Impact of Water Main Breaks on Hospitals and Care Facilities

A recent Utah State University survey has once again brought to light the failing water infrastructure in North America. Per the survey findings, water main break rates in North America increased by 27% between 2012 and 2018. As many as 14 breaks per 100 miles of water pipelines threaten the day-to-day functioning of public each year. Besides the grave loss of drinking water, this figure is especially alarming when one considers the deep impact of these breaks on public health. Cracks and fractures in water pipes create intrusion points for pathogenic bacteria to re-enter treated water. To cite an example, two major line breaks in Cabool, Missouri (winter of 1989-90) led to 243 cases of bloody diarrhea caused by an E. coli infection. This was one of the largest waterborne outbreak of E. coli recorded in the US.

Water pipelines in use currently vary considerably in age and material. As a result, no single reason can be attributed to pipe failure. Pipes get damaged due to a cumulative impact of several factors. Some of these are:

• Age of the pipes: Pipelines in the US have been laid out over the past 100 years. Surprisingly, a lot of the century old pipes are still being used. Pipes installed prior to 1960s are especially concerning since they were made from older cast iron with lead joints. These pipes are nearing the end of their service lives and need immediate replacement. The Utah State University survey found that the average age of a failing water main was 50 years.
• Temperature: It has been observed that water main break incidents increase during the winter. This is primarily due to the difference in thermal expansion of pipe material and water at freezing temperature.
• Pipe material and Corrosion: Both internal and external corrosion of the pipe material can cause leaks and breaks in the pipeline causing harmful chemicals and microorganisms to enter the water system. Cast Iron pipes have been found to have the highest failure rate due to corrosion.
• Soil conditions: Most utilities in the US rate their soil as having a moderate to high corrosive index. Besides corrosiveness, shifts in soil due to construction or due to the earth’s natural forces also cause pipe breaks.
• Other factors such as hydraulic transients (or water hammer), material fatigue, inadequate design, improper installation, manufacturing defects, external impact stress etc. also contribute to pipeline damage.

The USEPA has estimated that replacing or refurbishing the aging and deteriorating pipelines for drinking water will amount to USD 312.6 billion and will take about 20 years. One would imagine that there would be a sense of urgency around upgrading the drinking water infrastructure of the country given the financial and health impact. Sadly, the current scenario is entirely reactive with repairs being conducted only after the fact. The slow process of break discovery to service restoration leaves thousands of people stranded.

The impact of water main breaks is amplified exponentially when the affected region includes hospitals and care facilities. Boil Water Advisory (BWA) notices hold an altogether different meaning for such establishments. A National Infrastructure Advisory Council (NIAC) Report on Water Sector Resilience estimated that healthcare capabilities are almost entirely degraded within two hours of an interruption in water service. A brief look at the activities impacted by BWA notices can begin to paint a picture of how grim the situation of an impacted hospital is:

• Water consumption activities: Drinking faucets and fountains; Food preparation, etc.
• Essential care activities: Handwashing; Patient care, etc.
• Equipment requirements: Reprocessing of medical equipment; Fire suppression sprinkler systems; Water-cooled medical gas and suction compressors; Heating, ventilation, and air conditioning, etc.
• Sanitization requirements: Flushing toilets; Bathing patients; Laundry; Medical specialties that use water (e.g., dialysis); Decontamination/hazmat response, etc.

Hospitals and care facilities are forced to spend a lot of resources in dealing with such emergency water crises. Elective surgeries must be postponed, outpatients need to be redirected to other facilities, severely immune-compromised patients must be relocated to unaffected hospitals and ambulances need to be diverted from emergency rooms. Healthcare facilities must resort to using port-a-potties since hospital sinks cannot be used. Cafeterias must run on pre-packaged meals and bottled water for both patients and visitors.

It is impossible for hospitals to boil water following a water main break incident given the scale of their operation. At the same time, healthcare facilities need to go the extra mile to ensure that their water is contaminant and microbe free. Therefore, it is must for any healthcare facility to have efficient in-house water filtration and disinfection systems. Given the highly sensitive nature of operations and the immune susceptibility of patients, any care facility should invest in a robust in-house water treatment system instead of relying on water supplied by the local municipality. The superior efficacy of ultraviolet light in combating pathogenic waterborne micro-organisms makes it a unique disinfection system in that it does not need a secondary disinfection step. Combined with a top-of-the-line filtration system, a UV disinfection system is one of the most important investments any hospital and care facility should make.

by Saumya Garg

Further reading:

1. Deteriorating Buried Infrastructure Management Challenges and Strategies. USEPA, 2002.
2. Drinking Water Infrastructure Needs Survey and Assessment. USEPA’s 6th Report to Congress, 2015.
3. Water Main Break Rates in the USA and Canada: A Comprehensive Study. Utah State University, 2018.
4. Intrusion and leakage in drinking systems induced by pressure variation. Mora-Rodríguez J, Amparo López-Jiménez P, Ramos HM. Journal of Water Supply: Research and Technology – Aqua 2012;61(7):387.
5. Drinking Water Quality and Human Health: Impact of Harmful Algae and Water Pipe Breaks. Cynthia Jean Lin. University of North Carolina at Chapel Hill, 2018.
6. Drinking Water and Public Health in an Era of Aging Distribution Infrastructure. Martin Allen, Robert Clark, Joseph A. Cotruvo, Neil Grigg. Public Works Management & Policy, 2018.
7. Predicting Health Risks from Intrusion into Drinking Water Pipes over Time. John Gibson, Bryan Karney, and Yiping Guo. Journal of Water Resources Planning and Management, Volume 145 Issue 3 – March 2019
8. Emergency Water Supply Planning Guide for Hospitals and Healthcare Facilities. Centers for Disease Control and Prevention and American Water Works Association. Atlanta: U.S. Department of Health and Human Services; 2012. Updated 2019.