Water management programs (WMPs) are fundamental for ongoing control of opportunistic premise plumbing pathogens in health care building water distribution systems. There is consensus about the components of these programs: a multidisciplinary team, a risk assessment and system schematics, applying engineering controls with limits and corrective actions, verification of WMP implementation, and validation of WMP effectiveness. However, the processes for executing, maintaining, and evaluating WMPs are not standardized and require dedicated resources. This review describes practical considerations for optimizing WMP implementation and outcomes, highlighting the importance of the collaboration between clinical and facilities management disciplines to prevent patient harm.