As evidence-based design research becomes more important in the planning and design of hospitals, various flooring products are often part of the research. This is particularly true for the following areas:
Slips and falls. How does the product contribute to safe design?
Infection control. Is the product easy to maintain, and what antimicrobial and antifungal properties does it have?
Noise reduction. Does the product absorb sound in patient areas?
Low toxicity. Can the product be maintained without toxic chemicals?
The selection of the right product can be daunting, but vitally important are safety, maintainability and appropriateness. Sustainability should also be a very high priority, even if the project is not Leadership in Energy and Environmental Design (LEED) certified.
While such considerations may seem straightforward, they often can lead to confusion. For instance, although many organizations are currently looking at various coefficient of friction (COF) testing methods, there is no consensus for a COF number. (This does not mean that the COF numbers provided by manufacturers should be ignored. It just means they are not universally accepted.) Likewise, while many low- and no-maintenance flooring products have been introduced, they are still being waxed when such unnecessary maintenance can lead to slip-and-fall accidents.
Key flooring products
Not all products are suitable for every space, so it is important for the designer to understand all aspects of the products being considered. Environmental services departments must also learn about the products because they will maintain them. Here is a look at some key flooring products:
Rubber. Rubber flooring, both tile and sheet, is made from materials that are environmentally friendly and naturally sustainable. Rubber is flexible, resilient and nonporous and can be used in patient rooms, corridors and operating rooms. It’s resistant to staining, extremely slip-resistant, antimicrobial and antibacterial. Rubber flooring has nearly double the sound absorption of other hard flooring and is a very close second to carpet. Its softness also reduces foot fatigue. Products from Nora Rubber Flooring (www.norarubber.com), Lawrence, Mass., and Italy’s Mondo (www.mondousa.com) can be specified with a cushioned backing to increase resiliency.
During installation, seams in sterile areas should be heat-welded; however, other areas can be cold (or chemically) welded or butt-joined.
Most rubber flooring requires only a dry sweep and a daily damp mop to retain its luster. No waxing or buffing is needed. If a higher sheen is desired, most manufacturers can provide instructions on how to achieve it.
Wood-look flooring. Few products warm up patient areas as much as wood-look flooring. There are many products on the market, including sheet goods and planks. The six-foot product, available in dozens of wood-grains, offers the best overall design options and wearability. It provides cushioning under foot and helps sound control.
Boca Raton, Fla.-based Teknoflor’s (www.teknoflor.com) sheet vinyl flooring product helps increase slip-resistance. It does not require waxing, buffing or sealing, thus contributing to a cleaner environment and minimal maintenance for staff. It can be cleaned by damp-mopping or auto-scrubbing. Wax will not adhere to the product’s grooves and will lead to an uneven appearance. Scuff marks are removed by simple cleaning, and the matte surface helps hide floor imperfections.
The product’s seams should be heat-welded, prohibiting bacteria from penetrating or seeping underneath. Because so many wood grain colors are available, the design possibilities are endless.
Other features include very high wear-resistance per the Taber Abrasion Test (12,000 cycles with a 500-gram load). It’s also made with 80 percent recyclable post-consumer content and is antifungal and antibacterial-treated.
The savings from wax-free flooring can be substantial. Given that the national average to maintain a vinyl floor is approximately $2 per square foot a year (including sealers, finishes, buffing, recoating and stripping), a 10,000-square-foot area costs about $20,000 a year to maintain. With a no-wax floor, the approximate cost to damp mop is 50 cents per square foot (or $5,000) a year, providing a $15,000 one-year savings.
Sealed or stained concrete. Concrete has always been a low-maintenance flooring with sustainable benefits, but its drab look deterred its use in many facilities. In health care environments, concrete has traditionally been found in back-of-house areas due to its institutional and sterile appearance. With designers and artisans now utilizing decorative stains, scoring and stamping methods, the aesthetic nature of concrete has changed, allowing it to become a viable design element.
Among its advantages, concrete requires only basic dusting and damp mopping with a neutral cleaner for daily maintenance. If polished concrete is used in high-traffic areas and the shine begins to dull, simple buffing with a commercial polishing compound will revitalize the floor. Another strong selling point is its life-cycle cost, which far surpasses many of the alternative floor finishes that are applied to a concrete floor, such as carpet and vinyl. Additionally, because concrete can function as both the foundation slab and the finished floor, the costs of additional flooring finishes are saved.
While the use of concrete flooring has increased, there are some limitations. For instance, it lacks the sound absorption and underfoot cushion that soft surfaces provide. Also, color uniformity is not guaranteed, and samples are not always representative of the final result due to the composition of the concrete. Also due to its composition, cracking can occur. Finally, as with any hard surface, the floor will become slick when wet, and risk of injury can become an issue. Many facilities with concrete floors use area rugs or running mats to deter this problem.
Terrazzo and terrazzo tile. Terrazzo has very low maintenance costs and is among the most durable flooring finish available. It may contain both post-industrial and post-commercial aggregates, such as stone, marble and glass. Therefore, it is often considered for LEED projects. Because there are no VOCs, it also contributes to good indoor air quality.
The aggregates, which are held together by a binder (either cementatious or epoxy), give designers endless design combinations. And when properly maintained, terrazzo will keep its color and finish throughout its life.
It is an excellent solution for heavy-traffic areas because it’s so durable and easily maintained. Neither tile nor poured-in-place terrazzo has grout lines to stain or crack. Terrazzo also can be used on stairs and landings.
When installed, a cleaning and polishing with two coats of sealer is required. Then, all that is needed is sweeping, dust-mopping, damp-mopping or auto-scrubbing with a neutral pH cleaner.
Though terrazzo has a higher installation cost per square foot than many other products, it is an ideal choice for health care applications. While a typical warranty can range 10 to 20 years, the product may last more than 40 years.
Poured epoxy flooring. Epoxy flooring is an extremely durable, versatile material. Its benefits to designers range from ease of maintenance to a long life span. It’s a seamless material, usually installed with an integral base that can play an important role in infection control in all settings.
Epoxy is frequently used in wet areas like bathrooms and kitchens as well as in sterile areas like the central sterile department. The textured surface gives it high slip resistance. Because it is a poured material, it also can be easily sloped around drains.
Because it is resistant to impact and abrasion, it’s capable of handling the heavy equipment and carts frequently used in health care facilities. It also holds up to heavy foot traffic with the need for very little repair.
It is highly stain-resistant and is maintained using a wet mop and a standard, industrial-strength cleaning solution. There is no need to wax or buff this flooring. After a few years, a new coat of sealer should be applied to the floor to help maintain its performance.
The design possibilities with epoxy flooring are extensive. Because it is a seamless poured material, patterns of all shapes and sizes are possible. They are installed with divider strips that help enhance the pattern.
Linoleum. Linoleum is used primarily in lobbies, public corridors, cafeterias, administration support areas and break areas of health care facilities. It is inherently antistatic and antimicrobial. However, linoleum is still a controversial product for patient rooms, exam rooms or clinic corridors. While some manufacturers say it is suitable for these areas, some health systems limit its use.
Armstrong World Industries (www.armstrong.com), Lancaster, Pa., and Switzerland’s Forbo Group (www.forbo.com) offer a wide range of colors, making it a logical choice when extensive patterning is desired. Both companies offer a “top finish” to their product, eliminating additional waxing and thus decreasing dust particles and off-gassing from the waxing process, contributing to better air quality. After installation, damp mopping will maintain the linoleum. Scuffs can be removed and scratches can be fixed in the field with very little disturbance.
Porcelain tile. Porcelain tile is a type of ceramic, composed of feldspar and clay and fired at very high temperatures. It is available in a variety of shapes, sizes and colors; patterning and design is thus limited only by tile dimensions and the designer’s creativity. Porcelain tile is a durable and versatile product, most often utilized as flooring in areas where maintenance and performance are paramount, such as lobbies, cafeterias, connecting corridors and public restrooms.
It is 30 percent harder than granite and is stain- and scratch-resistant. Due to these properties, care and maintenance is simple. According to commercial tile manufacturer Mannington Mills Inc. (www.mannington.com), Salem, N.J., maintenance of porcelain tile is limited to “regular cleaning with clear water or a mild detergent.” To preserve the tile and grout, manufacturer Dal-Tile Corp. (www.daltile.com), Dallas, recommends sweeping or vacuuming the area, then mopping with a nonacid- or ammonia-based product. It advises nonoil-based cleaning agents for glazed tiles.
Carpet tile. With the growing importance of evidence-based design, carpet can promote emotional healing and provide a soothing aesthetic. Carpet tile offers a wide variety of styles, colors and installation methods for designing innovative and flexible spaces. It is mainly used in public areas and patient corridors where sound absorption, slip-and-fall safety and foot fatigue are concerns. It also has been used successfully in clinical areas such as neonatal intensive care units and well-baby nurseries.
One common misconception about using carpet in hospitals is that carpet contributes to airborne allergens. In fact, carpet fibers tend to act as magnets for allergens and are held down until the surface is vacuumed. Of course, regular vacuuming and stain removal is imperative.
Fiber type is a critical factor in the performance and appearance retention of carpet. A Type 6,6 nylon with hollow filament or trilobal construction offers a denser molecular structure, resulting in excellent resistance to matting, crushing and stain penetration. A carpet tile created with solution-dyed yarns will be unaffected by a bleach-based cleaning solution and is a must for health care facilities where vigorous cleaning methods will be employed. If a few tiles are damaged, they can be replaced in the field immediately.
There are many innovative ecologically friendly installation systems, from no to low-VOC adhesives and peel-and-stick releasable adhesives to adhesiveless options, such as the Tactiles™ system from InterfaceFlor (www.interfaceflorcommercial.com), LaGrange, Ga. Many modular products are also manufactured with recycled fibers and plastics. Several companies in the carpet industry are run by green practices and green energy, have policies for recycling fibers and backings, and offer reclamation.
Many choices
Health facilities professionals may choose among many flooring products for hospital applications. These guidelines should provide a good starting point for making the right decisions.
Barbara A. Dellinger, IIDA, AAHID, is director, health care interiors, East Coast, at HDR, Alexandria, Va. Her e-mail is barbara.dellinger@hdrinc.com. She was aided by the following HDR employees: Kristen A. Eckensburg, Assoc. IIDA, LEED AP, senior interior designer; Kelley Dorsett, IIDA, senior interior designer; Patricia E. Yager, Assoc. IIDA, Allied ASID, interior design coordinator; Aneetha McLellan, IIDA, director of interior architecture; Erin Cooper, LEED AP, interior designer; Keri Firebaugh, interior designer coordinator; and Jessica News, interior design coordinator.
| Sidebar - Flooring plays critical role in design of high-touch, high-tech Tennessee hospital |
With a goal of creating “the hospital of tomorrow, today,” HDR, Alexandria, Va., sought to make St. Mary’s Medical Center North in Tennessee a facility that would enhance the healing process through innovative design and state-of-the-art information and communication systems while incorporating evidence-based design features throughout. Creating a patient- and family-focused hospital was essential, along with building a facility where safety features were built in. Thus, specifying the right flooring was an important part of the interior design plan, which included the use of symbols, colors and textures that can be found in the surrounding forests, mountains and lakes of the Great Smoky Mountains. Wood-look sheet flooring from Teknoflor (www.teknoflor.com), Boca Raton, Fla., was selected for the patient rooms. Due to tiny grooves in its walking surface, the flooring is slip-resistant. It also has antibacterial and antifungal properties. Additionally, it requires no wax, and its low-gloss finish rarely shows scuff marks. The same product was used with decorative floral borders in the seating area of the ED, in the cafeteria and in post-anesthesia care unit holding areas. Carpet tile was used throughout the corridors, offices and conference rooms to help absorb sound and give a hospitalitylike appearance. Research suggests that carpet’s comfort underfoot has a significant impact on the physical and emotional well-being of patients and staff. People also tend to be quieter around carpet, which can last more than 10 years when properly maintained. Other products used in the hospital include the following:
|
This article first appeared in the August 2008 issue of HFM.
To respond to this article, please click here.
Click here for a FREE subscription to Health Facilities Management.
