Water and Sewage Losses

Water and sewage leakage in healthcare organizations can originate from many sources (e.g., domestic waterlines and systems; drains and drain lines, frozen pipes, sewage systems, leaky roofs and windows). During a water damage loss, organizations will not only have to repair building damage, but they may also incur substantial losses associated with the replacement costs of damaged furniture, fixtures, medical equipment, and valuable papers. Most importantly, a water damage loss can interrupt healthcare services and may force organizations to displace clients. Ambiguity in lease agreements has led to lack of clarity surrounding who has responsibility for water and sewage infrastructure repair and maintenance pre- and post-loss leading to increased exposure to the healthcare organization.

Expected Outcomes

Adopt standardized evidence-based liquid damage prevention strategies. 

Adopt an evidence-based water, sewage, and liquid leakage emergency response plan.

Adopt best practice for lease agreements (contracts).

Definitions and Acronyms

• Client – includes all persons who receive healthcare and related services including patients, residents and persons in-care
• Critical rooms – rooms or areas with containing vital systems and assets that provide essential services and are necessary for the provision of healthcare services(e.g., MRIs, data centres)
• Healthcare organization - organizations engaged in providing, financing, improving, supervising, evaluating, or other activity related to health care

Common Claims Themes and Contributing Factors

System / Organizational

• Failure of storm water sewer systems to accommodate the volume of rainwater in a short period of time leading to water infiltrating the building.
• Failure to provide protection to domestic and chilled waterlines located over high-value equipment (e.g., MRIs and CT scanners).
• Lack of staff, client, and visitor awareness regarding proper disposal of items that clog drains (e.g., sanitary products and wet wipes).
• Failure to comply with National Fire Protection Association codes (e.g., inappropriately installed sprinkler heads).
• Improper maintenance of heat in buildings during extreme cold weather causing burst pipes and water damage to the surrounding area and contents to medical equipment and room contents.
• Inability to relocate high-value equipment from below grade (e.g. MRIs, CT scanners, computer server rooms, laboratory equipment).
• Inadequate staff training regarding emergency response procedures and operations (e.g., inability to locate water shutoff valve, causing water to escape for over an hour and significant water damage).
• Inadequate and infrequent inspections and maintenance of pipes resulting in giving way to wear and tear.
• Failure to provide appropriate heating for chilled and domestic water systems, particularly in penthouses and diesel generator rooms, and / or failure to close doors and louvers.
• Insufficient number of and malfunctioning sump pumps contributing to significant damage to underground occupancies such as parking garages, elevators, and main electrical rooms.
• Failure to prevent corrosion between dissimilar metal materials in domestic water piping.
• Failure to properly close doors to rooms that contain high-value equipment (e.g., polarizers), especially in winter.
• Significant restoration costs for property losses in remote locations due to increased expenses for things such as transportation of supplies, and skilled labour and expertise.
• Lack of backflow prevention valves to prevent sewer backups into the facility when municipal sewer lines and storm water systems become overwhelmed by heavy rains and widespread spring flooding.
• Poorly drafted or inadequate contract language and / or lease agreement in place.

Mitigation Strategies

Critical Rooms

• Implement formal evidence based / best practice strategies to reduce water, sewage, and liquid damage in critical rooms (FM Global, 2022a). 

Additional Considerations

Example of strategies to reduce water, sewage, and liquid damage in critical rooms :

• Periodic checks of the room’s envelope for potential leak sources and entry points;
• Providing catch pans for supply and drain pipes located overhead;
• Ensuring below grade areas have sump pumps in good working condition, are connected to emergency power, and are equipped with monitored high-liquid-level alarms;
• Equipping below grade drains and sewer lines with check valves;
• Providing drainage or leak detection in rooms with liquid sources (FM Global, 2018) (FM Global, 2022b) (Insurance Bureau of Canada, 2016).

• Consider rerouting:
  • Steam lines (FM Global, 2018);
  • Liquid lines directly above high-value equipment (MRIs, CT scanners, etc.) (FM Global, 2022a).

Domestic and Chilled Water Lines    

• Implement formal strategies to increase the awareness and visibility of shutoff valves as well as domestic and chilled water lines for first responders (well-marked and visible shutoff valves, maintaining an up-to-date diagram or map of all water lines and shutoff valves including the direction of the water flow) (FM Global, 2021).

Below Grade Occupancies    

• Implement formal evidence-based / best practice strategies to reduce potential water runoff, flooding, and sewer backup losses in below grade occupancies (FM Global, 2021). 

Additional Considerations

Examples of strategies to reduce potential water runoff, flooding and sewer backup losses in below grade occupancies:

• Installing sump pumps at points of water ingress or collection (i.e., low points or around open floor drains near backflow prevention valve). These sump pumps should be at minimum of 50 gallons per minute and should be connected to emergency power. Ensure that the power supply is appropriately sized for the pump. Test the device on a quarterly basis and before major storm events;
• Ensuring door thresholds, door seals, and window seals are water impervious;
• Installing leak detection, which alarms to a constantly attended location, for high-value equipment areas and critical occupancies in basement or below-grade areas;
• Reviewing exterior grading to ensure there is an adequate slope away from buildings and openings;
• Reviewing downspouts to ensure they are extended away from buildings;
• Storing materials (e.g., paper records, documents and files) on shelves, racks, cabinets, or skidded off the floor (FM Global, 2022a) (FM Global, 2022b) (FM Global, 2021).

Sewer and Drainage Systems    

• Implement formal evidence-based / best practice strategies to ensure the optimal functioning of the site’s or facility’s drainage system(s) (FM Global, 2022a).

Additional Considerations

Examples of strategies to ensure the optimal function of drainage systems:

• Becoming familiar with the facility’s drainage system. Map the entire system to identify connections, water flows, system capacities and asset condition to quickly identify the source of drainage problems (e.g., blockages, seepage or ground contamination) (HIROC, 2021);
• Equipping sewer lines and drain systems with backflow preventions (e.g., backflow prevention valve, designed to prevent a backup of municipal sewer lines from entering the facility, such as flash flood) (Insurance Bureau of Canada, 2016) (FM Global, 2021);
• Ensuring all shutoff valves are well-marked and accessible (FM Global, 2022a) (FM Global, 2021);
• Conducting scheduled preventive inspections of all basement floor drains and external drainage systems (e.g., ensure they are free from obstructions) (HIROC, 2019).

Preventive Maintenance Programs    

• Adopt a standardized evidence-based / best practice water and sewage preventative maintenance program (FM Global, 2018) (FM Global, 2022a) (Zurich Services Corporation, 2011) (HIROC & FM Global, 2021). 

Additional Considerations

Examples of elements of a water and sewage preventative maintenance program:

• Exercising domestic water control valves annually;
• Checking and clearing HVAC condensate drains monthly;
• Checking and clearing roof drains quarterly;
• Testing sump pumps quarterly;
• Scheduling checks of water pumps for excessive vibration;
• Scheduling checks of water heaters for signs of corrosion (FM Global, 2018) (FM Global, 2022a).

• Implement a standardized evidence-based / best practice winterization program (FM Global, 2022a). 

Additional Considerations

Examples of elements of a winterization program:

• Ensure space heaters as well as space heaters as well as any heat-tracing systems are maintained and working (FM Global, 2021);
• Ensure adequate heat is provided for sprinkler, chilled, and domestic water systems, in particular for stairwells where exterior doors are present, diesel generator rooms, fire pump and sprinkler riser rooms, trailers and temporary housing, and office structures and penthouses (FM Global, 2022b).

Incident / Emergency Response    

• Implement a formal evidence-based / best practice water, sewage, and liquid leakage emergency response plan (FM Global, 2018) (HIROC, 2019) (Zurich Services Corporation, 2011) (FM Global, 2019).

Additional Considerations

Examples of elements of a water, sewage and liquid leakage emergency response plan (FM Global, 2018):

• Identifying the location of the main and critical valves;
• Labelling supply lines to indicate the direction of liquid flow;
• Identifying the location of mobile spill control cart supplies for first responders;
• Maintaining an up-to-date contractor list (HIROC, 2021) (FM Global, 2019).

• Implement strategies to ensure timely access to trained first responders for all shifts; ensure such staff have the training and authorization to:
  • Investigate sewer backups and determine the source and severity (Zurich Services Corporation, 2011) (FM Global, 2021);
  • Shut manual backflow valves (if available) to stop backflow (Insurance Bureau of Canada, 2016).

Team Training and Education

• Implement formal strategies to support and enhance first responders’ knowledge, skills (technical and non-technical), practical experience and compliance with the organization’s water, sewage, and liquid leakage emergency response plan including (but not limited to) scheduled skill drills and simulations (FM Global, 2018) (FM Global, 2022b) (FM Global, 2021).
• Ensure the first responder training and education strategies consider or involve: 
  • Identifying the location of sump pumps and backflow valves (if any) (FM Global, 2022a);
  • Identifying floor and building shutoffs for sprinkler systems (Insurance Bureau of Canada, 2016);
  • Locating domestic and chilled water systems (FM Global, 2021);
  • Utilizing a communication cascade to ensure management and remediation contractors are notified to assist with cleanup efforts (FM Global, 2018) (HIROC, 2019) (FM Global, 2021).

Procurement and Contract Management

• Implement formal process to ensure a valid lease agreement is in place whenever the organization leases or rents property (FM Global, 2021) (HIROC, 2018a).

Additional Considerations

Examples of elements to consider in lease agreements:

• Ensure clear language to describe the obligations of the landlord (lessor) and the tenant (lessee):
  • Use of property, what is allowed and not allowed;
  • Maintenance responsibilities of landlord and tenant;
  • Responsibilities for damages as a result of third party activities;
  • Landlord provisions for safety and security;
• Ensure insurance clauses specify (not an inclusive list):
  • Types of insurance coverage, limits of liability, and the deductibles;
  • Requirement of tenant to purchase property insurance (HIROC, 2018a) (HIROC, 2018b).

• Ensure lease agreements are reviewed by legal counsel before finalizing (where indicated) (HIROC, 2018a).

References

• FM Global. (2018). Liquid damage. FM Global.
• FM Global. (2019). Water leakage emergency response plan. FM Global.
• FM Global. (2021). Health care facilities: Liquid damage guidelines. Prepared for HIROC.
• FM Global. (2022a). Protection against liquid damage. FM Global.
• FM Global. (2022b). Prevention of Freeze-ups. FM Global.
• HIROC & FM Global. (2021). Property Loss Prevention Mannual. 
• HIROC. (2018a). Contracts - Commercial lease agreements. Risk Notes.
• HIROC. (2018b). Contracts - Insurance clauses. Risk Notes.
• HIROC. (2019). The property top three. The HIROC Connection.
• HIROC. (2021). Is your site protected against water damage? HIROC.
• Insurance Bureau of Canada. (2016). Water damage: Are you protected? Insurance Bureau of Canada.
• Zurich Services Corporation. (2011). Water damage prevention: Avoid costly water damage claims with a water damage mitigation program. Zurich Services Corporation.