By Shari Solomon

Hospitals and other healthcare facilities are more than familiar with the enhanced cleaning and disinfection procedures necessary to stop the spread of infection. Healthcare-associated infections (HAI) are a recognized hazard, with the U.S. Centers for Disease Control and Prevention (CDC) reporting that on any given day, about one in 31 hospital patients has at least one HAI. 

More worrisome are the increasing occurrences of infections related to multiple drug-resistant microorganisms. Prior to lapses in reporting due to the pandemic, 2019 data from the CDC estimated at least 2.8 million antimicrobial-resistant infections occurred in the United States each year, and more than 35,000 people died as a result. In response, healthcare facilities now practice enhanced cleaning and disinfection of shared surfaces, including furniture, in response to needed infection prevention and control procedures. 

Specifiers, manufacturers and designers of furniture sold to healthcare facilities must recognize that certain fabrics do not have the chemical resistance to withstand the frequent cleaning and disinfection conducted in these high-risk environments. Due to their varying degrees of chemical resistance, coated fabrics have demonstrated failures such as peeling, cracking, and puddling prior to the recognized lifespan of the product. 

These failures have generated additional costs for facilities because they require replacement and repair of damaged furniture before their life cycles, as well as a potential for transfer of infection due to the damaged fabrics, which create reservoirs for pathogens. In the hopes of preventing such damage, a standard and series of tests have been developed to ensure products and fabrics can withstand frequent cleaning, disinfection and other stressors found in healthcare environments. 

Testing, testing 

The Chemical Fabrics and Film Association (CFFA) is an international trade association representing manufacturers of polymer-based fabric and films used in building design, construction, automotive, fashion and many other industries. The CFFA has developed coated fabric test methods and evaluated them over many years to determine the physical properties of chemical coated fabrics and films, facilitate quality control and ensure customer satisfaction. 

The test methods in CFFA-Healthcare-201-Minimum Performance Standards for Vinyl-Coated and Other Chemical Coated Upholstery Fabrics for the Healthcare Environment (CFFA-HC-201) were selected specifically to prevent common product failures due to incorrect fabric selection in healthcare environments. The standard can be found here. 

The self-certification program offered to manufacturers and sellers of coated fabrics consists of 16 test methods identified within the standard. For a coated fabric to be certified, it must pass all tests through an accredited laboratory. Even if a fabric fails just one of the 16 tests, it cannot be certified. If this occurs, tests must be re-run to verify it has met all the testing requirements, or changes must be made to the fabric construction or formulation in order to meet the requirements for certification. 

Spotlight on certification 

Coated fabrics are found in all departments of healthcare facilities. Vinyl is the principal coated fabric produced by manufacturers, but urethane, silicones, acrylic and other polymers fall within the scope of the standard and must meet the minimum performance requirements to be certified. By choosing fabrics for products certified under CFFA-HC-201-certified, designers and managers can be sure the products can withstand repeated exposures to cleaners and disinfectants once installed in healthcare facilities. 

The CFFA-HC-201 certification can help specifiers, designers and furniture manufacturers more easily identify appropriate coated fabrics for healthcare environments. Certification marks can be found on the: 

• certified product or pattern itself 
• certified product or pattern packaging, tags, labels and packaging inserts, such as owners’ manuals and product specification sheets 
• certified product promotional materials, as long as such use complies with these guidelines 
• certified product sample cards 
• website and social media pages specifically promoting a certified product or pattern. 

Products certified to CFFA-HC-201 can be found on the CFFA website. 

CFFA-HC-201 is a self-certification program, meaning a manufacturer or distributor must use its own accredited laboratory or hire a third-party, accredited test facility to complete testing. In performing the required tests, an accredited laboratory must adhere to CFFA’s standard conditions of test methods as outlined in ASTM D751-19-Standard Test Methods for Coated Fabrics. 

Testing includes parameters to measure chemical resistance, stain resistance, durability and other considerations. Once all tests are successfully completed, CFFA requires the certification form be filled out and signed, stating the product or pattern passes all tests within the standard. 

CFFA-HC-201 certification is in its beginning stages, so it is important to encourage industry acceptance by urging fabric manufacturers and distributor partners to get products certified. Once a product has passed CFFA-HC-201, designers can ask that it be labeled as such and market products that brandish the certification mark. 

Over time, the advantages of appropriately selected products in healthcare facilities will arise and result in increased product reliability, with less need for new installations. The goal of the CFFA-HC-201 standard is to prevent failures with healthcare furnishings by helping designers and managers select products that are reliable and fit for use for many years. 

Shari L. Solomon, Esq., is president and founder of CleanHealth Environmental, LLC. CleanHealth provides infection prevention and industrial hygiene training and consulting services geared toward facility personnel and vendors responsible for infection prevention, cleaning and disinfection, and facility operations and maintenance practices. Solomon has more than 20 years of environmental consulting and federal regulatory experience. An attorney by trade, combined with her experience in the industrial hygiene field with a focus on healthcare, Solomon holds a unique expertise and understanding of liability prevention techniques, offering clients practical and valuable risk management solutions.