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Local healthcare centres can vary widely in the range of services provided. A typical primary healthcare centre would include accommodation for patients, staff, consulting, examination and treatment spaces, as well as office provision and utility spaces – and so specifying the right sanitaryware is essential.
As with every aspect of hospital design, fundamental criteria include a requirement that facilities should be high quality and as easy as possible to manage and operate. This will influence component choice and have an impact on whole-life costs. But what is the right balance to strike between cost and durability? Here we consider the whole-life costs of WCs, basins, sinks, taps and showers for healthcare facilities and, in the table below, we break down the costs of a range of shower trays.

<B><font size="+2">Factors affecting durability</font></b>
<B>Maintenance</b>
Regular maintenance is mainly about keeping the equipment clean and checking for malfunction or damage. Where damage occurs, for example a fall that knocks a basin loose from its fixing, or deterioration is caused by a leaking tap, then the appropriate response should be made promptly.
The life-cycle costs for regular maintenance can be modelled with a higher degree of certainty than the costs and frequencies of responsive maintenance.
One solution to the latter is the examination of past maintenance records of a similar healthcare facility and modelling the costs based on historic information.

<B>Fixings</b>
The fixings for sanitaryware should anticipate the live loadings generated by users, such as leaning on sinks or sitting on WCs. Non-corrodible fixings such as stainless steel are preferred. The assembly should be able to withstand a load of 140 kg.

<B>Specifying for use</b>
The design of a healthcare facility should foster an atmosphere that puts patients at ease and minimises anxiety. A more relaxed environment may be achieved by making the premises less institutional or less like a hospital. This could be achieved by specifying sanitaryware that satisfies the same functions as standard healthcare sanitary assemblies but is more domestic in style.
However, in environments where misuse is a problem, installation of stainless steel WCs or basins is a realistic option to minimise whole-life costs. An alternative approach to vandalism is that of keeping sanitary provision clean and ensuring the patient sanitary facilities are in sight of a reception desk, or similar.
In all cases design and component choice should incorporate provision for people with disabilities.

<B><font size="+2">Components</font></b>
<B>WCs</b>
WC pans may be of vitreous china to BS 3402, the pan's dimensions to be BS EN 997 or BS 5504. This standard would have a service life in excess of 25 years. Pans may be floor-fixed, in which case non–corrodible fixings should be used, such as stainless steel. Wall-hung WC pans offer whole-life cost advantages related to cleaning and the durability of floor coverings. Cleaning is simplified so will be marginally quicker. There is no opportunity for a build-up of cleaning chemicals at the WC pan floor junction, which can retain dirt and accelerate the deterioration of the floor covering. Laying floor coverings is more straightforward as a cut does not have to be made around the base of the pan. Alternatively the pan does not have to be lifted to allow the floor to be laid.
In more demanding environments, consider using a stainless steel WC pan to BS EN 997. Made of austenitic stainless steel to BS EN 10088–1 grade 1.4301 (UK type 304), with a minimum thickness of 1.2 mm before forming.

<B>Basins</b>
Avoid inset basins, as these have increased whole-life costs as a result of dirt lodging at the basin's rim-surface junction. If a basin with a horizontal surface is required then an integral unit should be specified, these may be of cast resins, stainless steel or vitreous china.
Vitreous china basins should be to BS 3402.

<B>Sinks</b>
Sinks for cleaning or janitorial use should be from austenitic stainless steel to BS EN 10088-1 grade 1.4301 (UK type 304) with a minimum thickness of 1.2 mm for a service life in excess of 25 years.
Bowl sinks for domestic duty service may be of stainless steel as above, enamelled steel specified to BS 1244–2 or vitreous china to BS 3402 for similar service lives.

<B>Taps</b>

• Draw–off taps should have a metal body to BS 1010–2, BS 5412 or BS EN 200.
• Mixer taps should be specified to BS EN 1286, low-pressure mechanical mixing valve to BS EN 1287, low-pressure thermostatic mixing valve to BS EN 817, high-pressure mechanical mixing valve, BS EN 1111, high-pressure thermostatic mixing valve.
• Spray taps to BS 5388 with a metal body to BS 1010–2, BS 5412 or BS EN 200. Taps should comply with The Water Supply (Water Fittings) Regulations.
• Ceramic disc taps are virtually maintenance free. Where limescale is prevalent, cleaning or replacement will be a consideration.
• The thickness of chrome plating determines how long the finish will remain intact for a given level of use; 5 mm should be specified for longevity of finish.
• The service life of taps is in excess of 20 years.

<B>Modes of failure</b>
These modes of failure are described in relationship to shower trays. There will be some similarities to components of similar items such as basins and WCs.

<B>Surface deterioration</b>
This will affect plastic shower trays more markedly than ceramic or enamelled finishes. Surface deterioration is largely a function of use; the more the shower is used the quicker the surface will deteriorate. Inappropriate cleaning, with abrasive cleaning substances will hasten surface deterioration. Surface deterioration is the driver for replacement in the whole-life cost model.
In rare cases water softening chemicals may have a deleterious affect on the wearing gel coat surface of cast-resin stone shower trays.

<B>Accidental damage</b>
Cracks to the plastic, chipping of enamel or glaze or finished surface may occur where the tray is mistreated, such as when heavy or hard items are dropped on the tray surface.

<B><font size="+2">Durability tips</font></b>
<B>Water-saving devices</b>
Whole-life costs may be reduced by the incorporation of water-saving additions such as timed flow devices, which pass water for a set time then automatically stop. A 15-second timed-flow control can save up to 60% of water usage. Invariably the initial cost is higher than traditional alternatives, but it is a relatively simple matter to calculate the payback in terms of water saved. What is not so easy to quantify is the savings made by preventing taps being left running.
The incorporation of flow restrictors or spray taps offer further means of conserving water in the use of showers and taps.

<B>Electronic controls </b>
Taps and WCs can be operated electronically so avoiding lever-action taps, lever or pull flushing mechanism. The most common device is the infrared proximity control. Electronic controls are increasingly finding favour where provision is made for people with a disability. From a whole-life perspective, a relatively simple mechanical operating device is replaced with a number of sophisticated electronic devices including sensors, power supply and solenoid valves. Where an electronic control system does fail, the repair or replacement costs are likely to be higher than a traditional arrangement. Touch or tactile controls offer a more robust technology.

<B>Showerheads</b>
Showerheads with a self-cleaning mechanism to prevent scale formation should be selected to reduce maintenance demands.

<B>Local water heaters</b>
Energy savings may be realised where local water heaters are used rather than connecting basins or showers to a central hot water supply. Local water heaters may be powered by electricity or gas. They may be instantaneous or have some capacity for hot water storage. Energy savings are most likely where hot water demand is low and the outlet is at some distance from the central hot water producing plant.