By Jennifer Kenson / Special to Healthcare Facilities Today

Maintaining patient health is always a top priority for healthcare facilities—now more than ever.

Standards of care are designed around patient wellness and multi-disciplinary care that help keep patients out of the hospital. With that objective in mind, materials used within healthcare spaces must be scrutinized for their impact, not only on the immediate patient environment but their broader environmental impact as well. With an increased focus on whole body health, integrative medicine practices—which use a combination of modern healthcare practices to diagnose and treat a patient—are a leading group of physicians that advocate for healthier spaces.

In fact, a large healthcare system in the Philadelphia suburbs has developed a master standards program that includes a consistent level of quality and specific products to utilize across the entire system. When these standards were initially developed, the focus on healthy materials was not a top priority, and oftentimes the available options and costs limited the system’s ability to ‘standardize’ healthier products.

When it came to implementing these standards for an integrative medicine practice, one of the directives from the physician group was to use materials that did not impact their patients’ health. As health advocates, they questioned the established standards, which in turn led the team on a path to research and specify products that met their expectations.

The FCA design team reviewed the current state of industry standards for products and materials as they developed a response for the design strategy for the integrative medicine practice. The team looked at how products are evaluated to better educate themselves and their clients. The common denominator for good products was their transparency—knowing where the products come from, what they are made of, and where they go at the end of their life cycle.

As LEED certification criteria developed with each successive version, the way materials are considered and weighted has changed. The importance of the EPD (Environmental Product Declaration) and HPD (Health Product Declaration) have become an essential part of the evaluation criteria of MR Credits. Th impact of this has expanded beyond LEED projects, providing an increased awareness of the available data for materials. As a collective, the architecture and design community is applying the pressure for increased product transparency regardless of whether their clients are working toward LEED certification or not. The Healthy Hospital Initiative (HHI) is experiencing a similar impact by including programs that avoid the use of chemicals linked to negative health and environmental impacts. Although HHI looks holistically at the community and built environment, architects and designers can impact projects by ensuring the implementation of safer chemicals.

Architecture and design firms are also asking our manufacturers to clearly identify how they are certified in their respective industries, such as do they meet the requirements of criteria such as ‘DECLARE’ or Green Globes. There are also website specific tools that can search for sustainable products. These sites partner with the United States Green Building Council, simplify the specification process by having a centralized search engine. As an example, the Healthcare Without Harm website is a great resource to locate materials that meet the HHI requirements with PDF downloads of product vendors and products.

There are products available in the marketplace that meet the healthy material goals for nearly every surface found in healthcare facilities. It is important to discuss how facility maintenance teams clean their facilities, including the frequency, equipment, and cleaning products used. The selected materials must perform as well as their less healthy alternatives. Floors, walls, and ceilings take up most of the materials in any construction project. Both the applied finish materials and unexposed materials below should be evaluated and specified with sustainability in mind.

Floors

Rubber and linoleum are leaders in this area, as material content for the products is composed mostly of natural, renewable ingredients. These two products are better options than vinyl composition tile, sheet vinyl, and luxury vinyl tile. With increased pressure from the architecture and design community, the resilient flooring industry has invested in providing PVC-free, resilient products. There is also an increased transparency for all flooring products—EPD’s and HPD’s are readily available. In addition, designers are able to select from a wide variety of options to create the type of interior aesthetics that clients are looking for.

The use of carpet within healthcare interiors is limited, and varies from project to project, client to client and regions across the country. Manufacturers now offer PVC-free carpet backing for their products, and overall, the producers have a great track record for being at the forefront of recycling programs—both in the taking back of products and within the manufacturing process itself. This is evident in the amount of credentials that their products carry to meet sustainable requirements.

Walls

Another prevalent surface material found in healthcare interiors is wall protection and related products.From corner guards, crash rails, bumper rails, and rigid sheet products, they are all used to protect gypsum wall board substrates in high impact areas. The large manufacturers of these products offer a PVC-free option that performs equally to their PVC predecessors. Using the PVC-free option should be a default specification.

The paint industry has been years ahead of most other product categories. Low VOC and zero VOC were first introduced in the 1990s. This is another product type that is typically specified as water-based, low- or VOC-free. Newer to the market are the microbicidal paints that can kill bacteria on the surface over a certain length of time, although they are a higher cost option. Prioritizing where they are used to be most effective can help control the costs.

Ceilings

When specifying acoustical ceiling panels and tiles, paying attention to the details can ensure that the products with the best benefits are utilized to their fullest extent. The trend of recycling, and using recycled content of mineral fiber ceilings continues to increase. Even the less expensive options have recycled content that can increase the overall benefits of the space.

Hard Surfaces

Numerous surfacing materials have been developed with health benefits in mind. Clients are assessing these products to evaluate their effectiveness, mostly for combatting hospital acquired infections (HAI).

Several have evidence-based research to provide information on effectiveness. The cost is usually higher than regular materials, however if a project has the budget, the reduced HAI rate can impact a hospital's bottom line as facilities are not reimbursed for treatment by some insurers, for infections acquired by patients during their hospital stay.

One hard surface product developed by EOS Solid Surfaces uses the inherent antimicrobial properties of copper through the integration of copper nanoparticles within the product. Primarily used to make countertops, if kept clean, the surface can kill bacteria in roughly 30 minutes.

Another interesting product, the Krion K Life, has been developed to clean the air of certain contaminants through the use of natural light and the photocatalytic process. If there is adequate natural light within a space, a product like this might be beneficial for spaces such as patient treatment rooms that have an exterior window. The product is 100% recyclable, and meets many other sustainability criteria.

Textiles

Cubicle curtains can be found in most healthcare settings to provide privacy for patients. The fibers used in most cubicle curtains are some combination of the following products: FR polyester, post-consumer recycled FR polyester, post Industrial recycled polyester, and Trevira CS polyester. For the ‘FR’ and ‘CS’ products, one important detail to note is that fire-retardant properties have been developed to be integrated into the fiber, not as an applied treatment.

While this is a positive, manufacturers must ensure that the products are OEKO-TEX Standard 100 certified. This certification verifies that all components of a product are “tested for harmful substances and that the article therefore is harmless in human ecological terms.”

When selecting curtains, designers should also request products that are free of PFC, antimicrobials or other fire retardant products that are not tested and certified safe.

Fabrics for healthcare settings have evolved beyond basic vinyl. There are now PVC-free products and silica-based products that can be selected. Each of these options had growing pains with performance based on the construction and delamination issues. But as technology has improved, so have the products, and they can now withstand the immense wear and tear of the healthcare environment. New to the US market is a product called Celliant—a fabric backing product for textiles that has been clinically proven to increase circulation and is an FDA approved wellness product.

Below the Surface

Every construction project uses a large amount of materials that we do not see, such as metal studs, ductwork, plywood substrates, and gypsum wall board. All of these essential building products are available with characteristics that decrease the impact to our environment. Designers and architects must rework master specifications to include these features as a baseline for all projects. Having a minimum for recycled content, a policy on no urea formaldehyde for wood products, limiting fire retardants, and requiring EPD’S and HPD’s pushes all projects to a healthier baseline rather than a few select ones. The FCA team compiled their findings and reviewed with their integrative medicine healthcare client.

Ultimately, the client stayed true to their vision and pushed the team to use the best products for their practice. FCA specified many of the products discussed and expect to see a completed product, utilizing these new practices and products by early 2021.

Jennifer Kenson, Principal, Interior Designer at FCA (Francis Cauffman Architects)