During this course, we explore how vacuum plumbing can help design professionals create projects that save water, energy, and money and contribute to sustainable design. We review how vacuum plumbing can help contribute to LEED projects and prevent the spread of infectious diseases, especially during a pandemic. Our team illustrates the differences between vacuum plumbing and gravity plumbing and how they compare regarding sustainability, health and safety, cost and design and use of existing real estate flexibility. Finally, we examine case studies that include healthcare facilities, commercial projects, and prisons.