Understanding vacuum system compliance in healthcare
The design of healthcare facilities in the UK is evolving. Water safety is no longer only about water supply (HTM 04-01), but increasingly about the risks present within drainage systems.
For four decades, our people have developed trusted and eco-efficient sanitation solutions used around the world. We believe technology can make a positive difference – and that dedication and competence are key to making it happen.
– Infection control is a science of precision. We control surfaces, airflow and clinical pathways in detail, but drainage is often overlooked, even though it can directly impact occupied areas, says Kris Wojcik.
The inclusion of vacuum drainage in NHS guidance signals a clear shift: from passive management to active risk reduction – starting at the design stage.
What is NETB 2024/3 – and why does it matter?
NHS Estates Technical Bulletin NETB 2024/3 is a guidance document focused on designing safe environments for patients at high risk of infection from waterborne pathogens. It highlights a key point: infection risk is not only linked to water supply, but also to drainage systems – including aerosols generated from toilets.
When assessing toilet solutions, the document notes that vacuum toilets may offer a safer option for certain patient groups:
Vacuum toilets may provide a safer option as the vacuum draws air into the toilet when flushed, minimising the risk of aerosol transmission. At the same time, it emphasises the need for thorough, project-specific assessment of solutions in healthcare environments.
From “gravity by default” to risk-based design
Traditionally, drainage systems in healthcare buildings have been designed based on established solutions – often without question. Design teams are expected to carry out site-specific risk assessments, with a clearer duty to investigate what actually works in each project.
The focus is moving from repeating what has always been done to identifying what actively reduces risk – both clinically and operationally.
– There’s a shift from justification based on precedent to justification based on risk. That changes how drainage is evaluated in healthcare projects, says Kris Wojcik.
Why vacuum
Conventional drainage systems can contribute to the spread of aerosols in clinical environments. Vacuum systems take a different approach. As outlined in NETB 2024/3, vacuum toilets can significantly reduce the risk of aerosol transmission, while also supporting more robust system performance.
– When you flush a conventional toilet, you risk creating a plume. With vacuum, air is drawn inwards – not pushed out. That’s a fundamental difference, explains Wojcik.
Two key effects:
- Aerosol mitigation
By removing surrounding air during flushing, the “plume” effect – which can spread pathogens – is reduced or eliminated - Operational resilience and flexibility
Lower blockage rates and the ability to transport wastewater independent of gravity provide greater flexibility in practice – particularly in refurbishment projects and complex builds, such as those under the New Hospital Programme (NHP)
– Vacuum systems don’t just reduce risk – they also give designers more freedom. That becomes critical in modern healthcare builds, he adds.
Water safety group – from document to practice
A Water Safety Group (WSG) should be established early in the project (RIBA Stage 1) to ensure water safety is managed throughout the entire lifecycle of the building – not only during design.
This includes:
- Ensuring due diligence in the assessment of alternative technologies, such as vacuum drainage – even where long-term UK performance data is still developing
- Addressing both waterborne infection risks and the colonisation of drainage systems by multi-drug resistant organisms
- Bridging the gap between construction and clinical operation, ensuring that opportunities to reduce infection risk for both high-risk and immunosuppressed patients are fully explored
– It’s about connecting design decisions with real clinical outcomes. Drainage plays a bigger role than many expect, says Kris Wojcik.
Where clinical and financial benefits align
Vacuum drainage is not only a clinical consideration – it is also a financial strategy. Reducing healthcare-associated infections (HAIs) can significantly lower bed-day costs while also reducing long-term estate maintenance burdens.
– When you reduce infection risk, you’re not just improving patient outcomes – you’re also reducing cost and complexity across the building lifecycle, says Kris Wojcik.
This creates a clear link between clinical outcomes and financial performance, aligning with broader NHS priorities such as Net Zero and sustainable procurement.
At the same time, vacuum systems support more efficient construction processes – including shorter build programmes, compatibility with Modern Methods of Construction (MMC), and simplified prefabrication. In many cases, this can be achieved from a cost-neutral starting point, while delivering additional long-term benefits.
A shift in how we think about drainage
– Vacuum drainage changes the premise. Instead of managing risk within the system, it removes many of the risks altogether, says Wojcik.
Vacuum drainage is therefore not just a technical alternative – but a clinical and operational one.
And perhaps most importantly, it shifts drainage from being a hidden risk to becoming an active part of infection control – and ultimately, patient safety.