InstallerSHOW Content Agenda

Water distribution and associated sanitary pipework systems in healthcare facilities are essential for patient hygiene, wellbeing, and infection prevention and control, yet, they can also act as hidden reservoirs of infection. Poor design, complex layouts, poor controls, and stagnation create ideal conditions for microbial growth and biofilm development. Within these environments, waterborne pathogens such as Legionella species, Pseudomonas aeruginosa, and non-tuberculous mycobacteria (NTMs) can proliferate, posing a significant threat especially to the most vulnerable patients and contributing to outbreaks of healthcare-associated infection. Compounding these risks is the global threat of antimicrobial resistance (AMR), recognised by the World Health Organization as one of the greatest challenges to public health and modern medicine. Stagnant and low-flow conditions, together with inappropriate design and use of sanitary fittings, promote the persistence and exchange of AMR determinants within biofilms, allowing resistant organisms to spread through healthcare water and wastewater systems both within the facility and onwards to the community. This presentation explores how plumbing design, materials, procurement and installation and maintenance practices can influence microbial ecology and infection risk. It highlights practical, evidence-based strategies to prevent stagnation, maintain flow, and reduce microbial growth—recognising plumbing systems as a frontline defence in the global effort to protect patients and combat AMR. The practical case study from Frimley Health NHS Foundation Trust discusses their approach in-combating AMR threats through improved hospital design and innovation, particularly focusing on water and wastewater systems. This multidisciplinary approach underpins the BEIPI (Built Environment Infection Prevention Initiative), which was launched by the Healthcare Infection Society (HIS) in 2025.