In rural areas all over the United States, local access to healthcare can be the difference between a region that thrives, and one that shows signs of decline.
As reported by the National Rural Health Association, the hospital is typically among the top three employers in a rural community. When other employers are deciding where to locate or expand, they evaluate the availability of health care as part of evaluating quality of life. Long travel times to meet basic needs such as primary care and emergency treatment pose hardships for residents, especially for elderly patients with multiple medical problems.
In response to an alarming wave of rural hospital closures in the 1980s and 90s, the Centers for Medicare and Medicaid Services (CMS) created the Critical Access Hospital (CAH) program. Hospitals can receive this designation if they are located 35 miles from any other hospital (or 15 miles in rugged terrain) and have no more than 25 inpatient beds.
These small but important facilities are required to provide round-the-clock emergency services, with agreements and transportation in place to refer patients to larger institutions as needed. In return for their anchoring role, CAHs qualify for greater flexibility in staffing requirements and financial accommodations through Medicare.
One such local mainstay is the Community Hospital of Staunton, in southwest Illinois. Until recently, facility managers faced a common challenge in their efforts to serve the region. One essential aspect of keeping patients safe and comfortable is to maintain a safe and reliable water supply. At the same time, without technology to keep temperatures in balance, it can be difficult for large and complex networks to deliver hot water with the needed consistency. Users may experience long wait times, or the discomfort of a chilly wash.Faced with this kind of chronic frustration, Community Hospital consulted GF Piping Systems, a provider of automated solutions for fluid transport. GF evaluated Community Hospital’s blueprint and recommended installing the company’s Hycleen Automation System.
A system back in balance
The Hycleen Automation System allows plant operators to monitor and manage system conditions in real time through a centralized interface. Using a 10-inch touchscreen, managers can program desired parameters. Automated balancing valves and/or flushing valves are positioned throughout the network, with sensors that report data continuously. Plug-and-play components and a single cable for electricity and data help to simplify installation.
“Hycleen allows us the rebalance the entire system constantly,” said Dan Burns, director of plant operations at Community Hospital. “I think the single biggest value for us is the centralized control system. Being able to access the information from all the valves in that one place, to see what the system’s doing, to analyze where there may be an issue. I’m able to go there and know what the temperatures are in all of the loops, and then I’m able to control those, globally or individually.”
Hycleen can also be integrated into the existing building automation system or managed through cloud-based remote access, called Hycleen Connect.
At Community Hospital, the original goals of the project were to reduce hot water wait times and improve disinfectant residual levels. In addition to replacing the hospital’s existing mechanical balancing valves, GF recommended the inclusion of automated flushing valves as well.
Once the system was in place, the Community Hospital maintenance team discovered an unexpected benefit of flushing: they no longer experienced unsightly discoloration in the wake of manual flushing cycles.
“I compare it to building automation, where thermostats used to be the control for each room but now you have centralized systems where you can see the whole building,” said David Bohn, senior maintenance technician at Community Hospital. “This does that for hot water loop balancing. Since we’ve had the Hycleen system, I haven’t seen brown water and I haven’t had complaints that somebody’s had to take a cold shower.”
Protecting the vulnerable
But hospitals also have a higher regulatory burden to meet, in the interest of protecting vulnerable patients. In particular, many standards are aimed at control of waterborne pathogens such as legionella. The legionella family of bacteria can cause pneumonia in patients who breathe in aerosolized droplets of contaminated water (as when taking a shower). And the risk of harm is grave: hospital-acquired legionella pneumonia has a fatality rate of 28%.
As noted by the Centers for Disease Control (CDC), water management programs are a critical way for health facilities to combat such dangers. While U.S. tap water generally meets high standards, it is not sterile, meaning that water from public supplies does contain some level of bacteria and other microbes. To prevent the growth of legionella and other sources of infection, managers must use a combination of disinfection, temperature control, and stagnation prevention.
Legionella in particular grows best between 77 and 113 degrees Fahrenheit, so that keeping hot water hot and cold water cold becomes important. To comply at the same time with anti-scald regulations, it may be necessary to mix hot and cold water to usable temperature very near the point of use. To prevent stagnation, managers must maintain accurate flow diagrams and flush systems as needed to keep water moving. Otherwise, biofilms can accumulate in “dead end” areas, fostering microbial growth. Stagnation can also bring temperatures into the favorable range for legionella growth and/or reduce levels of disinfectant.
Legionella standards compliance
Authorities have set hygiene standards for health care facilities, including in the area of legionella control.
For example, CMS Memo S&C 17-30 requires facilities to “develop and adhere to policies and procedures that inhibit microbial growth in building water systems that reduce the risk of growth and spread of Legionella and other opportunistic pathogens in water”.
Professional associations set standards and guidelines as well, such as ANSI/ASHRAE Standard 188. Keeping up with changes in the regulations can require great diligence from health care facility professionals: in just the past few years, updates were made to at least three important sets of published guidelines (including ANSI/ASHRAE 188), and the Joint Commission on Accreditation of Healthcare Organizations issued new standards as well.
In this regard, automation of the water management process is even more important as an aid to safety than it is for comfort. Hycleen can maintain safe water temperatures with great consistency. Regular water exchange through automated flushing combats stagnation. Hycleen’s data logging capability simplifies the process of record keeping and regulatory compliance. Reflecting the importance of these benefits in a health care setting, medical centers and senior living facilities have been among the solution’s earliest adopters.
“Water quality is important in any facility, but particularly in the health care industry — there are more eyes looking, and stricter regulations,” said Burns. “As our water management criteria get stricter and we work through the process of meeting the standards, Hycleen allows us to do that.” For example, once Hycleen was installed, the maintenance team reported the hoped-for improvement in routine measurements of residual disinfectant.
Leveling the playing field
With a 2023 population of only 4,914, Staunton is the second largest city in Macoupin County. Established in 1951, Community Hospital provides this largely rural region of Illinois with 24-hour emergency care and an array of specialty services including cardiology, OB/GYN, urology, orthopedics, and pain management. In 2023, Community Hospital was honored by the Illinois Critical Access Hospital Network for its rank in the top 10% of CAHs on quality of care.
Over two-thirds of rural hospitals in the United States are in the critical access category. One important purpose for the program is to reduce geographic disparities in health care: simply by existing, a CAH improves the odds that community members will get the help they need when time is of the essence.
Where options are few, the quality of service is a matter of great local importance — and, in Staunton’s case, great local pride. With effective and efficient automation technologies such as Hycleen, sophisticated water management is no longer a luxury that only the largest and best-known hospitals can afford. Instead, best-in-class comfort and safety can be had wherever it is needed—whether big-city lights are nearby or far away.