For manufacturers of hard flooring, hospitals present unique challenges in the areas of performance requirements, installation, safety and infection control. Due to continuous traffic, there is often a need to install flooring quickly. Heavy rolling loads require high-indentation resistance. Safety is also an ongoing concern, both with infection control and slip-and-fall prevention.

Without a doubt, hospitals offer greater challenges than any other type of facility, says Tom Burns, health care market manager, the Stonhard Group, Maple Shade, N.J. "Hospitals are patient-centric, meaning all work elements are driven to support a healing environment. As a manufacturer of hard flooring, the challenges involve dealing with variables such as indoor air quality, infection risk control, room pressurization and sound control."

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The good news is that recent advances in flooring materials and installation methods have helped manufacturers to meet these challenges.

Advanced materials

The flooring industry has made advances in both wear layer and adhesive technologies, according to Kathy Griffel, director of health care sales, Mannington Commercial, Calhoun, Ga. "New adhesives allow for immediate traffic and perform in areas with high moisture content. Wear layers provide ease of maintenance and slip-and-fall resistance. For example, our Quantum Guard HP wear layer provides a low-maintenance, no-wax solution with resistance to scratching and staining," she notes.

Luxury vinyl tile (LVT) has led innovation in the flooring industry in recent years. LVT can create compelling visuals that rival natural materials while providing value through speed of installation and ease of maintenance. "Given LVT's wide range of installation options, it's one of the fastest materials to install, which allows health care environments to become operational more quickly," says Russ Rogg, president and CEO, Metroflor Corp., Norwalk, Conn.

The shift to LVT in many hospitals is being driven by a need to create a homelike look and feel with easy-to-clean flooring that can be installed quickly. "Designers are specifying noninstitutional-looking products that resemble the home experience during functional renovations and new builds. Selecting these products based on evidence-based design is believed to help with the patient's healing process," says Carol Priefert, segment marketing manager, Armstrong Commercial Flooring, Lancaster, Pa.

Improved cleanability is another feature built into the latest hard flooring. Manufacturers familiar with the maintenance challenges in health care environments offer similar finish layers that utilize various forms of urethane technology, according to Mark Huxta, director of health care sales, Ecore Commercial Flooring, Lancaster, Pa. This technology offers stain- and wear-resistance without the need for applied finishes or polishes. "What was once a differentiator has become the surfacing standard for health care environments."

Innovations in the wear layer, in addition to no-wax finishes, are becoming increasingly popular because they eliminate the task of waxing floors and increase wearability, says John Stephens, vice president of marketing, Shaw Contract Group, Cartersville, Ga. Also, products are now engineered to resist stains that are common in health care environments.

Wayfinding applications

Flooring that helps patients, visitors and staff find their way has become an increasingly important feature. "Flooring is taking a greater role in wayfinding by using colors and patterns to designate floors or specific departments. In some cases, flooring literally becomes the signage for getting people around a facility. The use of insets, waterjet or laser cut, is a popular option when the budget allows for it," says Jim Bistolas, health care market segment director, Forbo Flooring Systems, Hazleton, Pa.

Evidence-based design includes wayfinding to help patients and families navigate through an already stressful time. "Resilient flooring designs can help to delineate specific areas and guide visitors along the right path. This allows staff to spend less time providing directions and more time caring for patients. Armstrong's broad palette makes it easy to find the right colors, textures and designs to enhance wayfinding in any area of a facility," says Priefert.

Rogg says the ubiquitous smartphone may be fueling the trend toward wayfinding in flooring, as people tend to look down at their phones instead of up. "Custom Compass Motifs inlaid into hard flooring are popular. Hospitals are even asking for themed floors in children's areas," he adds.

Likewise, the use of colors and patterns in hard flooring is prevalent and growing, and can be specified for specific areas of a hospital. The human element of health care has come to the forefront as many facilities are warming up previously sterile environments. Today's use of warm wood colors in adult patient areas and bright and bold primary design themes in pediatrics make the previously bland environments look and feel more welcoming.

"Color continues to attract the attention of health care providers, particularly warm color palettes that contribute to a soothing, healing environment. So do new flooring products that more closely mimic stone, wood and other natural products," says Tim Cole, vice president of marketing, nora systems Inc., Salem, N.H.

To that end, Lonseal Inc., Carson, Calif., recently introduced Londante, a resilient sheet vinyl that comes in seven colors and features a cross-hatch pattern that imparts a distinctly Italian flavor to an interior space. Its delicately etched lines suggest intricate marble and stone textures, and its saturated colors range from plush leafy tones to ocean-horizon blue. Londante's colors reportedly stand on their own while complementing a wide array of wood looks and solids.

New resilient products, available in a variety of colors and designs, complement other types of flooring. "Shaw Contract Group's health care design studio is focused on providing maximum flexibility for clients. In terms of visual aesthetic, pattern and palette, our sheet and LVT products are designed to coordinate with other collections, including carpet, for varied design options," Stephens says.

Shaw's Collective Time Resilient is the company's first launch of sheet and LVT styles designed to coordinate with a specific carpet collection. The two heterogeneous sheets allow facilities managers to experiment with color and build scale, while the plank provides a softer, coordinating gradient. The carpet tile and broadloom products provide complete flooring options for health care spaces.

Tarkett, Chagrin Falls, Ohio, has introduced Acczent Flourish heterogeneous sheet flooring. Designed and colored to coordinate with Johnsonite homogeneous products, Acczent Flourish comes in three design visuals, each offered in 10 different colors, and complements a wide range of commercial environments. It also works with Johnsonite LVT in large spaces. With fewer seams for germs to hide in and the ability to be flash-coved and heat-welded, the product is suitable for application in sterile areas, the company reports.

Metroflor Corp. has launched its first commercial LVT brand, Aspecta, which comprises a 100-plus range of LVT tiles and planks, ranging in size from 24 by 24 inches to 7.25 by 48 inches, respectively. "The collection includes 52 woods, 33 stones and 24 abstract designs, which bring a wide choice of options that are pleasing to the eye, while also delivering in terms of functionality and hygiene," Rogg notes.

Forbo Flooring Systems has introduced Marmoleum Modular, which includes tile and plank in different colors and patterns. These products offer a wide design range for such areas as patient rooms, waiting areas, exam rooms and clinical spaces — all in durable, easy-to-maintain Marmoleum. The visual qualities are appropriate for the current trend toward wood-look products, the company reports.

Installation and maintenance

Quick and easy installation is another key feature of new flooring. For example, noraplan nTx is a resilient rubber sheet flooring that cuts installation time by up to 50 percent when compared with standard polyvinyl chloride (PVC) sheet installation.

"It is resistant to moisture and has no pH limits. As a result, the floor covering eliminates the need for time-consuming, costly moisture testing and remediation, and requires minimal preparation of the concrete slab. Because noraplan nTx eliminates the use of a wet adhesive system and associated curing and drying time, floors can be cleaned or walked on immediately after installation," Cole says.

Patcraft, a commercial flooring brand of Shaw Industries, has introduced Brookwood+ and Organic Hue, heterogeneous flooring that can be heat-welded and flash-coved for seamless installation, a requirement for infection control. Durability and ease of maintenance make these resilient styles suitable for high-demand, health care environments.

Mannington Commercial calls its introduction of Teles smooth rubber tile a true innovation for health care spaces. "It has all of the comfort underfoot, acoustic properties and slip-retardance of traditional rubber flooring in a new proprietary formulation that doubles the industry standard for indentation resistance. Teles also contains a three-wax internal compound as a low-maintenance option," says Griffel.

Thinking green

The latest resilient flooring products also are constructed with sustainability in mind. The architecture and design community is demanding complete transparency around the products they specify for health care projects. In response, manufacturers are providing clarity about their flooring ingredients and meeting requirements for certification programs.

"Shaw Hard Surface products contribute to LEED green building certification, are FloorScore-certified and have low-volatile organic compounds (VOC). Safe for sensitive areas, they are independently certified by third-party labs to ensure safe and clean air post-installation," says Stephens.

Patcraft has developed EcoWorx resilient flooring, which offers a recyclable vinyl alternative with an environmental guarantee. A sustainable resilient flooring solution, it is phthalate- and PVC-free and offers guaranteed reclamation and recycling at end of life.

Hospitals continue to look for flooring products that offer simple cleaning regimens while meeting strict hygiene requirements. As more attention is placed on preventing health care-associated infections and improving overall appearance, resilient flooring products are well-suited for today's facilities. "The push for flooring products that don't require a finish continues to build momentum nationally, both from environmental and cost-saving standpoints," Bistolas says.

Non-PVC chemistry also has gained momentum in some markets. A number of alternative chemistry products have been introduced over the past several years, according to Huxta.

What flooring features and price factors should hospital facilities managers consider when selecting hard flooring? Experts agree that they need to consider the following performance features:

  • durability to withstand heavy rolling loads;
  • stain resistance to disinfectants, blood, urine and acids;
  • a nonporous surface that resists dirt and the growth of bacteria;
  • sound absorption to create a restful environment;
  • resilience to provide comfort underfoot for staff working long shifts;
  • low-VOC emissions for improved indoor air quality;
  • a simple maintenance regimen;
  • a long life span that supports sustainability goals.

The best value

"Flooring may comprise only 3 percent of a health care facility's budget, but it accounts for about 30 percent of the overall area and is impacted by the most wear and tear," Priefert notes. "Choosing the best hard flooring has a big impact on how a facility is perceived and on the long-term value of the investment."

Neal Lorenzi is a freelance writer based in Mundelein, Ill.



In the details

Piedmont Newnan Hospital's Marmoleum Composition tile flooring gives the facility a dynamic design.

Forbo Flooring Systems

Cross colors

Londante is a resilient sheet vinyl that comes in seven colors and features a cross-hatch pattern.

Lonseal Inc.

Relaxed aesthetic

The combination of Natural Creations ArborArt Nouveau luxury vinyl tile in maple honey and maple light natural create a calming feel.

Armstrong Commercial Flooring

Perfect match

Mixed Materials is a resilient product that provides a seamless transition between surfaces, creating a safe surface for walkers or for rolling wheelchairs.


Fit for traffic

This sound-absorbent and stain- and slip-resistant rubber flooring is featured in the new Parkland Memorial Hospital in Dallas.

nora systems Inc.

One with nature

Ecore Forest rx creates a natural look in the reception area of the heart and vascular intensive care unit at the Pennsylvania Presbyterian Advanced Care Pavilion.

Ecore Commercial Flooring

Friendly flooring

Stonres RTZ's swirling patterns and warm colors create pathways and a welcoming environment at Huntsville Hospital.

The Stonhard Group