Steps to Establish a Water Conservation Program

1. Audit current water use

1. Install water meters at strategic locations in the facility
2. Read/record water readings weekly and analyze the data. Look for high water use
areas, trends, and unusual occurrencesIdentify water conservation opportunities
2. Identify water conservation opportunities
0. Fix drips, leaks, and unnecessary flows
1. Implement changes to improve practices in cleaning, laundry and kitchens
2. List opportunities requiring engineering/equipment solutions (toilets, sterilizers,
boiler, chillers, etc.)Determine cost of opportunities and potential return on
investment
3. Determine cost of opportunities and potential return on investment
4. Prioritize water conservation opportunities
5. Develop a phased plan that fits your budget
6. Obtain funding (revise plan, if necessary)
7. Implement plan
8. Measure and document success
Where to look for Water Conservation Opportunities
Wherever water is used there is often an opportunity for conservation. Here are several
ideas for getting started on water conservation projects and programs.
Increase Awareness
Educate the staff, seek suggestions, assign responsibility and post signs to increase
employee awareness of water conservation
Increase patient and visitor awareness of water conservation (e.g., signs in patient
rooms and restrooms, publicize water conservation policy)
Pick the low hanging fruit
Locate and correct drips, leaks, and unnecessary flows in bathrooms, laundry,
kitchen, labs, etc.
Repair/adjust flush mechanisms on toilets so that they work as designed
Irrigate grounds and wash vehicles less often
Reduce domestic water use
Install toilet tank water displacement devices on older models or replace inefficient
toilets and urinals with low-flow models
Retrofit flushometer toilets with water-saving diaphragms
Before selecting new equipment (e.g., low flush, dual flush), check out third party
tests to determine actual effectiveness. Under third party maximum performance
(MaP) tests, toilets are tested to see how much waste they will flush away instead of
their ability to clear away a minimal amount of media.
Install flow reducers (<2.5 gpm) and aerators on sinks and showers
Install automatic shutoff valves or motion sensor-activated faucets
Processing Equipment
As appliances and equipment wear out, replace with air-cooled or water-saving
models
Develop a steam trap inspection plan and replace faulty steam traps with effective,
low-maintenance units
Install steam condensate temping systems on vacuum and gravity sterilizers (retrofit
kits are available)
Replace water-induced vacuum devices on sterilizers with electric pumps (retrofit kits
are available)
Replace or retrofit continuous flow-through systems on film processors with flow
control equipment
Recover condensate from refrigerators, freezers and icemakers for reuse
Water Reuse
 Water can be taken from the reject side of the radiation therapy linear accelerator
(creates high-energy radiation to treat cancers) heat exchangers and pumped to the
facilitys cooling towers and reused for evaporative cooling
Reject water produced in the reverse osmosis process can be reclaimed for non-
miscellaneous potable water use or in the cooling towers
Water Supply/Systems
Install pressure-reducing valves where system pressure is higher than 60 psi
Reduce excessive blow down of cooling towers; operate cooling towers near
manufacturer recommended level of total dissolved solids (TDS)
Consider using ozone as a cooling tower treatment to reduce water used for make-up
Return steam condensate to boilers for reuse
Minimize water use for irrigation (e.g., adjust or repair sprinklers, install wet weather
shutoff and/or soil moisture controllers)
Investigate sources of used water
Kitchen and Laundry
Wash only full loads in the dishwasher
Turn off the continuous flow used to clean the drain trays of the coffee/soda beverage
island (only clean the trays as needed)
Reprogram washing machines to eliminate additional rinse cycles, if possible and not
restricted by the health department
Wash full loads only or reduce water levels to minimize water required per load of
washing
Key Resources for Water Conservation
An abundance of water conservation methods and techniques applicable to healthcare
facilities are available. The following are sites Practice Greenhealth found to be
particularly useful resources. (Please note that links to commercial sites or commercial
product literature are offered as examples of available information and should not be
considered an endorsement. If you have information you would like see posted here,
contact Practice Greenhealth.)
WaterSense is a voluntary public-private partnership sponsored by the EPA to
promote water-efficient products and practices. WaterSense will provide businesses
with a simple way to make smart choices, with the confidence that the products will
perform at least 20 percent more efficiently than their wasteful counterparts.
WaterWiser The Water Efficiency Clearinghouse: This American Water Works
Association (AWWA) website provides water conservation, efficiency, and demand
management information.
Green Guide for Health Care Series Water Conservation Strategies: H2E
teleconference resources pertaining to water conservation, including a downloadable
presentation and case studies.
Promoting the Efficient and Sustainable Use of Water- This webpage, developed by
the Alliance for Water Efficiency, highlights mechanisms to reduce water in Medical
and Healthcare Systems. Focuses on steam sterilizers and x-ray film processing.
Water Efficiency Practices for Health Care Facilities NH Dept. of Environmental
Services provides water conservations tips for
Domestic/Sanitary Water Efficiency Practices
Sterilizing Equipment Water Efficiency Practices
X-Ray Equipment Water Efficiency Practices
Kitchen/Cafeteria Water Efficiency Practices
Outdoor Water Efficiency Practices.
Every drop counts From North Carolina, a 5 page water conservation checklist for
hospitals and medical facilities
 1. The best practice must have substantially contributed to the improvement of the living environment on a
sustainable basis, especially to the living conditions of the poorest and most disadvantaged groups of
society, and demonstrate a positive impact. Possible impacts to be considered include but are not limited
to:
i. Improvement of health conditions;
ii. Improvements in disaster prevention, preparedness and mitigation;
iii. More effective and efficient administrative, management and information systems;
iv. Social integration and reduction of exclusion;
v. Gender equality and equity in decision-making, resource-allocation and programme design and
implementation;
vi. Community participation in decision making and resource allocation.
2. The best practice must have made an outstanding contribution to the sustainable management of water.
Contributions to be considered include but are not limited to:
i. IWRM;
ii. Adaptation to climate change;
iii. Improvement in water quality, decrease in water pollution;
iv. Increase in water efficiency;
v. Improvement in water governance; and
vi. Protection and conservation of natural resources and of the environment, e.g. establishment and
management of protected areas of special importance for the water cycle.
3. The best practice results in lasting changes in at least one of the following areas:
i. Legislation, regulatory frameworks, by-laws or standards formally recognising the issues and problems that
have been addressed;
ii. Institutional frameworks and decision-making processes that assign clear roles and responsibilities to
various levels and groups of actors, such as central and local governmental organisations and community-
based organisations; and
iii. Efficient, transparent and accountable management systems that make more effective use of human,
technical, financial and natural resources.
4. The best practice should be based on a partnership between at least two of the following actors:
i. Government organisation or agency, including bilateral aid agencies;
ii. City, local authority;
iii. Non-governmental organisation (NGOs);
iv. Community-based organisation (CBOs);
v. Private Sector (e.g. water operators);
vi. Research and academic institution;
vii. Media;
viii. Public or private foundation;
ix. Educational institution.
5. The best practice includes social policies and/or sectoral strategies that have the ability to be up scaled.
6. Additional criteria:
i. Empowerment of the community to maintain water services and infrastructures;
ii. How others have learnt or benefited from the initiative;
iii. Means used for sharing or transferring knowledge, expertise and lessons learnt.

Category 2: Best participatory, communication, awareness-raising and education

practices
The following specific selection criteria will be applied to Category 2 candidatures:

1. The ability, as demonstrated in the proposal narrative, to improve participatory practices and
communicate clearly and effectively.
2. Leadership in inspiring action and change;
3. The best practice must have made an outstanding and tangible contribution to improving participation
and developing awareness on water and sanitation issues. Possible impacts to be considered include but
are not limited to:
1. Increased stakeholder engagement in specific actions.
2. Increase of community awareness on proper use of water and sanitation in daily life;
3. Increase of community understanding of the water existing situation, causes for the situation, its linkages to
food security and related challenges;
4. Increased awareness of environmental sanitation.
4. The best practice has been successful in developing awareness on water and sanitation issues
among most disadvantaged groups of society, particularly:
1. The impoverished people;
2. People with low levels of literacy;
3. People with disabilities;
4. Women; and
5. Indigenous people.
5. The best practice has contributed to education through child/adult literacy and post literacy programs.
6. The best practice has been successful in proposing the most appropriate formats for the target audience.
This could include:
1. Community group meetings;
2. Street drama/cultural programmes;
3. Talk/interaction programmes;
4. Group discussions;
5. Radio, TV programmes, video documentaries;
6. Seminars/workshops;
7. Publication of wall newspapers; and
8. Distribution of posters, leaflets, etc.
7. Community perceptions have been considered and integrated within the communication, education or
awareness-raising initiative.
8. The best practice has contributed to change people's attitudes and/or behaviours.
9. The best practice is associated with a water supply and/or sanitation project.
10. The best practice has helped people to exchange experiences, learn from each other and/or encouraged
dialogue and debate.
11. The best practice has resulted in effective changes in water management practices