Can Hospitals Safely Reuse Water?

Subscribe to our YouTube Channel to see each video podcast we release.

Episode Description

On this episode, we'll be speaking with Bob Salvatelli, director of Water Organization for NextEra Distributed Water, and Patricia Sinicropi, executive director of the WateReuse Association, about how hospital water reuse systems work, costs that hospitals need to consider up front for installation and ongoing maintenance, and what policymakers should consider for codes and standards governing hospital reuse.

Listen to Audio Version


This episode is sponsored by Epic Cleantec. Epic Cleantec is closing the loop on water, helping buildings recycle up to 95% of their wastewater right onsite. Named a TIME Magazine Best Invention of the Year, the Epic OneWater system has set a new standard for water reuse in the built environment. Learn more at

Christoph Lohr: The high volume of wastewater generated by hospitals historically is a challenge for engineers that want to promote safety and sustainability. Not only that, but due to waterborne pathogen concerns, hospitals are set to flush even more water to drain in an effort to control water age.

On today’s podcast, I’ll be speaking with Bob Salvatelli, director of Water Organization for NextEra Distributed Water, and Patricia Sinecropi, executive director of the WateReuse Association, about how hospital water reuse systems work, costs that hospitals need to consider up front for installation and ongoing maintenance, and what policymakers should consider for codes and standards governing hospital reuse.

Let's get to our discussion.

Pat, welcome to the show.

Patricia Sinicropi: Thank you. Pleased to be here.

Christoph Lohr: And we also have joining us Bob Salvatelli. Bob, thanks for joining us.

Bob Salvatelli: Thanks for having me. Happy to be here.

Christoph Lohr: I’m really excited to have both you guys on here to talk about the subject because I think it’s one that’s probably maybe an emerging concept that a lot of us are starting a conversation about, but in some ways it’s already been established too.

Let’s start with the question, especially in health care, hospitals historically use a lot of water. What steps can hospitals take to reduce their wastewater discharge to the building sewer system? And Pat, do you have any thoughts on that?

Patricia Sinicropi: Sure, yes, and as you noted in your introductory remark, that hospitals are not only high users of water, but the discharge of their wastewater stream obviously contains a lot of biohazard material that otherwise we wouldn’t want in our surface waters and demand a higher level of treatment.

Water recycling systems is a very good alternative for hospitals to take a look at and consider installing so that they’re not only reducing their overall water consumption from the general grid, if you will, but they’re also providing that additional treatment to their waste streams that produces a higher quality effluent and minimizes the risks, the public health risks associated with otherwise their conventional wastewater stream. I think it’s a great alternative for hospitals to look at.

Christoph Lohr: I think that’s a really nice broad-based view of this and diving into the details a little bit, there’s obviously the implication of hospitals using a lot of water and this opportunity here. But then the next question I think that comes up is can hospitals safely reuse their wastewater?

Bob, are there uses for treated hospital wastewater?

Bob Salvatelli: Yeah, absolutely, Christoph. We have an example in the photograph behind me of a hospital we commissioned a few months ago in Atlanta that’s treating up to 250,000 gallons a day of combined wastewater and safely using it in cooling tower applications, boiler makeup applications, maybe eventually some land application for irrigation as the hospital settles out its construction.

The answer is yes, it’s being done today. Pat was correct that the streams are very different than domestic waste, traditional domestic waste, with dialysis and all the pharma that goes on within a hospital setting. You have to use a little bit more sophisticated equipment up close and personal when you do on-site reuse to really effectively do what you want to do to meet the reclaim standard. But absolutely, it can be done and is being done as we speak.

Christoph Lohr: Excellent, excellent. Well, there’s an opportunity there, it can be done safely. But the one question that seems to come up a lot now with hospitals is waterborne pathogens, right?

Things like Legionella pneumophila. Pat, maybe let me direct this question toward you. More hospitals are flushing water at showers and lavatories daily. I’ve been having a lot of conversations on my end with a lot of different facilities that are really trying to be mindful of this concern of waterborne pathogens, such as Legionella pneumophila.

Is there a possibility of collecting this gray water and using it to flush toilets in certain areas?

Patricia Sinicropi: Oh yeah, absolutely. And that’s really what the design purpose is for these on-site systems, is capturing the gray water, treating it to very high standards and using it for non-potable application purposes in the building, such as flushing and other cooling needs and other purposes as Bob just outlined.

And the benefit of taking a water recycling approach is that you’re using the most sophisticated treatment technology that exists. You’re putting in redundant treatment systems. You’re really pulling out absolutely every potential harmful constituent in that water, including pathogens and viruses.

Technology is becoming increasingly affordable that really does purify water to a standard that is beyond drinkable. And hospital effluent is a perfect use application, if you will, for using those technologies that can really treat to quite high standards and allow the hospital to reuse that water stream.

Christoph Lohr: Pat, that’s a really wonderful way of explaining that. I hadn’t thought of that before. When I’ve worked in health care, as a plumbing design professional, so many of the systems, like a medgas or whatnot, always had redundancy to them to have some sort of additional fail safe, and what you bring up is this wonderful point of redundancy in water quality. And that’s what I’m definitely going to hold on to from our conversation here. We have this opportunity for additional redundancy, maybe let me bounce this back to Bob here.

We have this opportunity for additional redundancy, enhanced water safety. What does that look like? What does a water reuse system look like in a health care facility? How do they work? What monitoring and testing protocols ensure the quality of the reuse water? Are there any costs that hospitals and health care facilities should be aware of for installation and ongoing maintenance?

Bob Salvatelli: That’s a loaded question there. Selfishly, the plug for this project is that we did this under a water processing agreement by which the hospital doesn’t pay anything, so it’s just like a solar transaction. There is no additional cost to the client. We bear the expense, both the design-permitted commissioning and execution of the project and then the ongoing maintenance.

In this scenario it’s really a win for the hospital and their payback is essentially Day One. In a normal environment, as Pat mentioned, you’re talking about some very sophisticated equipment with MBR technology and things of that sort with 0.01 micron effectiveness of removal of pathogens in addition to dual disinfection, and also we do not decouple from the water treatment supplier on site.

There’s still a chemical biological process that happens or dosing that happens biosize that happened to correct cooling tower Legionella, potential Legionella issues. When you add all that in and the redundancy of controls to allow for the inline monitoring of all this, Pat said it better than I could – it’s basically drinking water. It’s not sold as drinking water, but it’s drinking water quality because these technologies, these are light years ahead of conventional systems. When you bring it up close, you can use it very quickly. You can turn it around in eight to 12 hours, and then you could add storage as part of the resiliency for the system, so clean water storage to allow for something on the other side so the city water turns off for a few hours, those cooling towers and boilers can keep going, surgeries can keep happening. The resiliency play, in addition to not costing anything, really was the driver for that project.

Christoph Lohr: That’s another insightful piece here is the resiliency, the water gets shut off from the city for some kind of natural disaster of some kind.

Again, there seems to be a lot of really amazing benefits here. As we talk about benefits, we always have to be mindful of things to be kind of considering during that process of utilizing new technologies or maybe not even new technologies, but technologies new to a certain owner or facility.

I imagine there’s probably some skill sets that hospitals should consider when they’re hiring a water reuse system designer, installer, and maintainer, and maybe Pat, you can touch on that a little bit, what you’ve seen and what guidance maybe you would give in that regard.

Patricia Sinicropi: Sure. Certainly as more communities and businesses are adopting water recycling approaches and systems, the need for capacity, a workforce to be able to operate and maintain those systems, is obviously heightened and needed. Thankfully, there’s now quite a few consulting engineering firms, Bob’s company, for example, other businesses that have the talent that you would need to come in and operate and maintain those systems.

Facility managers of buildings that adopt on-site water recycling systems will obviously need to receive certifications and acquire the talent needed to operate an on-site system locally. It does require additional expertise, but thankfully, we’re seeing more and more engineers with the skill set needed to maintain and operate the systems efficiently.

Christoph Lohr: That’s really good to hear, and I think that obviously, as systems and what we do in industry becomes more complex, there’s definitely this need for additional people and then additional standards. And I think when it comes to codes and standards, one more question for you here, Pat, is how should municipalities think about codes and regulations that govern hospital water reuse?

On our end IAPMO, we have the Water Efficiency and Sanitation Standard, which has a lot of water reuse provisions in there. There's new IAPMO/ANSI Standard Z1324, if I remember the number correctly, that talks about the specific things. And I know as an engineer, when I was doing design, if I could easily refer to a standard or to a code section, it definitely streamlined my process.

What's been your experience, Pat, in terms of guiding municipalities in terms of codes and regulations when it comes to water reuse to try to help streamline this process maybe a little bit more?

Patricia Sinicropi: Well, one of the things we’re doing at the WateReuse Association is supporting the efforts that are underway to develop a standard set of local regulations and ordinances that can oversee the operation of on-site systems. We support the National Blue Ribbon Commission for nonpotable on-site water recycling systems. The work that they’re doing is precisely this work, identifying those standards and regulations that need to be in place locally to ensure the safe oversight of on-site systems.

Luckily, we’re now further down the road than we were 10 years ago, and there are many examples of communities that have adopted regulations, ordinances, that other communities can look to and adopt pretty easily on their own. That’s the work that I think is in front of us, trying to encourage as many communities and municipalities as possible to adopt local plumbing standards that facilitate greater adoption of on-site systems. It’s important work and it’s being done.

Christoph Lohr: That’s really exciting to hear. Well, as we wrap up, let me ask each of you one last question. Pat, you’ve already been on here. This is your second time on the podcast. We’d absolutely love to have you on a third and fourth and so on many times. And Bob, this is your first time on. I would imagine we’d have you come back on to talk more about water reuse in general because it does seem to be a very hot topic now. The next time you guys come on, the next year or two, what do you think we’re going to be talking about when it comes to water reuse?

I’ll start with you, Bob, and then Pat, if you want to wrap us up.

Bob Salvatelli: Yeah, the first projects we did out of the gate were on the smaller side, half a million gallons a day, sub-1 million. By the time we talk again, you’ll see some examples of 2- and 3- and 4-million-gallon-a-day systems using all methodologies that you can imagine from treatment of like MBR all the way to desal; we have a very robust pipeline and a lot of adoption coming forward because of projects like this.

Because of the things the WateReuse Association has done with regard to changing policies in specific states like 1289 in Texas recently that will allow folks like us to do what we do. I think the adoption is, we’re in the early stages of it, and I think in the next couple years you’ll see some massive things all on the way to direct portable reuse, but I think there’s an interim step, which is on site, for the next couple decades before we get very serious in that space.

Christoph Lohr: Excellent. And Pat, bring us home. What do you think we’re going to be talking about the next time we have you on the podcast in regard to water reuse?

Patricia Sinicropi: How much its adoption has accelerated. We’re seeing places we never thought we would be talking to, talking to them about water recycling. Regions of the country that don’t have necessarily water scarcity issues actually do have water scarcity issues. And so I think in two or three years, we’re all going to be surprised by just how accelerated the interest in adoption is in water reuse.

Christoph Lohr: Well, on behalf of the Authority Podcast: Plumbing Mechanical and IAPMO, I just want to say thank you, Pat, thank you, Bob, for joining, for sharing your expertise and your insights, and I look forward to having you back on the show sometime soon.

Patricia Sinicropi: Sure thing. Thank you, Christoph.

Bob Salvatelli: Thank you, Christoph.

Patricia Sinicropi: Thanks, Bob.