Today’s healthcare providers are embracing Evidence-Based Design (EBD) principles, which are based on the profound effect of the build environment on patients’ experiences and outcomes, as well as the health and well-being of the staff. Incorporating EBD has become a necessity, since it’s a healthcare institution’s financial responsibility to ensure their capital investments achieve many objectives.

With this in mind, The Johns Hopkins Hospital (JHH), formed in 1889 in Baltimore, Md., is ahead of the curve. A national leader in patient care, medical research, and teaching, Johns Hopkins Health System (JHHS) includes six academic and community hospitals, four suburban healthcare and surgery centers, more than 30 primary healthcare outpatient sites, as well as programs for national and international patient activities. When it was time to start thinking about an alternative to carpet, JHH went to work.

“We can’t keep carpet clean,” said Teri Bennett, RN CID CHID IIDA NIHD EDAC & Lead Interior Designer in Architecture & Planning Department at JHH. “Our consultants wanted us to use new products in projects that hadn’t been tested in active healthcare environments. We didn’t want to install them without testing.”

Under the direction of the hospital’s Facility Planning and Maintenance Team, JHH conducted a system wide multi-disciplinary research flooring testing study over a 90 day period from November 22, 2014 to February 21, 2015. The test protocol and process utilized the 2014 FGI Guidelines Surfaces and Furnishings for performance criteria selection guidelines. The objectives of this test were to:

• Research and develop test protocols for flooring safety, performance, and cleaning methodology

• Implement those protocols in a coordinated comprehensive testing period, concluding in developing flooring standards for use at JHH 

• Learn how EBD surface material selection contributes to improved patient outcome and HCAHAPS scores.

The first two challenges were to reduce the use of under-performing, environmentally harmful, expensive, and difficult surfaces to maintain and to establish a no-carpet flooring policy for all future projects. As a result, JHH tested 20 products; 11 resilient surfaces and 9 acoustic, non-carpet surfaces; more specifically: 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,” said Andrea Hyde, AAHID, MDCID & Planner Designer in Architecture & Planning Department at JHH. “We wanted to prove to ourselves that we could try sustainable products and see how they do.”

The fourth and fifth challenges for JHH were to test 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. In other words, installing products that don’t require wax and that could be cleaned and maintained using Oxi-Clean and Oxi-Seal.

The JHH test area that was 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. One direction/side of each product was sealed and the other side was unsealed. Installing an unsealed floor is not an uncommon practice at JHH, since many times this procedure cannot occur until after rooms are occupied.  “That really showed itself,” said Hyde. “Some products became complete dirt magnets without sealer.”

“It was a true test,” said Bennett. “It was between November 2014 and February 2015, so it was right at winter time.” Hyde added, “Even though the Metro is underground, the weather was a factor. You really did see the tracked in salt and moisture and things coming from people’s feet and going across it (the surfaces).”

The result: “Some of the most sustainable products failed really miserably,” said Hyde. “They needed more care than we could give, or material collected soiling due to the inherent open pore design.” JHH only had 2 product failures, because the surfaces didn’t wear well or changed color with the use of the Oxi-Seal. “It wasn’t a dirt wear; the product got darker and darker as we cleaned it," said Bennett.

One of the products that performed the best was Ecore Commercial Flooring’s Terrain rx. Available in 6-foot-wide rolls, this flooring features 5 millimeters of Ecore's performance rubber fusion-bonded to a contemporary, modern heterogeneous vinyl sheet surface. This dynamic duo results in 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,” said Hyde. 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,” said Hyde. “We felt the products we were testing on that side, Ecore’s (Terrain rx) included, were truly making a sound difference, as people rolled on that side of the floor. It was rattily on the tile. Then you moved, and it would be dead – the clicking, the rolling noises, and all that stuff,” said Hyde.

Those using the JHH Testing Corridor also noticed when the Terrain rx was no longer there. “People commented when it left,” said Hyde. “People were not happy. The (Metro) tunnel can be quiet loud.” Bennett added, “people definitely noticed it felt better under foot too.”

Other test areas Terrain rx performed well in included durability, stain removal, and clean-ability.

When analyzing the sheet goods, like Terrain rx, JHH placed the seam in the middle of each testing site, using the manufacturer’s recommended weld rod. “We were a little concerned about the rx because of the compression factor,” said Hyde. “We wondered if we would see some failure at the heavy traffic edge. We did not; it worked great actually.”

With regard to cleaning, some products changed color with the Oxi-Clean or Oxi-Seal. “The rx product never had an issue at all,” said Bennett. “There were no issues with cleaning at all on both sides (sealed and unsealed). And the seam remained intact throughout the test.”                

Another benefit of specifying Terrain rx is that the surface’s high-quality cross-linked polyurethane reinforcement (PUR) provides a low cost, polish-free maintenance regime for the lifetime of the product.

As a result of Terrain rx’s positive performance and because it fulfilled JHH’s 4 criteria challenges – to be a  high performance surface that is not carpet and incorporates green/sustainable materials that requires low-VOC cleaning techniques and is not a high-gloss surface – JHH specified and installed in November Forest rx for 56 inpatient rooms in the JHH Meyer Neuro & Rehab facility.

“It was because of the success of the Terrain rx product that we made the commitment to use Forest rx in our Meyer renovation,” said Bennett.  

Forest rx is Terrain rx’s sister product and features all of Terrain rx’s attributes and benefits with a different visual – wood instead of stone. To learn more about Terrain rx and Forest rx, visit: http://www.ecorecommercialflooring.com/rx/index.php. To learn more about JHH, visit: http://www.hopkinsmedicine.org/.