Main Takeaways
- Hospital plumbing poses clinical risk because patients are immunocompromised and water is a direct route for infection.
- California facilities are subject to HCAI (formerly OSHPD) and the California Plumbing Code.
- The 2025 Title 24 code took effect January 1, 2026, adding Legionella controls for hot water systems.
- Since 2017, CMS certification has enforced federal water management requirements.
In most buildings, plumbing is infrastructure. In a hospital, plumbing functions as clinical equipment. The same water that runs a sterile processing department also reaches the bedside tap of a patient whose immune system can’t handle an organism a healthy adult would never notice.
Why Healthcare Plumbing Is Different From Standard Commercial Plumbing
Hospital plumbing differs from other commercial work because failures can harm patients. Unlike most commercial buildings, hospitals can’t close while work is underway, and for hospital buildings, HCAI review replaces the local plan check, so most healthcare plumbing work requires state approval before it can start. Site work outside those buildings may still go to the local jurisdiction.
What Plumbing Requirements Do Hospitals Need to Address?
Hospital plumbing systems have very detailed needs, all of which are regulated.
Potable water supply and distribution
Unlike most commercial buildings, plumbing for hospitals requires a second water supply path. They must also be able to shut off one section at a time to allow for repairs or replacements, and any new or altered pipe must be disinfected before it’s placed.
Hot water temperature and recirculation
In hospital water systems, hot water must be stored at a temperature high enough to kill Legionella but delivered at a temperature that doesn’t scald patients. It also needs to be kept moving to prevent organisms from multiplying.
Backflow and cross-connection protection
Multiple machines, equipment, and processes all connect to the water supply. If pressure drops, whatever’s in that equipment can be drawn into the water. Backflow preventers stop this from happening.
Drainage and sanitary waste systems
Standard sanitary drainage isn’t sufficient for healthcare plumbing systems. Lab waste is often acidic and must be neutralized, and pharmaceutical waste requires dedicated handling.
Handwashing and plumbing fixtures
Specialized clinical plumbing
A commercial building can run on water that’s simply safe to drink. In a hospital, dialysis, sterile processing, and laboratory equipment each need water treated to a standard beyond that.
Hospital Plumbing Requirements Checklist
Use this checklist as a starting point when reviewing your facility:
- Install sectionalizing valves so zones can be isolated without a full shutdown
- Document disinfection of all new and altered piping
- Monitor hot water temperatures and balance recirculation
- Test backflow assemblies annually and retain the records
- Maintain a current water management program, and a record of all plumbing maintenance activities
- Verify materials comply with HCAI restrictions
Need help working through this list? We offer healthcare facility plumbing maintenance on request.
How Do Hospitals Reduce Legionella and Waterborne Pathogen Risks?
Healthcare facility plumbing reduces Legionella and pathogen risks by managing the conditions they need to grow. That means keeping stored water hot enough to control growth, keeping it moving through the building, and maintaining disinfectant levels.
What Plumbing Codes Apply to California Healthcare Facilities?
Hospital plumbing codes apply in three layers: state code, agency amendments, and federal standards.
California Plumbing Code
The California Plumbing Code covers everything from pipe materials to fixture counts and applies statewide. Formally, it’s Part 5 of Title 24, the state building standards code. A new edition is published every three years.
HCAI and OSHPD requirements
Plans and inspections go to a state agency — The Department of Health Care Access and Information (HCAI) — known as OSHPD until 2021 and still called that in the code, which adds its own rules on top of the state code. Non-compliant work is caught during inspection and must be addressed.
Federal and industry water management standards
Federal and industry standards sit outside the building code. ASHRAE 188 sets out what a water management program must contain. It’s mandatory in hospitals because the Centers for Medicare & Medicaid Services (CMS) requires it as a condition of billing, and the Joint Commission reviews it during accreditation surveys.
What Changed Under California’s Current Plumbing Code?
The 2025 California Plumbing Code revised six areas:
- Handwashing fixture flow rates on clinical sinks.
- How many fixtures public waiting areas need.
- When a new pipe must be disinfected.
- Required temperatures for kitchen and food service.
- New requirements for Legionella control.
- Updated requirements for dialysis water systems.
How Should Plumbing Work Be Planned in an Operating Hospital?
Plumbing work in a hospital has to be planned around patients and should follow three steps:
- Step one: Agree on the protections. Infection control risk assessment, containment, and interim life safety measures.
- Step two: Survey before you schedule. Existing conditions in older buildings rarely match the drawings.
- Step three: Plan and share the shutdown. Which departments What Happens When a Hospital Loses Its Water Supply?
- lose water, for how long, when, and who approves it. Then tell everyone affected.
When a hospital loses its water supply, clinical services stop, and canceled surgical lists and diverted admissions all impact the hospital’s bottom line.
When Should a Healthcare Facility Bring in a Commercial Plumbing Contractor?
A healthcare facility should engage a commercial contractor as early as possible. On a new construction, that means before design decisions are made.
In an existing building, service and repair support should be brought in as soon as there are recurring hot water complaints, Legionella is found in a sample, a backflow test fails, or an expansion affects water demand.
Healthcare Plumbing in Southern California
Most hospital plumbing work in Southern California occurs inside buildings that treat patients. California’s 2030 seismic compliance deadline under SB 1953 has moved much of the region’s acute care stock into retrofitting, and while limited delays to 2033 or 2035 are available to facilities that qualified under AB 869, most buildings are working toward the original date.
Some of that mandate is plumbing scope. Meeting NPC-5 generally means 72 hours of on-site potable water and wastewater capacity, sized against a water rationing plan reviewed by HCAI and CDPH. With construction documents for that work already due, many facilities are building now rather than planning.
How Andersen Commercial Plumbing Supports Healthcare Facilities
Founded in 1994, Andersen Commercial Plumbing (ACP) is Southern California’s market-leading commercial plumbing provider, serving regulated industries and handling HCAI-reviewed projects, occupied-facility retrofits, and ongoing hospital plumbing maintenance.
Learn more about ACP or contact us to discuss your project today.
