nearby health care

facilities; and(b) include at least one of the following:

(i) rehabilitation hospital;(ii) chronic patient care for hospitals with at least 200 licensed beds;(iii) mental health facilities;(iv) special rehabilitation services for disabled persons;(v) transplantation centres; and(vi) continuing care centres for management of chronic diseases.

Class A-2 HCF — a facility(a) in which patients are

(i) accommodated on the basis of medical need; (ii) provided with continuing medical care; and(iii) provided with supporting diagnostic and therapeutic services that can extend beyond 12 h;

and (b) that does not meet the other requirements of a Class A-1 HCF. Notes: (1) Class A-2 HCFs include facilities for patients rendered incapable of self-preservation as a result of their medical

condition.(2) Class A-2 HCFs typically provide trauma and emergency services, have surgical operating rooms, and are

referred to as “active treatment” or “acute care” institutions.

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6 March 2009

Class B HCF — a facility in which residents, as a result of physical or mental disabilities, are unable to function independently and are accommodated on the basis of medical need for constant care by health care professionals or the need for intensive therapies that require supervision by health care professionals, but where interventional and other invasive procedures are not performed. Notes: (1) Class B HCFs include facilities for patients rendered incapable of self-preservation as a result of their medical

condition.(2) Class B HCFs include extended care, intermediate care, multi-level care, group home, hospice, mental health,

and rehabilitation facilities.

Class C HCF — a facility in which ambulatory patients (a) are accommodated on the basis of medical need; (b) are provided with supportive, diagnostic, non-invasive interventions and treatment services; and(c) stay for no more than 12 h. Notes: (1) Class C HCFs include facilities for patients who remain capable of self-preservation.(2) Class C HCFs include outpatient clinics, dentists’ offices, doctors’ clinics, and private residences.

Lavatory — a sink that is permanently installed and connected to a water supply and drainpipe located in a bathroom or in a patient care area and used for hand washing.

Micro-organism — an organism that is too small to be seen by the naked human eye. Note: Micro-organisms include bacteria, fungi, archaea, and protists, but not viruses and prions.

Pathogen — a disease-causing microbe. Note: Pathogens include viruses, bacteria, helminths, and protozoa.

Patient care area — an area intended primarily for diagnosis, therapy, or care.Notes: (1) The administrator is responsible for determining whether an area should be classified as a patient care area and, if so,

whether it is a basic, intermediate, or critical care area. (2) Bathrooms and washrooms are not always considered part of the patient care area.

Peak demand — the quantity of water necessary to maintain either the design or measured maximum quantity of water that the facility requires to maintain its normal operation at peak periods of water usage.

Potable water — water that meets Health Canada’s Guidelines for Canadian Drinking Water Quality — Summary Table.

Private water supply system — an assembly of pipes, fittings, valves, equipment, and appurtenances that supplies water from a private source to a water distribution system.

Sanitary drainage system — a drainage system that conveys sewage.

Sanitizing — a process that results in a reduction of the microbial population on an inanimate object.

Sewage — liquid waste other than clear water waste or stormwater.

Sink — a utility or janitorial sink that is permanently installed and connected to a water supply and drainpipe. Note: Sinks are generally located in service areas, kitchens, and janitors’ closets.

Stormwater — water that is discharged from a surface as a result of rainfall or snowfall.

Subsoil drainage pipe — a pipe that is installed underground to intercept and convey subsurface water.

Water closet (toilet) — a plumbing fixture specifically designed to discharge human excrement into the sanitary drainage system.

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March 2009 7

Water distribution system — an assembly of pipes, fittings, valves, and appurtenances that conveys water from the water service pipe or private water supply system to water supply outlets, fixtures, appliances, and devices.

Water service pipe — a pipe that conveys water from a public water main or private water source to the inside of the building.

Water supply system — a system consisting of the water service pipe and water distribution system within the health care facility.

Water system — a private water supply system, a water service pipe, and a water distribution system, or parts thereof.

4 General requirements

4.1 Codes and regulatory requirementsPlumbing installations shall conform to the requirements of the National Plumbing Code of Canada (NPCC), applicable local codes, and the authorities having jurisdiction. Regulatory requirements shall supersede all others.

4.2 AlarmsAlarms shall be located at continually supervised locations. The alarm system shall have power supplied by the essential electrical system.Note: An automated alarm notification may be initiated from the building automation system.

4.3 MaterialsMaterials shall be selected for use in plumbing installations in accordance with engineering principles, applicable CSA standards, and the NPCC. Considerations shall include material durability, corrosion resistance, effect on water quality, and resistance to micro-organisms.Notes: (1) Designers should also consider those materials used for components, such as jointing seals and washers within devices.(2) See Annex A for additional considerations for plumbing installations in health care facilities.

4.4 Operations and maintenance program

4.4.1 GeneralAn operations and maintenance program helps to ensure the health and safety of facility occupants and visitors. The administrator shall develop a documented operations and maintenance program for the health care facility’s plumbing system that includes (a) regular cleaning, repair, and maintenance; (b) preventive measures; (c) procedures for emergency conditions; and (d) methodology to monitor and document compliance.Notes: (1) The documented maintenance program should be developed in consultation with the health care facility’s plumbing

operational supervisors, maintenance management, and infection control personnel. Operations issues should be addressed by the quality improvement component of the maintenance program.

(2) The maintenance program should include proper start-up, flushing, and test procedures for areas that have been shut down for extended periods. See Clause 6.2.3.

4.4.2 FrequencyThe maintenance program and the frequency of its application shall be developed in accordance with the type of system and water quality.

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4.4.3 Infection control in plumbing installations

4.4.3.1Plumbing systems can contribute to infection if proper maintenance and disinfection are not performed in accordance with the established facility maintenance program. The maintenance program should have written policies and procedures on infection prevention and control in plumbing systems that are approved by the infection control committee and the administration. The policies should meet the requirements of this Standard.

4.4.3.2The maintenance program should address specific infection control issues related to regularly scheduled disinfection and maintenance of the plumbing system. The maintenance program should also include specific measures and contingences for the control and remediation of outbreaks associated with water-borne infections.Notes: (1) Consideration should be given to the following with regard to the established maintenance program:

(a) the cleanliness and condition of maintenance equipment, especially when in contact with patient care environments; and

(b) prompt recognition and immediate correction of water leaks (as water damage enhances mould proliferation).(2) Infection control issues should be addressed as part of the training program.(3) Legionella and other contaminants have been found in potable cold water supplies and systems. Consideration should

be given to treatment of the whole water system.(4) For more information on legionella, see CAN/CSA-Z317.13.

4.4.3.3The administrator shall ensure that training is available to all relevant staff. As a minimum, training should(a) address the infection control risks inherent in plumbing systems and include measures for prevention;(b) include means and methods for containment and protection of personnel; and(c) be specified as part of the job descriptions of health care facility staff, as applicable.

4.4.3.4Where high-temperature sanitization is used, domestic hot water tanks shall have the capability to maintain a minimum temperature of 80 °C.

4.4.3.5High-temperature flushing of domestic hot water systems shall be performed as follows:(a) All mixing valves in the system shall be set to the required temperature for sanitizing (71 to 77 °C).(b) The system temperature shall be stabilized and maintained at each outlet at a minimum of 71 °C. (c) Each outlet shall be flushed for a minimum 5 min. (d) After sanitizing, all mixing valves shall be reset to their normal operating temperature. (e) The temperature shall be verified prior to patient or staff use.Notes: (1) Consideration should be given to zoning the hot water distribution system to facilitate high-temperature sanitation.(2) Consideration should be given to allowable temperature tolerances when discharging high-temperature water to drain.

Cooling might be required based on local codes.

4.4.3.6Treatment methods other than high-temperature sanitization may be used provided that they have been proven to be effective.Note: Studies published by the American Water Works Association indicate copper-silver ionization, chlorine dioxide residual, ozonation, and monochloramine residual methods can be effective, depending on local water conditions.

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4.4.4 Risk managementValves shall be operated and maintained in accordance with an established program (see Clause 4.4.1), to ensure operability.

4.5 CommissioningPlumbing systems in newly constructed or renovated health care facilities shall be commissioned in accordance with CSA Z318.0. Commissioning phases shall include:(a) pre-design;(b) design;(c) construction;(d) facility start-up;(e) verification;(f) performance testing; and(g) training and instruction.

5 Hydraulic fire protection systems

5.1Class C facilities need not comply with Clause 5 but shall comply with applicable local codes.

5.2Hydraulic fire protection systems shall meet the requirements of the National Fire Code of Canada (NFCC) and NFPA 13. The requirements of the authority having jurisdiction shall take precedence over the requirements of Clause 5.

5.3During the design phase, consideration should be given to the longevity of the sprinkler system piping.Note: Consideration should be given to the durability and life expectancy of materials and the potential for future expansion of the sprinkler system.

5.4In areas requiring regular cleaning and sanitization of sprinkler heads, concealed sprinkler heads shall be used.

5.5In areas accessible to staff or to the public, with a maximum height of 2286 mm, sprinkler heads shall be of the concealed type where ceilings exist or shall be protected where no ceilings exist.Note: The intent of this Clause is to prevent damage to the sprinkler head resulting from collision with moving objects such as IV (intravenous) poles.

5.6Sprinkler heads in forensic and mental health facilities should be suitable for such facilities. In all cases, sprinklers shall be appropriate for patient care areas.Note: The designer should consult with the administrator or delegate regarding specific requirements for the installation.

5.7Fire hose cabinets shall have recessed hinges and latches to facilitate cleaning.

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6 Water systems

6.1 GeneralThe requirements of Clause 6 shall apply to(a) the potable water supply and its management;(b) potable water distribution systems; and(c) distilled, demineralized, steam and condensate, pure, or treated water systems.

6.2 Potable water supply

6.2.1 GeneralClass C facilities need not comply with Clause 6.2 but shall comply with applicable local codes.

6.2.2 Alternative water supply

6.2.2.1A reliable and adequate alternative water supply shall be provided such that service to the health care facility is not significantly interrupted in the event of failure of the primary potable water supply.

6.2.2.2Methods of compliance with Clause 6.2.2.1 may include(a) a secondary municipal potable water supply with two distinct points of entry into the facility;(b) a private water source approved by the authority having jurisdiction;(c) a proven contingency plan with the local supply authority and purveyor; and(d) installation of a covered hose connection outside of the building.

Interconnection between private and public water sources shall be approved by the local authority having jurisdiction.Note: Regardless of the method of compliance chosen by the health care facility, infection control authorities should be consulted to verify water quality.

6.2.3 Initial system treatment

6.2.3.1The complete potable water system shall be treated immediately prior to occupancy with one of the methods specified in Clauses 6.2.3.2 and 6.2.3.3.

6.2.3.2Hyperchlorination shall be performed as follows:(a) chlorine shall be introduced into the system;(b) at least 25 ppm shall be measured at all outlets;(c) the system shall not be used for 24 h; (d) based on pH adjusted to 7.5 to 8.0, the system shall have a stable residual chlorine concentration

of > 10 ppm; (e) the system shall be monitored at 2 h intervals for 24 h;(f) after 24 h, the system shall be flushed until no more than 5 ppm is measured at all outlets and they

are free of turbidity; and(g) a minimum of 10 samples shall be taken at the most remote points of the system (including faucets,

shower heads, and hot water tanks) and tested for growth of micro-organisms.Infection control and microbiology authorities shall be consulted for specific water testing procedures.

Notes: (1) Additional disinfection should be considered based on the number of positive cultures and any prior experience with

hospital-acquired cases of infection (e.g., legionella).(2) “Immediately prior” means at the completion of treatment and testing (where applicable).

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6.2.3.3Water shall be treated as follows:(a) water shall be superheated to a minimum temperature of 70 °C for at least 30 min, during which

time the system shall not be used;(b) the system shall be brought back to normal operating temperatures;(c) the system shall be flushed until it is free of turbidity; and(d) a minimum of 10 samples shall be taken at the most remote points of the system and tested for

growth of micro-organisms.

6.2.3.4Treatment of the potable water system in accordance with Clause 6.2.3.2 or 6.2.3.3 shall comply with the HCF’s established sanitization program.

6.2.4 Testing of potable water systems

6.2.4.1A program shall be established by the administrator or a delegate for testing of all potable water systems, both periodically and when an outbreak is suspected and/or identified, to confirm that such supplies comply with applicable public health requirements for potable water and the requirements of this Standard.Note: For further information regarding requirements for water quality, consult the authority having jurisdiction and Health Canada’s Guidelines for Canadian Drinking Water Quality.

6.2.4.2The system of pumps, valves, water distribution piping, and other devices comprising the facility’s backup water supply system shall be periodically tested in accordance with the HCF’s standard operating procedures to confirm that the system(a) is functioning properly; and(b) is able to provide potable water at points of use in case of failure of the primary potable water supply

(see Clause 6.3.2.5).

6.2.4.3The infection control service within the health care facility shall be notified in the event of interruptions to the primary water supply system.

6.2.4.4Contingency plans shall be developed to address situations such as breaks in water lines and power outages affecting water flow or filtration services.Note: When developing contingency plans, appropriate experts should be consulted. These experts may include those in plumbing maintenance and infection control. Contingency plans should address water for drinking, cleaning, bathing, toilet flushing, and flushing of lines following restoration of power or water flow.

6.3 Potable water distribution systems

6.3.1 GeneralClass C facilities need not comply with Clause 6.3 but shall comply with local applicable codes.

6.3.2 Design and construction

6.3.2.1Water systems shall be designed in accordance with engineering principles and applicable codes and standards to ensure delivery of water consistent with patient care needs.Note: For general use, water pressure should be maintained at 350 ± 70 kPa.

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6.3.2.2Isolating valves shall be accessible and identified by markings that are permanent, distinct, and easily recognized and shall be provided for each(a) water main;(b) connection to a water main;(c) base of a riser and each connection on the riser;(d) connection to a fixture or group of fixtures; and(e) connection to equipment.

6.3.2.3Cold water pipes shall be insulated and provided with a continuous vapour barrier. Plumbing fixture supplies need not be insulated, except fixture supplies on barrier-free lavatories (e.g., stops, supplies, traps, and drains) shall be insulated.Note: The purpose of insulation is to prevent condensation on cold water piping to prevent mould and pathogen growth.

6.3.2.4The design and installation of distribution mains shall facilitate commissioning and sanitizing of the entire piping system (see Clause 6.2.3).

6.3.2.5Due to the critical nature of potable water systems, the main components of such systems (e.g., distribution pumps, storage tanks) shall be provided with redundancy.Note: This Clause is not intended to require the use of a secondary fuel source for domestic hot water as part of the backup for the potable water system.

6.3.2.6

6.3.2.6.1The recycling of bath and shower water (grey water) involves distinct hygiene and infection control issues. As a result, recycled grey water shall not be used in HCFs.Note: Blood-borne pathogens and other contaminants might be present in grey water. All forms of grey water are capable of transmitting disease.

6.3.2.6.2Consideration should be given to developing strategies to reduce the consumption of water in HCFs (e.g., using rain water for cooling towers). Rain water shall be treated prior to storage.

6.3.3 Pressure-booster systems

6.3.3.1Where pressure-booster systems are required, the number and arrangement of pumps shall be such that peak demand can be met in the event of failure of one pump.

6.3.3.2Alarms shall be provided to indicate(a) failure of a pumping unit; and(b) low primary water supply pressure.

Alarms shall be annunciated in the building automation system as well as sounded in a continuously supervised location.

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6.3.4 Hot water systems

6.3.4.1Water distribution systems shall be arranged to provide hot water at every hot water outlet on demand.Note: The term “on demand” means that from the opening of the hot water tap the water temperature specified in Table 1 is available in less than 10 s.

6.3.4.2The temperature of hot water supplies shall be in accordance with Table 1.Note: Consideration should be given to the use of new technology such as copper-silver ionizing unit filters and ultraviolet systems, which help resist the growth of legionella and other microbes.

6.3.4.3Where instantaneous hot water heaters are used in a distribution system to maintain hot water in the piping network, each instantaneous water heater shall be supplied with a recirculation system.

A three-way thermostatic valve shall direct the recirculated water flow as required to maintain the temperature as specified in Table 1.

Adjustable thermostatic valves shall be provided on the instantaneous heater to achieve the required temperature.Notes: (1) When the distribution system is at the required temperature, the flow of water bypasses the water heater. When the

temperature in the distribution system reaches the minimum required temperature, the thermostatic element responds and will cause a portion of the water to be diverted through the heater.

(2) Consideration should be given to the sizing of instantaneous heaters when they are used for sanitizing the hot water distribution system.

6.3.4.4Mixing valves shall be located at the point of use (i.e., lavatories and sinks) to provide the water temperature as specified in Table 1. All mixing valves shall be identified and have their maximum discharge temperature measured and documented on a regular basis, as follows:(a) master and hydrotherapy mixers — monthly;(b) patient baths and showers — every six months; and(c) staff facilities — annually.Notes: (1) Monitoring of the maximum discharge temperature should be specified in the maintenance program and associated

quality monitoring activities.(2) Consideration should be given to additional mixing valves to provide zoning of the hot water distribution system,

facilitating high-temperature sanitation.

6.3.4.5The administrator or a delegate shall ensure that maximum temperatures specified in Table 1 are not exceeded.

6.3.4.6Check valves and/or backflow preventers shall be installed as required by applicable regulations.

6.3.4.7Where water is blended to produce hot water of a specified temperature,(a) precautions shall be taken to prevent the buildup of high-temperature water in piping during periods

of low or no use;(b) dead-leg piping shall be eliminated; and(c) check valves shall be provided to prevent bypassing of hot or cold water through the mixing valve.

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Notes: (1) The distribution system should be such that a continuous flow of blended water passes through the sensing point and

mixing valve.(2) Consideration should be given to using means in addition to integral stop checks to provide a cross-over barrier.

6.3.4.8Hot water pipes shall be insulated to(a) prevent injury; and(b) avoid unnecessary loss of heat.

6.3.4.9Stops and supplies on barrier-free lavatories and sinks shall be insulated.

6.3.4.10Domestic hot water recirculating piping and pumps shall be provided on the hot water supply piping in Class A-1, A-2, and B facilities.

6.3.4.11Recirculating lines shall be connected upstream of any local backflow preventers or mixing valves.

6.3.4.12A fail-safe high-temperature shutdown device shall be installed after the central mixing valve. The device shall have an audible and visual high-water-temperature alarm and shall be set to shut down the supply of hot water at water temperatures greater than (a) 65 °C for non-patient-care areas; and (b) 50 °C for patient care areas.

See Table 1.

6.3.4.13Fail-safe devices shall restrict only the flow of hot water. The flow of cold water shall not be restricted by fail-safe devices.Note: It is important to ensure that water is available at the user outlet when the supply of hot water is restricted by fail-safe devices as a result of the water temperature exceeding the limits specified in Table 1.

6.3.5 Water storage tanks

6.3.5.1Water storage tanks shall be made of, or lined with, corrosion-resistant material. This material shall be designed to reduce the risk of scale and accumulations such as sediments, slime, algae, and other microbial growth.

6.3.5.2Water storage tanks with a capacity of 2300 L (500 gal) or more shall be designed with a means of access, such as maintenance holes or bolted end plates.Note: This requirement is intended to allow for regular internal cleaning of the water storage tanks.

6.3.5.3Water storage tanks shall be provided with a drain at the lowest point.Note: This requirement is intended to allow for the complete removal of accumulated silt and sediment during cleaning.

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6.3.5.4Where central potable water storage tanks are employed, there shall be two or more tanks so that the normal water requirements of the facility are met with any one tank out of service.

6.3.5.5Consideration shall be given to preventing water stagnation in hot water tanks. This may be addressed by a piping configuration that ensures adequate water circulation through the tanks.

6.3.5.6For the purpose of sanitizing hot water storage tanks, and potentially the water distribution system, each hot water storage tank shall be capable of reaching a water temperature of 80 °C.

6.4 Distilled, demineralized, pure, or treated water systems

6.4.1 General

6.4.1.1The major processes for attaining high-purity water currently include one or a combination of the following:(a) resin deionization;(b) chlorination;(c) distillation;(d) reverse osmosis; and(e) membrane and filtering technology.

6.4.1.2Where a distilled, mineralized, pure, or treated water system is supplied, the quality of water shall meet the requirements of one or more of the water quality standards developed by organizations such as CSA, AAMI, ASTM, and NSF. The applicable standard(s) shall be determined by the administrator.

6.4.1.3The feed water for purifying equipment shall be analyzed to determine whether pre-treatment is necessary to produce the required water quality and to protect the equipment.

6.4.1.4Pipe loops shall be designed to provide sufficient flow velocity and to prevent dead-leg lengths of pipe. Flow rate shall be a minimum of 1.5 m/s.Notes: (1) Flow rates of less than 1 m/s are generally insufficient to disrupt the formation of biofilm on the internal walls of pipe.(2) The amount of contamination generated within a system can be directly related to the pathogen, nutrients, treatment

modality, piping diameter, or piping complexity (e.g., the number of valves, joints, junctions, and surface area).

6.4.1.5The materials used in the construction of the pure water distribution system shall not degrade the quality of the water. Recommended non-leaching materials include (a) passivated and degreased stainless steel;

Note: Appropriate welding techniques should be used to ensure the metallurgical integrity of the welding seam.(b) natural unpigmented polypropylene;(c) polytetrafluoroethylene (PTFE); and(d) polyvinyldenefluoride (PVDF).Note: Users of this Standard should consult the National Building Code of Canada (NBCC), NPCC, NFCC, local codes, and the requirements of the local fire prevention authority on the use of materials.

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6.4.1.6Valves for distilled, demineralized, pure, or treated water distribution shall be made of materials compatible with the piping system and designed to minimize contamination by micro-organisms.Notes: (1) The more complicated the valve design and the greater its internal surface, the greater its potential contribution to

particulate contamination; this should be considered in the selection of valves. (2) The placement of valves within the system should be upstream of the final membrane filter.

6.4.1.7Distilled, demineralized, pure, or treated water storage tanks shall(a) be capable of being sealed to prevent contamination;(b) be provided with a drain connection with a primed pure water trap;(c) be provided with an overflow connection with a primed water trap;(d) be equipped with an appropriate vent filter(s); and(e) meet facility requirements for distilled, demineralized, pure, or treated water.

6.4.1.8The following alarms shall be provided and annunciated at a continuously attended location:(a) high-water alarms;(b) a common alarm point that indicates a general subsystem failure;(c) an alarm that indicates low primary water supply pressure; and(d) an alarm that indicates failure of a pumping unit.

6.4.2 Deionization

6.4.2.1Where in-house deionization systems are in place or planned, staff trained in deionization processes and operations shall be available on site.

6.4.2.2Deionization systems shall meet the requirements of all applicable codes and regulations.

6.4.3 Distillation

6.4.3.1The distillate distribution system shall be capable of handling the elevated temperature of the water.

6.4.3.2Equipment, source piping, and valves shall be insulated to protect personnel and conserve energy.

6.4.3.3The distillation equipment shall be provided with a flushing and cleaning system to reduce scale buildup.

6.4.3.4The length of distilled water piping should be kept to a minimum.

6.4.4 Reverse osmosis

6.4.4.1The pre-treatment and feed water temperature of water for reverse osmosis equipment shall be appropriate for the membrane material used.

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6.4.4.2Reverse osmosis equipment shall have integral or independent cleaning equipment.

6.4.4.3Reverse osmosis equipment shall have automatic flushing to reduce the growth of micro-organisms within the equipment during periods of low use.

6.4.4.4If the reverse osmosis system is to be inoperative for more than 48 h, the membranes should be filled with a preserving solution.

6.5 Steam and condensateWater supplies to all steam-producing equipment shall be pre-treated to ensure the water quality recommended by the equipment manufacturer and to minimize the operations and maintenance requirements for the equipment.

7 Drainage systems

7.1 GeneralClass C facilities need not comply with Clause 7 but shall comply with applicable local codes.

7.2 ApplicationThe requirements of Clause 7 shall apply to(a) storm drainage systems; and(b) sanitary drainage systems.

7.3 Foreign objectsWhere foreign objects (e.g., clothing and sheets) could be flushed down the drain (see Clause A.6), consideration should be given to(a) installing a larger drain;(b) arranging drain runs with as few bends as possible;(c) performing additional cleanouts;(d) installing filtering or trapping devices; and(e) installing chopper/grinder pumps.

7.4 InsulationTraps and drains for which it is desirable to prevent condensation shall be insulated as specified in Clause 6.3.2.3.

7.5 Storm drainage systems

7.5.1 DischargeAll stormwater shall be piped independently of sanitary drainage systems to storm building sewers or storm drainage systems, except when the public sewer is a combined sewer. In such cases, stormwater and sewage may be combined at a maintenance hole located at the edge of the HCF’s property. Where services are combined in a maintenance hole, backflow preventers shall be used for both stormwater and sewage.

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7.5.2 Sump pumps

7.5.2.1Where sumps and sump pumps are employed,(a) each sump shall consist of two compartments (a settling compartment and a pumping

compartment) if the amount of suspended matter is likely to interfere with the operation of the pumps or cause excessive wear; and

(b) the pumping compartment shall be sized to limit the frequency of pump starts to that recommended by the manufacturer.

Note: When determining sump pit and pump capacities, consideration should be given to flows from(a) equipment drains;(b) seepage; and(c) accidental flooding.

7.5.2.2Sump pumps designed for permanent installation shall be(a) duplexed;(b) provided with an automatic alternator and a lag pump starting feature;(c) supplied from the essential electrical system in accordance with CSA Z32;(d) equipped with an alarm for the lag pump start; and(e) equipped with a high-water alarm.

7.6 Sanitary drainage systems

7.6.1 Sewage pumps

7.6.1.1Sewage pumps shall be(a) duplexed;(b) provided with an automatic alternator and a lag pump starting feature;(c) supplied from the essential electrical system in accordance with CSA Z32;(d) equipped with an alarm for the lag pump start;(e) equipped with a high-water alarm; and(f) of the grinder/macerator type.

7.6.1.2Sewage pumps shall not be used when gravity flow can be employed.

7.6.2 Design

7.6.2.1The installation of drainage pipes shall be avoided, where possible, within ceiling spaces or exposed areas where leakage or condensation could cause a hazard.

7.6.2.2Drains shall be accessible for cleaning.

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7.6.2.3Where it is necessary for drains to be located within the ceiling space of patient care areas, the piping system shall be welded or shall have encapsulated joints providing a waterproof seal.Note: Consideration should be given to applying this requirement to other areas such as(a) food preparation areas;(b) electrical rooms;(c) telecommunications rooms;(d) fire alarm centres;(e) central computer areas; and(f) operating rooms.

7.6.2.4Interceptors and neutralizing tanks shall be installed, in accordance with local codes, in the waste piping of areas such as(a) fracture room sinks and sinks in any other room where plaster casts might be applied or removed;(b) dental and other laboratories;(c) food preparation areas;(d) hair salons; and(e) autopsy suites.Note: This requirement is intended to prevent undesirable waste from being flushed into the sewage system.

7.6.2.5A reliable and adequate sewage contingency plan shall be developed prior to the interruption of service to the primary source of discharge.

7.6.3 Hazardous waste

7.6.3.1All waste handling in HCFs shall, at minimum, meet the requirements of CSA Z317.10. Where the requirements of CSA Z317.10 and this Standard differ, the requirements of this Standard shall take precedence.

7.6.3.2Fixtures likely to handle hazardous, bio-hazardous, or toxic waste shall be identified.

7.6.3.3Hazardous waste shall be (a) piped to a neutralizer and treated prior to discharge to a sanitary drain; or (b) collected in a holding tank for off-site disposal.

7.6.3.4Disposal of hazardous chemicals and chemical wastes shall comply with applicable federal, provincial, and local regulations. Each HCF shall assess the specific level of containment needed for that facility.

HCFs shall assess the hazards posed by the use of chemicals and ensure that their treatment after use is appropriate in all cases. Chemical reagents used in diagnostic testing equipment are often flushed to drain after processing; this practice shall be assessed and shown to be appropriate and meeting regulations in all cases.Note: Treatment methods include active treatment, neutralizing, collection for disposal, and flushing down drains.

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7.6.3.5The drains and piping systems of sinks into which chemicals can be poured shall be made of materials resistant and inert to the expected chemical agents.Notes: (1) For example, some pieces of laboratory equipment, such as blood cell counters, can use azide solutions in their

operation. These azides, if discharged into a drain before being treated to convert the chemical to a harmless compound, could react with copper, lead, brass, or solder in the plumbing system to form a compound that is highly explosive.

(2) Users should consult the NBCC, NPCC, NFCC, local codes, and the local fire prevention authority on the use of materials.

7.6.3.6Drains carrying radioactive wastes shall be identified as hazardous drains. The disposal of radioactive wastes shall be carried out in accordance with the license issued to the HCF. Radioactive waste shall be transferred to a licensed facility; only trace quantities shall be released to municipal waste or sewer systems.Notes: (1) The release of waste containing radioactive materials or nuclear substances is regulated by conditions of licenses issued

by the Canadian Nuclear Safety Commission. For further information, contact the Canadian Nuclear Safety Commission, Materials Regulation Division, Medical, Academic & Industrial Licensing Section (www.nuclearsafety.gc.ca).

(2) For further information on the management of low- and intermediate-level radioactive waste, see CSA N292.3.

8 Plumbing fixtures and fittings

8.1 General

8.1.1All fixtures and fittings shall, at minimum, meet the requirements of the CAN/CSA-B45 Series and the CSA B125 Standards. Where the requirements of the CAN/CSA-B45 Series, the CSA B125 Standards, and this Standard differ, the requirements of this Standard shall take precedence.

8.1.2Backflow preventers shall be certified and installed in accordance with the applicable requirements of the CAN/CSA-B64 Series and the NPCC or applicable codes of the authority having jurisdiction.

8.1.3Appropriate anti-splash fitting moderators that do not entrain air shall be used in all areas of the HCF. Class C facilities need not comply with this requirement but shall comply with applicable local codes.Notes: (1) The use of anti-splash fittings is intended to reduce the risk of environmental contamination of surroundings.

Aerator-type anti-splash fittings can accumulate sediment and provide a potential reservoir for the proliferation of micro-organisms.

(2) Aerosol-generating devices should not be used in the vicinity of immunosuppressed patients.

8.1.4Barrier-free design for plumbing fixtures and fittings within HCFs shall be in accordance with CAN/CSA-B651 and federal, provincial, and local regulations.

8.1.5Adequate and accessible service space shall be provided for all plumbing equipment requiring service (e.g., interceptors, neutralizing equipment).

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8.1.6HCFs shall develop a regular maintenance program for all plumbing equipment requiring service.

8.1.7Where automatic faucets are used, provision shall be made for appropriate regulation of the temperature of the water delivered to the faucet. The design shall be such that activating the water does not contaminate the hands. Class C facilities need not comply with the requirements of this Clause but shall comply with applicable local codes.Note: Hot water should be recirculated close to the faucet. Temperature control is important as extremes can negatively affect skin integrity and hand hygiene practices. While electronic-type fixtures and fittings offer hands-free, sanitary, and simplified operation, contamination of electronic faucets has been linked to infection in patients. See the CDC/HICPAC document, Guidelines for Environmental Infection Control in Health-Care Facilities.

8.1.8Automatic faucets shall have power supplied by the essential electrical system.

8.1.9Fixtures within the HCF shall not have an overflow unless the administrator determines, after evaluation of the infection-versus-flood risk, that overflows are necessary.

8.1.10Where an overflow is provided, the water supply should be integrated such that the overflow can compensate for maximum tap run. If a fixture has an overflow, a cleaning program shall be in place.Note: Overflows represent a source of micro-organisms and can be difficult to clean. In certain cases (e.g., drains in mental health facilities), an overflow might be preferred because the infection risk is relatively low compared with the flood risk.

8.2 Sanitary fixtures

8.2.1Class C facilities need not comply with Clause 8 but shall comply with applicable local codes.

8.2.2All water closets shall(a) be wall-mounted;(b) be made of vitreous china, stainless steel, or a material whose durability and imperviousness are

equivalent to vitreous china;(c) be designed to have a maximum flush volume of 6 L;(d) have an open front seat with integral check hinges and without a seat cover;(e) have a quiet action flush;(f) have a siphon-jet elongated bowl; and(g) have wall-mounted supports and grab bars.

8.2.3If the water closet is to be used for bedpan washing, it shall(a) conform to the requirements of Clause 8.2.2;(b) be equipped with bedpan lugs; and(c) have a pressure-reducing valve (PRV).Note: Consideration should be given to using technology that allows for disinfection of bedpans in soiled utility rooms.

8.2.4Wheelchair-accessible water closets shall meet the requirements of Clause 8.2.3 and CAN/CSA-B651.Note: Consideration should be given to the location of the water closet to allow for attendant assistance in patient ambulation.

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22 March 2009

8.2.5Water closets for bariatric patients shall be equipped with carriers or supports designed to support the extra weight of such patients.Note: Support or grab bars for bariatric patients require special installation.

8.2.6Urinals shall(a) be made of vitreous china, stainless steel, or a material whose durability and imperviousness is

equivalent to vitreous china; and(b) be designed to have a maximum flush volume of 1 L.Note: HCFs require water-saving measures that do not compromise hospital safety. New technology in urinals ensures proper operation and infection control at lower flow rates.

8.2.7Automatic flushing shall not be installed in patient care areas.

8.2.8If automatic flushing is provided in non-patient care areas (e.g., public areas), power shall be supplied by the essential electrical system where there is no manual override. Alternatively, self-recharging battery- powered devices may be used in non-patient care areas.Note: The proximity sensors on automatic toilets should be adjusted appropriately for operation.

8.3 Lavatories and sinks

8.3.1 Patient lavatories

8.3.1.1All lavatories shall(a) be made of vitreous china, stainless steel, or a material whose durability and imperviousness are

equivalent to vitreous china;(b) be self-rimming, counter mounted, or wall hung;(c) be equipped with a backsplash integral with the sink or countertop;(d) be equipped with concealed arm carriers (wall hung);(e) have hands-free or electronically controlled faucets;(f) be equipped with open grid strainers (stoppers and mechanical waste fittings shall not be used);(g) be equipped with cast brass P-traps with cleanouts, which are both chrome plated where exposed;(h) have supply fittings equipped with moderators designed to produce laminar flow to eliminate

aeration of water;(i) not be equipped with an overflow (see Clauses 8.1.9 and 8.1.10);(j) be equipped with gooseneck spouts; and(k) be sized and shaped to prevent splashing of the user.Note: Splashback from drains and traps can contaminate hands and the surfaces surrounding the sink area. Consideration should be given to water flow as well as sink and fixture shape, size, and design with regard to containing splatter and preventing environmental contamination.

8.3.1.2Each patient room in a Class A-1 or A-2 HCF shall have two lavatories, one for patient care and one for personnel hand hygiene. This requirement shall also apply to Class A services in a Class B facility (see Annex B). Consideration should be given to the design and location of the lavatory in the patient room, especially for multi-patient rooms. Notes: (1) The lavatory should be accessible and visible. (2) Infection control personnel should be consulted regarding sink location.

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March 2009 23

8.3.1.3Lavatories for personnel shall be located within the patient care area at the point of care. The lavatory shall meet the applicable requirements of Clause 8.3.1.1. The requirements of this Clause shall apply to(a) Class A-1 and A-2 HCFs; and(b) Class A services in a Class B facility.Notes: (1) The lavatory should be accessible and visible. (2) Infection control personnel should be consulted regarding sink location.(3) Consideration should be given to providing hand hygiene lavatories at the point of care for personnel in Class C

facilities as an infection prevention measure.

8.3.2 Other lavatory locationsLavatories for nursing stations, examination rooms, treatment rooms, and other similar locations shall be provided with(a) blade handles with a minimum length of 100 mm or with other appropriate means to permit

hands-free operation; and(b) open strainers.

8.3.3 Surgeon scrub-sinksSurgeon scrub-sinks shall(a) be made of vitreous china, stainless steel, or a material whose durability and imperviousness are

equivalent to vitreous china;(b) be of adequate size and design to permit the scrubbing of both hands and arms without having to

come in contact with any surface;(c) be sized and shaped to prevent splashing of the user;(d) have a non-swivel faucet that provides adequate flow for quick rinsing;(e) have hands-free operation (electric eye or knee/foot operation) and be designed to prevent

contamination of the hands when water is activated;(f) have a means of manual adjustment of water temperature;(g) be equipped with a seam-free backsplash integral with the sink that extends at least 60 cm (2 ft)

above sink level;(h) have backsplashes covering the areas under the paper towel dispenser and soap dispenser; and

Note: Because surgeon-scrub sinks are also used for hand hygiene at the end of a procedure, a paper towel dispenser should be installed. Paper towel dispensers should be installed so as to prevent splashing and contamination of the dispenser.

(i) be wall hung or free standing.

8.3.4 Flushing-rim-type sinks (hoppers)In areas where equipment such as bedpans are intended to be flushed or rinsed, sinks shall be(a) of the flushing-rim type;(b) equipped with a PRV; and(c) equipped with manually controlled supply fittings.Note: Where possible, consideration should be given to using a closed system for waste and body fluid disposal so that the disposal system is closed before flushing occurs.

8.3.5 Janitor or soiled utility sinksService sinks shall be equipped with manually controlled supply fittings with a wall brace.

8.4 Bathtubs and showers

8.4.1 Class C facilitiesClass C facilities need not comply with Clause 8.4 but shall comply with applicable local codes.

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24 March 2009

8.4.2 GeneralAll patient and staff bathing and shower facilities shall be(a) protected by a temperature- and/or pressure-compensating actuating valve; and(b) equipped with grab bars and supports.

8.4.3 Bathtubs

8.4.3.1 GeneralA standard bathtub shall meet the applicable requirements of the CAN/CSA-B45 Series and(a) have a wide rim on the open side of the tub;(b) have a slip-resistant floor; and(c) if required, be equipped with a hand-held shower head so located as to be convenient for use by a

patient seated in the bathtub.Notes: (1) Hand-held shower heads are a potential source of legionella and other water-borne bacteria. An appropriate

disinfection program should be established by the administrator as part of the maintenance program.(2) The requirements of this Clause are not intended to apply to therapeutic tubs.

8.4.3.2 Patients requiring assistanceA bathtub intended for use by patients who require assistance in bathing shall(a) meet the requirements of Clause 8.4.3.1;(b) meet the requirements of CAN/CSA-B651;(c) be installed such that the bathtub rim is at least 690 mm above the finished floor; and(d) have grab bars and supports.Note: The requirements of this Clause are not intended to apply to therapeutic tubs with mechanical devices, doors, or other devices to assist the user to enter the bathtub.

8.4.3.3 Special-purpose bathtubs

8.4.3.3.1 InstallationInstallation of special-purpose bathtubs such as whirlpool tubs shall be performed in accordance with the Canadian Electrical Code, Part I, and other applicable codes and regulations.Note: Special-purpose tubs should also meet the requirements of Clause 8.4.3.1.

8.4.3.3.2 Electrical safetySpecial-purpose tubs such as spas and hot tubs, as well as their associated equipment, shall meet the requirements of CAN/CSA-C22.2 No. 0 and CAN/CSA-C22.2 No. 218.1.Note: Hydromassage bathtub appliances are beyond the scope of this Standard. See CSA C22.2 No. 218.2.

8.4.3.3.3 Cleaning and disinfectionConsideration shall be given to the compatibility of the materials of the tub and its fittings with the requirements for cleaning and disinfection.Notes: (1) Nozzles, hand-held shower heads, and other water agitation mechanisms can pose cleaning and disinfection

challenges.(2) Some cleaning agents can react with tub materials.(3) Frequency and methods of use of chemical agents to disinfect equipment should be in accordance with established

infection control standards and the manufacturer’s recommendations.

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March 2009 25

8.4.4 ShowersA shower that is intended to be wheelchair-accessible shall(a) be curbless or have a curb that is designed to accommodate wheelchair traffic;(b) have a slip-resistant floor;(c) have a floor slope adequate to drain excess water from the floor; and(d) if required, be equipped with a hand-held shower head so located as to be convenient for use by a

patient in a wheelchair.Note: Hand-held shower heads are a potential source of legionella and other water-borne bacteria. An appropriate disinfection program should be established by the administrator as part of the maintenance program.

8.5 Floor drains

8.5.1Floor drains other than for showers shall be installed only in the following patient care areas:(a) hydrotherapy rooms; and(b) cystoscopy and urology facilities with a flushing-rim floor drain.Note: Floor drains should not be used in patient care areas because such drains provide a reservoir for the growth of bacteria. Where floor drains are present, there should be regular preventive maintenance, and cleaning protocols (as outlined in the established maintenance program) should be followed.

8.5.2Strainers shall be (a) nickel plated, bronze, stainless steel, or brass in finished areas; and (b) galvanized or lacquered cast iron in service areas.

8.5.3Combination funnel-type floor drains shall be provided for mechanical areas and for equipment drains.

8.5.4An interceptor such as a sediment bucket shall be provided in floor drains of areas where undesirable material can be discharged into the sanitary drainage system. These areas include(a) kitchens;(b) garbage rooms; and(c) incinerator rooms.

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26 March 2009

Table 1Hot water temperatures, °C

(See Clauses 6.3.4.1–6.3.4.5, 6.3.4.12, and 6.3.4.13.)

Site Normal operation Maximum

Hot water storage tanks 70 ± 10 80*

Piping distribution system 60 ± 5 65

Patient-/public-use outlets 43 48

General-use outlets,food preparation areas, and central supply rooms

43 60

Automatic washer(s) 77† (minimum) 82†

Laundry 77† (minimum) 82†

Other uses 43 65

*Each tank shall be capable of attaining a maximum hot water temperature of 80 °C where hot water sanitization is performed.†Additional point-of-use heating shall be available for these applications.Note: Cold water temperatures should be less than or equal to 20 °C.

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March 2009 27

Annex A (informative)Additional considerations for plumbing installations in health care facilities

Note: This Annex is not a mandatory part at this Standard.

A.1 DurabilityConsideration should be given to the durability of the materials used in the installation of plumbing systems. Some areas in HCFs are expected to operate continuously (8760 h/year); the durability of materials will affect the dependability of the overall system and the potential for downtime in critical areas.

A.2 Pipe locations

A.2.1 Consideration should be given to accessibility and serviceability (e.g., situating cleanouts in accessible but inconspicuous locations, away from traffic routes). Consideration should also be given to avoiding interference with other services (e.g., shutoffs above electrical services).

A.2.2 Pipes should not be located underneath areas in which the treatment or storage of acids takes place (e.g., water treatment areas, batteries).

A.2.3 Pipes should not be located in food preparation, dining, patient treatment, and electrical areas, where possible.

A.3 NoiseWhere possible, noise concerns regarding appliances and their related piping systems (e.g., from fixture flow, flush valves, bedpan washers, water hammers) should be taken into consideration during the initial design of the plumbing system. Potential areas of concern include patient rooms and the emergency ward.

A.4 EnergyConsideration should be given to reclaiming waste heat from potential sources.

A.5 Mixing valvesConsideration should be given to the type of mixing valves used to ensure suitable pressure, flow, and other operating conditions.

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28 March 2009

A.6 Foreign objectsWhere the flushing of foreign objects such as articles of clothing and sheets presents a problem, considerations should include(a) the use of filtering and/or trapping devices; (b) using 152 mm drains; (c) arranging drain runs with as few bends as possible; (d) using only 45° fittings; and (e) performing additional cleanouts.

Where pumps are used, chopper pumps or grinders may be beneficial.

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March 2009 29

Annex B (informative)Health care facility examples according to class

Note: This Annex is not a mandatory part of this Standard.

Table B.1Health care facility examples according to class

Health care facility Examples

Class A-1 Large acute care hospitals (more than 350 beds)

Trauma centres

Emergency care facilities

Some rural hospitals

Class A-2 Acute care hospitals (fewer than 350 beds)

Rural area access hospitals

Medical clinics with overnight stay or observation

Laser eye clinics

Outpatient surgical services

Cosmetic surgical offices

Dental surgical facilities

Other office surgical facilities

General physician offices (with treatment spaces)

Stand-alone laboratory facilities

Diagnostic imaging centres

Class B Nursing homes

Long-term care facilities

Assisted-living facilities

Mental health facilities

Forensic facilities

Rehabilitation facilities

Additional services facilities

Chronic care facilities

Class C Group homes

Hospice care facilities

Outpatient clinics

Primary care outpatient facilities

Stand-alone dialysis clinics

(Continued)

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30 March 2009

Table B.1 (Concluded)

Health care facility Examples

Class C (continued) General dental offices

General physician offices (without treatment spaces)

Laser eye clinics

Cosmetic surgical offices

Medical clinics with no overnight stay

Ambulatory clinics

Walk-in health clinics

Physiotherapy clinics

Pediatric clinics

Public health clinics

Adult daycare centres

Notes: (1) In some cases, a single building can house several of the functions listed in this Table. In such cases, the class of the

most stringent use shall be used in the design and operation of the facility.(2) The class of facility depends on the functions being provided in that facility. For example, a lab could be a small

blood/specimen collection area, which would be classified as a Class C facility, or it could be a “stat” and regional testing centre in an office building, which would be classified as Class A-2. A diagnostic imaging (DI) centre could be providing invasive DI treatments (angiography), which would be classified as Class A-2, or simply performing minor ultrasound procedures, which would be classified as a Class C facility.

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© Canadian Standards AssociationSpecial requirements for plumbing installations

in health care facilities

March 2009 31

Annex C (informative)Cleaning cooling towers and related equipment with sodium hypochlorite or calcium hypochlorite

Note: This Annex is not a mandatory part of this Standard.

Table C.1Cleaning duration and considerations

Note: The information in this Table is taken from the CDC/HICPAC documents, Guidelines for Environmental Infection Control in Health-Care Facilities and Guidelines for Preventing Health-Care–Associated Pneumonia, and the Public Health Agency of Canada document, Construction-related Nosocomial Infections in Patients in Health Care Facilities.

Initial free residual chlorine (FRC) Duration Considerations

Initial hyperchlorination

50 ppm and adjust pH to 7.5–8.0 Maintain FRC at >10 ppm for 24 h, monitoring at 2 h intervals

Consider hyperchlorinating or superheating stagnant potable water (especially if there is a concern about legionella in potable water supply)

A higher pH reduces biocide effect of chlorine

Might need additional FRC for significant biodeposits

Record temperature and time of installation of disinfectants

Mechanical cleaning

≥10 ppm Maintain FRC at ≥10 ppm for 1 h, then flush until free of turbidity

Adjust pH to 7.5–8.0

Ongoing maintenance/continuous chlorination

1–2 ppm at the tap Ongoing Requires flow-adjusted continuous chlorine injectors during operation

Can cause corrosion and leaks

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