Water management in hospitals: the 5 points that use the most water and how to cut

Water management in hospitals means measuring, area by area and bed by bed, where the water of a building that runs 24 hours a day goes, and cutting what is loss without touching what is patient care. In a public hospital in Brasília studied by the University of Brasília (UnB) and the Federal Institute of Goiás (IFG), toilets, general-purpose sinks, washing machines and kitchen sinks took 74% of the water, and leaks another 10%. At Rede D’Or, the water efficiency project with T&D cut consumption by 16.5% across 40 hospitals.

In short:

• The hospital studied in Brasília used 855 litres per bed per day, 113 litres per person and 11 litres per square metre of floor area.
• The 5 points that weighed the most: toilets (23%), general-purpose sinks (18%), washing machines (18%), kitchen sinks (15%) and leaks (10%).
• At São Paulo’s Heart Institute, fixing leaks alone lowered consumption from 1,618 to 1,158 litres per bed per day.
• In the University of São Paulo’s water conservation programme, the University Hospital’s consumption fell 48% between 1998 and 2003.
• At Rede D’Or, the 16.5% reduction added up to 260,000 m³ of water saved in 2025 and was published in the network’s sustainability report, under the GRI standard.

How much water does a hospital use per bed?

Hundreds of litres a day, and sometimes more than a thousand. Consumption per bed is the most common indicator for comparing hospitals, and the Brazilian and international studies gathered by the UnB research show the range:

Hospital	Consumption per bed per day	Note
Hospital de Apoio de Brasília (59 beds)	855 litres	Measured in 2018, with end uses fixture by fixture
Heart Institute, São Paulo	1,618 litres	Before fixing leaks (1996 and 1997)
Heart Institute, São Paulo	1,158 litres	After fixing leaks
University Hospital of Western Paraná	1,243 litres	2012 study
Multi-specialty hospital in India	1,093 litres	2016 study

The number changes with the profile: an on-site laundry, a kitchen that also serves companions, operating theatres, dialysis, laboratories and central air conditioning push consumption up. That is why the comparison that counts is the hospital against itself, month by month.

What are the 5 points that use the most water in a hospital?

Rarely the ones management imagines. The study by Livia Santana (IFG) and Daniel Sant’Ana (UnB), published in 2023, used flow sensors and counters to measure the taps, showers and toilets of representative washrooms at the Hospital de Apoio de Brasília, as well as the laundry and the kitchen, and arrived at this picture:

Point	Share of consumption	What reduces it
Toilets	23%	6-litre toilets instead of the 9-litre ones the hospital used, adjusted flush valves
General-purpose sinks (sterile supply, nursing stations, laboratories)	18%	Aerators or flow restrictors where infection control allows, revised routines
Washing machines	18%	Full loads, weighing each batch, efficient washers
Kitchen sinks	15%	Aerators, lever taps, scraping leftovers before washing
Leaks	10%	Leak detection and repair at the right spot

The remaining 16% was split among showers, washbasins, the physiotherapy pool, water filters, floor washing and equipment. By area, the largest consumers were maintenance, washing and cleaning (23%) and staff washrooms (22%), ahead of the kitchen (17%) and medical care (14%).

Leaks deserve separate attention. There were 13 points with water running all day, in washbasins, kitchen sinks, nursing-station and dressing-room sinks, a utility sink, a pool shower and a shower, adding up to 4,320 litres a day. A single shower accounted for more than half. The authors link the losses and the high flow rates to an old, worn plumbing system.

How do you cut water use in a hospital without affecting patient care?

By starting with what does not touch the patient. Most of the savings lie in the infrastructure:

1. Meter by area. Meters in the laundry, kitchen, sterile supply, cooling system and pool show where consumption drifts. Without them, the hospital only sees the monthly bill.
2. Hunt for leaks. It is the measure with the fastest return: at the Heart Institute, fixing them cut consumption per bed by 28%.
3. Replace toilets and adjust valves. 6-litre toilets instead of old ones and adjusted flush valves tackle the hospital’s largest end use.
4. Adjust tap flow outside care areas. In care areas, any change goes through the hospital’s infection control committee first.
5. Organise the laundry. Weigh each batch, wash only full loads and assess more efficient washers. University hospitals in Paraná and São Carlos have studied reusing laundry water and harvesting rainwater for non-drinking uses.
6. Review equipment. Distillers, autoclaves and purification systems can discard a lot of water. In the University of São Paulo programme, distillers lost about 50 litres of water for every litre distilled.
7. Look after cooling. In US hospitals, the EPA lists cooling equipment among the largest water uses, alongside sanitary fixtures, landscaping and medical equipment. A cooling tower without control of its discharge wastes water.
8. Monitor tanks 24 hours a day. In a building that never closes, night-time consumption is the best clue to a leak, and the alert must reach someone who can act.

The details of the leak test, from the signs to detection equipment, are in invisible leaks: find them before the bill does.

How much can a hospital save?

Results published in Brazil range from 15% to almost half of consumption, depending on the starting point and what was done:

Case	What was done	Result
Heart Institute, São Paulo	Leak repairs	From 1,618 to 1,158 litres per bed per day (28% less)
Heart Institute, second stage	Replacement with water-saving fixtures	From 1,382 to 1,171 litres per bed per day (15% less)
University of São Paulo University Hospital	Leaks, water-saving fixtures and ongoing management	35% less by 2001 and 48% by 2003
Rede D’Or, 40 hospitals	Water efficiency project with T&D	16.5% less and 260,000 m³ saved in 2025

The authors attribute part of the University Hospital’s variation to fixing a problem in its storage tanks. It is one more sign that, in hospitals, hidden losses tend to be the first slice of the savings.

How did Rede D’Or cut water consumption by 16.5%?

With continuous monitoring and active correction. In Rede D’Or’s sustainability report, T&D’s TDRR platform is credited with three fronts: remote monitoring of the reservoirs, identification of deviations that signal the start of a leak, and alerts by app, text message and email to the people in charge. The result, published under the GRI standard, was a 16.5% reduction in consumption across the 40 hospitals served, with 260,000 m³ of water saved in 2025.

Márcio Botelho, maintenance supervisor at Rede D’Or in Rio de Janeiro, put it this way in his testimonial to T&D: “I am satisfied with the monitoring system and SEA, which brought cost reductions and operational gains to the hospital, alerting us to possible leaks and controlling water consumption.” The full case is in the Rede D’Or case: 16.5% less water in 40 hospitals.

For other hospitals, the path is the same: TDRR monitors reservoirs, cisterns, pumps and hourly consumption, and SEA 360º handles implementation, with no construction work, with a baseline under IPMVP, electronic leak detection, repairs and maintenance training, followed by ongoing management with monthly efficiency and ESG reports.

Which indicators should hospital water management track?

One overall indicator and a few by area. The Brasília study shows how each is calculated and what values it found:

Indicator	What it is for	Value at the Brasília hospital
Litres per bed per day	Comparing the hospital with itself and with others	855
Litres per person per day	Accounting for staff, patients and visitors	113
Litres per m² of floor area per day	Comparing buildings of different sizes	11
Litres per kg of laundry washed	Tracking the laundry	26
Litres per meal	Tracking the kitchen	30
Night-time and weekend consumption	Finding leaks and out-of-hours use	Compare with the hospital’s own pattern

Consumption per bed also goes into the sustainability report. How to take water figures to the report, with the GRI 303 indicators, is in ESG and water management, and the roadmap for any organisation in the guide to water savings for businesses.

Frequently asked questions

How much water does a hospital use per day?

It depends on size and profile. The Hospital de Apoio de Brasília, with 59 beds, used on average about 1,500 m³ a month, or 855 litres per bed per day. Studies of other hospitals found from 1,093 to 1,618 litres per bed per day.

Which hospital area uses the most water?

At the hospital studied in Brasília, maintenance, washing and cleaning (23%) and staff washrooms (22%), ahead of the kitchen (17%) and medical care (14%). By end use, toilets lead, with 23% of the water.

Are leaks common in hospitals?

They are, especially in old buildings. At the Brasília hospital, 13 points leaked non-stop and took 10% of consumption. At the Heart Institute, fixing leaks cut consumption per bed by 28%.

How do you save water in a hospital while protecting infection control?

By concentrating changes outside patient care: leaks, toilets, laundry, kitchen, cooling and tanks. In care areas, any change to taps or routines goes through the hospital’s infection control committee first.

Can a hospital use reclaimed water or rainwater?

Yes, for uses that do not require drinking water, such as irrigation, washing outdoor areas and, with a dedicated installation, flushing toilets. University hospitals in Paraná and São Carlos have studied reusing laundry water and harvesting rainwater, with tanks and pipes kept separate from drinking water.

Sources

• Santana, L.; Sant’Ana, D. Water end-use analysis in a public hospital in Brasília, Brazil. Engenharia Sanitária e Ambiental, v. 28, 2023: consumption per bed, end uses, leaks and the review of the Heart Institute, Paraná, São Carlos and India studies
• Silva, G. S.; Tamaki, H. O.; Gonçalves, O. M. Implementation of water conservation programs in university campi. Ambiente Construído, v. 6, n. 1, 2006, in Portuguese: University Hospital results and distiller losses
• EPA WaterSense, Types of Facilities: the largest water uses in US hospitals
• The Rede D’Or case: 16.5% less water in 40 hospitals, with figures from the network’s sustainability report (GRI standard, 2025)
• T&D TDRR and SEA 360º