Health-Care Flooring for the New Normal
CASE STUDY: UNIVERSITY OF WISCONSIN HEALTH’S UNIVERSITY HOSPITAL
The designer’s main focus in choosing flooring at a newly renovated Neuroscience Intensive Care Unit at a hospital in Wisconsin was slip resistance, footfall noise, and comfort underfoot.
The University of Wisconsin (UW) Health’s University Hospital in Madison, Wisconsin, sought to reduce noise and improve the patient and staff experience in its newly renovated, 18-bed Neuroscience Intensive Care Unit (Neuro ICU). An ergonomic health-care surface provided the solution.
University Hospital features a Level I adult and pediatric Trauma Center, an American College of Surgeons-verified Burn Center, Organ Transplant programs, one of the nation’s first certified comprehensive Stroke Centers, and the UW Carbone Cancer Center. UW Health is an integrated health system at the University of Wisconsin-Madison serving more than 600,000 patients each year.
According to Ardis Hutchins, AIA, IIDA, CHID, EDAC, a licensed architect and registered interior designer with UW Health, noise reduction to improve HCAHP scores was a high priority.
“We are a teaching research hospital, so we have many groups of people in the corridors and going into rooms, which creates added noise,” Hutchins says. “We experienced flooring failures with the old LVT product installed in the area. It delaminated over time.”
Kate Bautista, LEED AP, NCIDQ, associate vice president of HGA Architects and Engineers, was selected as the lead interior designer on the project.
To make the remodeled inpatient unit a quieter, calm, healing environment, hospital decision-makers conducted research to identify the most appropriate flooring. She was impressed with an engineered, high-quality homogenous vinyl surface fusion bonded to 5 millimeters of vulcanized composition rubber.
“Making the right selection on flooring is really critical in areas that are occupied 24/7,” Hutchins says. “We were interested in this product because of its acoustic properties and resilient design.”
“When it comes to patient safety in the health-care setting, acoustics and falls are among the top issues to address,” Bautista adds. “Slip resistance, footfall noise, and comfort underfoot then become the factors to consider when selecting flooring.”
Hutchins and the team requested and reviewed background research from the flooring manufacturer on its flooring line, which included touring other product installations at the Mayo Clinic Health System in Sparta, Wisconsin, and Johns Hopkins Hospital in Baltimore.
The second phase of the assessment included extensive in-house testing. A mockup was used to assess cleanability, waterjet cutting, heat welding, patching, push/pull of heavy equipment, and static load indentation recovery.
During the design and evaluation process, the hospital also considered feedback from patients and families. “We met with representatives from the Patient and Family Advisory Council (PFAC) on several occasions to show them the product, present test results, and make some design adjustments based on their aesthetic preferences.”
With testing and evaluation complete, the team chose the rubber-backed vinyl flooring in a wood-grain look for patient rooms. For a more modern look in the corridors, a combination of the product in more solid colors was selected. “The soothing, tonal nature of the flooring acts as a timeless backdrop to the modern design,” Bautista says. In total, the installations covered 13,500 square feet.
“All of the feedback we have gotten so far on this particular unit has been really positive,” Hutchins says. “Everyone really likes the floor with regard to comfort, and ergonomically it is definitely less stress on people’s knees. The unit is very quiet, too, even with noisy shoes like heels.”
CASE STUDY: JOHNS HOPKINS HOSPITAL
The vulcanized composition rubber-backed flooring specified for a unit of John Hopkins Hospital met a number of criteria, including resiliency and cleanability.
When Johns Hopkins Hospital (JHH) in Baltimore, decided it needed an alternative to carpet, the designer relied on science to determine an alternative. “We cannot keep carpet clean,” said Teri Bennett, RN, CID, CHID, IIDA, NIHD, EDAC, lead interior designer, Architecture & Planning Department, JHH.
Under the direction of the hospital’s Facility Planning and Maintenance Team, JHH conducted a system-wide multidisciplinary research floor testing study over 90 days from November 22, 2014 to February 21, 2015. The test protocol and process utilized the 2014 edition of the FGI Hospital/Outpatient Guidelines and focused on overcoming four challenges.
JHH’s first two challenges were to reduce the use of under-performing, environmentally harmful, expensive, and high-maintenance surfaces and to establish a no-carpet flooring policy. JHH tested 20 products: 11 resilient surfaces and nine acoustic, non-carpet surfaces. This included textile composite, rubber, rubber composite, vinyl rubber composite, and heterogeneous and homogenous resilient flooring.
The third challenge was for all renovation projects to incorporate green/sustainable material specifications. “We had little experience with green, recycled products, and products made from alternative materials,” says Andrea Hyde, AAHID, MDCID, planner designer, Architecture & Planning Department, JHH.
The fourth and fifth challenges for JHH were to test and establish new standard cleaning procedures and protocols to comply with sustainable, low-VOC guidelines, and to also meet infection control and aging issues by eliminating the use of high-gloss surfaces, prior to implementation.
The JHH test area chosen for the 20 surfaces was the corridor connecting JHH Main Campus and JHOPC, including the Metro subway entrance to JHH East Baltimore Campus. This area receives more than 20,000 estimated footfalls per day. Each of the 20 product test sites measured 6 feet by 18 feet with 4 feet of walking width. The result: “Some of the most sustainable products failed really miserably,” Hyde says. “They needed more care than we could give, or material collected soiling due to the inherent open-pore design.”
One of the products that performed the best was a floor made specifically for health-care settings that features an engineered resilient surface comprised of heterogeneous vinyl fusion bonded to a 5-millimeter vulcanized composition rubber backing. The result: a surface that reduces the risk of injury associated with falls, and offers sound control and comfort underfoot.
“The entire side that we were testing acoustics on was interesting,” Hyde says. Using rolling carts, JHH conducted acoustic tests over all of the test products. “You hit the granite tile, then you rolled over our resilient floor, then you hit the granite tile again, and then you rolled over the acoustic test floor,” Hyde explains. “We felt the products we were testing on that side were truly making a sound difference as people rolled on that side of the floor.”
With regard to cleaning, some products changed color with the Oxi-Clean or Oxi-Seal. “The specialty product never had an issue at all,” Bennett says. “There were no issues with cleaning at all on both sides (sealed and unsealed). And the seam remained intact throughout the test.”
As a result of the vulcanized composition rubber-backed flooring’s positive performance and because it fulfilled JHH’s four criteria challenges, JHH specified it, as well as another product from the company’s collection, for installation in 56 inpatient rooms in the JHH Meyer Neuro & Rehab facility.
Ergonomics
Selecting the right surface can contribute to the comfort of the people using it, in addition to potentially reducing the risk of serious injury from a fall. When it comes to the comfort of a surface underfoot, the force reduction and energy restitution of a surface must be considered.
Ergonomic surfaces balance the absorption of force and the return of energy. Two common terms used to describe this relationship are force reduction and energy restitution.
Force reduction: This is how much energy a surface absorbs; for example, when a person walks on it. Surface of concrete would have extremely low force reduction because it absorbs very little energy, returning most of it back to the person’s feet, legs, and body.
This is tested and measured by ASTM F2569-11: Standard Test Method for Evaluating the Force Reduction Properties of Surfaces for Athletic Use.
Energy restitution: This is how much the surface returns energy. A surface of sand has very little energy restitution and high force reduction, meaning it will absorb almost all the energy and return very little back to the person’s body, making walking difficult and fatiguing. When specifying flooring for a health-care space, it should be selected based on the force reduction and energy restitution desired for the application.
Energy restitution is how much energy a surface returns. Force reduction is how much energy a surface absorbs.
Slips and Falls
The health-care industry has been guided by long-standing requirements for coefficient of friction (COE) to prevent slips. But what has never been addressed is the actual impact that happens when a fall does occur. And falls do occur even when strict protocols are followed. Ironically, there are playground safety standards as noted in ASTM F 1292 for Height Impact Criteria. Yet no such standard exists for hospitals or senior care facilities.
Therefore, it is incumbent on the designer or specifier to pay attention to the flooring being considered and how it affects impacts. A lessened impact could make the difference between a minor and a major injury.
Hygienic surfaces
Up to this point, we are already asking a lot from our health-care setting flooring: comfort, noise reduction, fall impact reduction, etc. But there is another element that is especially critical in health-care settings in these times: surfacing that helps prevent the spread of viruses, germs, and bacteria. Flooring that helps stop the spread of pathogens must perform well on three levels: 1) be a cleanable surface, 2) be compatible with cleaning products, and 3) have welded seams.
While much attention is given to surfaces such as countertops and handrails where viruses can be transmitted from person to person, viruses can also be transmitted on flooring from room to room. Research is underway regarding the migration of microbes through shoe traffic. Specifying a flooring material that can be effectively and efficiently cleaned is more important now than ever.
Plus, the flooring surface must be impervious to the robust cleaning products used in a health-care setting. This means it should not discolor or deteriorate when cleaning products are used.
Finally, the flooring should be seamless, with welded seams impervious to topical spills and liquids, especially in the flash coving. There is a critical need for sealed floors in patient rooms and corridors.
The case study on the next page shows how the proper specification of flooring contributes to the ability of a highly respected hospital to prevent the spread of pathogens.
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