Flooring for Healthcare:
An Evidence-Based Design Approach
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Agenda
 Flooring Issues in Health Care
Environments
 Different Floor Covering Options
 Evidence Based Design Approach to
Evaluate Flooring (safety, comfort
and well being of patients & staff)
 Installation Issues
 Floor Coverings Strengths &
Weaknesses
Flooring Issues in Healthcare
Aesthetic Needs
Moisture Management
Indoor Air Quality (IAQ)
Odor/Infection Control
Antimicrobials
Safety (Slip/Fall)
Ergonomics/Comfort
Thermal Properties
Roller Mobility
Acoustics
Visual Comfort/Glare
Durability
Environmental Impact
First Cost/Life-Cycle Costs
Maintenance
Installation
Flooring Types
Hard Surface
Wood
Bamboo
Laminate
Terrazzo
Stone
Marble
Porcelain Tile
Ceramic Tile
VCT
Flooring Types
Hard Surface
Resilient Flooring
Wood
Bamboo
Laminate
Terrazzo
Stone
Marble
Porcelain Tile
Ceramic Tile
VCT
Cork
Linoleum
Sheet vinyl
LVT
Rubber
Flooring Types
Hard Surface
Resilient
Wood
Bamboo
Laminate
Terrazzo
Stone
Marble
Porcelain Tile
Ceramic Tile
VCT
Cork
Linoleum
Sheet vinyl
LVT
Rubber
Carpet
Broadloom Carpet (Tufted and Woven)
Printed Carpet
Axminsters (Woven wool carpets)
Performance-Back Carpet
Modular (Carpet Tile)
Flooring Types
Hard Surface
Wood
Bamboo
Laminate
Terrazzo
Stone
Marble
Porcelain Tile
Ceramic Tile
VCT
Resilient
Cork
Linoleum
Sheet Vinyl
LVT
Rubber
Carpet
Hybrids
Broadloom
Printed
Axminsters
Performance-Back
Modular
Flocked Nylon Flooring
Woven Vinyl Flooring
Hybrid Resilient Sheet
Flooring
Evidence-Based Design
Process of basing decisions
about the built environment on
credible research to achieve the
best possible outcomes.
Evidence-Based Design
Objectives:
 Improve patient/resident as
well as visitor and staff
satisfaction
 Improve quality & operational
effectiveness
(clinical outcomes)
 Lower cost of ownership
Indoor Air Quality
Issues
1. Volatile Organic Compounds
2. Respiratory Contaminants
3. Microbial Growth
Indoor Air Quality / Infection Control
How does flooring affect
IAQ/Infection Control?
Select floorcoverings that
are impermeable to
moisture.
Why?
 Spills do not “flow through” to
subfloor
 Easier to clean with less
chemicals
 Does not provide food source
and environment for micro
organisms including mold.
Moisture Management / Infection Control
Flow Through vs.
Impermeable
Moisture Management / Infection Control
Impermeable
Moisture Barrier
Indoor Air Quality / Infection Control
How does flooring affect
IAQ/Infection Control?
Select floor coverings that can
serve as a “sink” to trap airborne
particulates and be easily and
effectively removed.
Why?
Shiny does not equal “Clean.”
It equals “Shiny!”
Is “shiny” clean?
Infection Control
Hospital-Acquired/
Nosocomial Infections
90,000 deaths annually
Most important
preventative measure?
Infection Control
Hospital-Acquired/
Nosocomial Infections
Surface Sanitation
High-Touch
(door handles, bed rails)
Low-Touch
(Floors and Ceilings)
Infection Control
Hospital-Acquired/
Nosocomial Infections
“Extraordinary cleaning and decontamination of floors in
health-care settings is unwarranted.“
Centers for Disease Control
Infection Control - Summary
CDC GUIDELINES:
Extraordinary cleaning and decontamination of floors in health-care
settings is unwarranted. Studies have demonstrated that disinfection of
floors offers no advantage over regular detergent/water cleaning
and has minimal or no impact on the occurrence of
health-care–associated infections.947, 948, 977–980
Additionally, newly cleaned floors become rapidly recontaminated
from airborne microorganisms and those transferred from shoes,
equipment wheels, and body substances.971, 975, 981
Focus on those surfaces in close proximity to patient (e.g., bedrails)
and those that are frequently touched (e.g., doorknobs).
FLOORING IS CONSIDERED A “LOW-TOUCH” SURFACE
Infection Control – Use of Antimicrobials
Antimicrobial Treatments
What are they?
Do they work?
Are they really needed?
CDC INFECTION CONTROL GUIDELINES (2003)
“Over the last few years, some carpet manufacturers have treated their products with
fungicidal and/or bactericidal chemicals. Although these chemicals may help to reduce
the overall numbers of bacteria or fungi present in carpet, their use does not preclude
the routine care and maintenance of the carpeting. ”
Safety & Ergonomics
Implications of Flooring
Selection
 Impact of Slip/Fall Incidents
 Ergonomic/Human Factor
 Rolling Resistance/Mobility
Safety & Ergonomics
Impact of Slip/Fall Incidents
 1800 fatal falls per year in
nursing homes
 29% of injured die with six
months
 50% do not return home
(Source: Nursing Times Magazine)
Safety & Ergonomics
Impact of Slip/Fall Incidents
Study Summary
 213 fall/accidents studied
27 Falls (13%) occurred on soft
surface (4 injured = 15%)
 186 falls (87%) occurred on hard
surface (167 injured – 90%)
Safety & Ergonomics
Effects on Staff
Safety & Ergonomics
Most common injuries
experienced by nurses.
Together, knee and ankle injuries
(sprains/strains) account for 10%
of workers’ compensation claims.
Safety & Ergonomics
Ergonomic/Human Factor
Univ. of Pittsburgh Study
Conclusions:
1. Cushion and carpet pile density affect
muscle response.
2. Firm cushion provides lowest muscle
responses (less muscle fatigue).
3. Low pile height has the lowest muscle
response (less muscle fatigue).
4. Low pile height in conjunction with a
very firm cushion provided lowest
muscle response of all samples tested.
Safety & Ergonomics
Rolling Resistance/Mobility
Hard wheel rolling on and deforming a
soft surface, resulting in the reaction
force from the surface having a
component that opposes the motion
Safety & Ergonomics
Rolling Resistance/Mobility
Gurney + 200 lbs.
Movement of Gurney + 200lbs.
VCT
Modular Carpet/
Hard Backing
Hybrid Resilient
Sheet Flooring
Effort Required to Initiate Movement
10.6 lbs
14.6 lbs
17.85 lbs
Effort Required to Sustain Movement
8.2 lbs
11.8 lbs
13.3 lbs
Effort Required to Push Around Corner
11.0 lbs
14.7 lbs
14 .0 lbs
Safety & Ergonomics
Rolling Resistance/Mobility
Wheel Chair + 200 lbs.
Movement of Wheel Chair + 200lbs.
VCT
Modular Carpet/
Hard Backing
Hybrid Resilient
Sheet Flooring
Effort Required to Initiate Movement
2.0 lbs
4.6 lbs
7.85 lbs
Effort Required to Sustain Movement
1.2 lbs
3.8 lbs
5.3 lbs
Effort Required to Push Around Corner
3.4 lbs
4.7 lbs
7 .5 lbs
Thermal Properties
R-Values (h2 – F/btu)
Acoustics
Better acoustics







Lower stress
Lower blood pressure
Improved sleep
Higher patient satisfaction
Increased visitation
Lower error rates
Higher staff moral
Rise In Hospital Noise Poses
Problems For Patients And Staff,
Science Daily 2005
Acoustics
Since 1960, daytime sound levels have risen
from 57 decibels to 72; nighttime has
jumped from 42 decibels to 60.
All exceed the World Health Organization's
1995 hospital noise guidelines, of 35
decibels. The measurements vary little
among different types of hospitals,
indicating the problem is universal.
Acoustics
Closed Cell Cushion
reduced reverberation
times from 8% - 25%1.
1LEE
SOUND DESIGN, Inc.
Consulting Engineers in Audio,
Acoustics and Video Acoustical
Report.wpd (classroom analysis)
Visual Comfort/Glare
 Glare plus compromised vision can
create eye pain
 Wet/slippery appearance has
paralyzing effect
 Resident can become immobile due
to fear, anxiety, confusion
 Result is “passive restraint”
 Glare can be measured –
Light Reflectance Value (LRV)
Visual Comfort/Glare
Visual Comfort/Glare
Visual Comfort/Glare
Installation
 24/7 Occupancy
 Floor Prep/Moisture Limits
 VOCs (Adhesives & Sealers)
 Adhesive set-up and “cure” time
 Downtime/Lost Revenue
Hard Surface Flooring
STRENGTHS
WEAKNESSES
Lowest level of roller resistance
Increased incidences of slips/falls and
related injuries
Easy to clean & disinfect
High glare (waxed VCT / Marble)
Most Durable
Maintenance costs (equipment, man
power and chemicals when waxed)
Impermeable to moisture
Poor acoustical properties/increased noise
Low thermal insulation value
Undesirable ergonomics/comfort
Installation limitations
Resilient Flooring
STRENGTHS
WEAKNESSES
Low level of roller resistance
Potential for slips/falls and related injuries
Easy to clean & disinfect
Varying levels of glare (when waxed)
More Durable
Maintenance costs (equipment, man
power & chemicals when waxed )
Impermeable to moisture
Increased Airborne Particulates
Creative flexibility for inlays
Varying levels of thermal value
Varying levels of ergonomics/comfort
Scuffing and scratching of no-wax finishes
Installation limitations
Carpet
STRENGTHS
WEAKNESSES
Lower incidences of slips/falls and related
injuries
High Level of roller resistance
Eliminates glare
Less durable
Better acoustics
Difficult to Maintain
Some thermal benefits
Moisture permeable / Flow-thru
Better ergonomics/comfort
Stains easily / Harbors Odors
Microbial Growth / Infection Control
Installation Limitations
Hybrid Resilient Sheet Flooring
STRENGTHS
WEAKNESSES
Lower incidences of slips/falls and related
injuries
Medium level of roller resistance
Eliminates glare
Textile surface restricts use to non-clinical
spaces in acute care facilities
Improved acoustics
Maximum thermal benefits
Impermeable moisture barrier / Welded
seams
Comfort under foot / Reduced fatigue
24/7 Installations / Immediate Occupancy
Thank you
Flooring for Healthcare:
An Evidence-Based Design Approach
Course: TANHC1011 (AIA)
40411 (NCIDQ)
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