By Larry Bernstein / Special to Healthcare Facilities Today

No one chooses to go to the hospital. However, the time spent in the hospital —whether it be as a patient or visitor —can have be made more agreeable with the right flooring. For medical staff, the maintenance crew and every other employee in the facility, the right flooring can make a difference.

While traditionally considered a passive surface, the floor is the foundation of all interior space. Flooring selection plays a key role in healthcare settings and is part of solving critical issues related to hygiene, infection control, durability, ease-of-cleaning and maintenance.

With growing expectations and shrinking budgets in healthcare facilities, the right flooring can help meet challenges with a broad range of durable, functional, efficient, sustainable, high quality and welcoming choices for every space and budget.

Sustainability

Trends are emerging in the flooring market as companies strive to meet the needs of healthcare facilities. One area of concern when it comes to flooring is sustainability. While this is not a new concern, "today, sustainability has grown-up and it's more than just adding recycled content or rapidly renewable materials," said April Hoelscher, Senior Marketing Manager, Commercial for Armstrong Flooring. "It's about transparency, life-cycle thinking and making an overall better product from a holistic perspective." 

These added considerations mean more complicated decisions when considering flooring. "Sacrificing long-term performance for what may be considered preferable green attributes does not account for life cycle," said Mark Huxta, Director of Sales – Healthcare for Ecore Commercial Flooring. "Maintenance plays into that holistic perspective as well as products that require less chemicals to preserve the sterile environment would contribute to sustainable initiatives." 

Another sustainability flooring trend is the reduction in harsh chemicals for cleaning. Health Care Without Harm announced their Healthy Flooring Initiative in November 2018. It establishes specific environmental attributes for resilient flooring in healthcare settings. This initiative, and others like it, create demand for PVC-free flooring products that perform in healthcare environments. Kieren Corcoran, Patcraft Director of Marketing for Institutional Markets said the company recently introduced EcoSystyem, a PVC-free resilient collection which is designed to perform in high-demand environments.

Infection control

While infection control has always been a concern at hospitals, floors are now also part of the battle. Because they are considered a low-touch area, the most important aspect is the ability to sanitize. The challenge of keeping the floors teams falls upon the environmental health safety (EHS) team.

 "The EHS team is challenged to turn over patient rooms as quickly as possible, and therefore use the same chemicals to clean the furniture, equipment in the space, as well as the flooring," said Jeremy Salomon, National Director of Segment Strategy, Healthcare for Tarkett."Not properly maintaining the floor with the correct chemicals can damage the floor and impact the performance of the floor."

These days, there is a move away from the use of antimicrobials in flooring products. Prevalent thinking in healthcare is that antimicrobial additives can have potential negative impacts. However, Natalie Jones Director of Healthcare Markets for Shaw Contract said, "There's a lack of evidence that additive antimicrobials effectively reduce HAIs (hospital-acquired infections). Additionally, they may result in resistance to antibiotics as well as migrate into our wastewater systems and negatively affect the environment."

Ease of maintenance

Healthcare facilities are looking for ways to restrain costs. Low-maintenance flooring products can help in that effort. There's a trend toward polish-optional products which offer hassle-free maintenance and eliminate harsh cleaning chemicals in the breathing zone to help improve indoor air quality. This trend is fueled by concerns about the chemicals used in the stripping and polishing process, as well as the time constraints faced by the EHS team.

Selecting flooring with maintenance in mind can be a challenging task. "There are good flooring products on the market in healthcare that seem like a good choice until it is realized that the maintenance process is so complicated a facility can’t afford the labor to keep them clean," said Jim Bistolas Healthcare Sales Director for Gerflor USA. "This is why even in the “no wax” world we live in, you will see a facility fall back to some type of protective coating to enable their environmental services team to keep the floor clean."

 While day-to-day maintenance procedures can eliminate the need for waxing and regular stripping, other factors should also be considered. "It's important in healthcare environments to have floors that will stand up to stains (e.g. from products like Betadine), harsh chemicals, and rigorous cleaning," said Kevin Reusch, Manager of Architectural/Engineering Program for Stonhard.

Noise control

Concern over noise control as evidence has shown that a quiet place to heal will improve patient outcomes. Flooring can contribute to the reduction of noise and impact the patient’s experience in the space. Despite this, Corcoran said, "The market is trending with the use of more hard surface flooring and open spaces, which have increased complaints about noise."

Waiting areas and other common spaces are seeing more luxury vinyl tile (LVT) for its natural-looking appearance, design flexibility and residential feel. Yet it also brings noise. Therefore, it’s important to include an acoustical underlayment for these products.

Rubber tile is an excellent choice to support sound absorption, according to Solomon. "More recent design innovations are making rubber flooring suitable in more high-profile spaces than just the gym and locker room, turning this once utilitarian product into a real design asset. 

Since HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) includes sound and acoustic issues in its patient surveys, hospitals have become more concerned about noise levels. And for good reason. "With reimbursements tied to HCAHPS, a financial component has been added to this issue, one that impacts the providers top line revenue," said Huxta.

Style/design

When considering facility style/design, flooring can be crucial. "Flooring is the largest horizontal surface in a facility and the design of the space plays off the flooring choice," Bistolas said. Trends in flooring are related to nature and replicating the home. The goal of each trend is to creating a calming, peaceful environment and a comfortable space for both patient and staff.

"Designers today are specifying non-institutional products that resemble the home experience," said Hoelscher. "They feature warm designs that do not feel institutional, offer coordinating colors and patterns, and facilitate wayfinding – all while matching specific facility aesthetics." She adds that flooring can contribute to biophilic design by replicating colors and textures found in nature and by creating graduated transitions that are commonly seen in nature. The different colors can allow "staff to spend less time providing directions and more time caring for patients."

At Shaw, Jones sees the use of LVT growing. However, she added, "Wood looks are still an important visual because of the visual warmth and residential aesthetic; however, we are seeing more modern interpretations on this classic e.g. abstracted woods, modern palettes, etc."

Keeping up with the trends and considerations above can be quite a challenge particularly since some conflict with each other. Jones suggested involving your flooring manufacturer, "who can be an effective partner in alleviating key challenges unique to this sector.

"Having deep conversations early in the selection process to engage and align key stakeholders"

Reusch agreed, "A conversation is required including texture review, typically through a mock-up process, to insure all parties are in agreement that the selected texture is appropriate for the environment in question."

When it comes time to select flooring for a healthcare facility, there are a number of attributes to consider which ultimately come down to budget considerations and performance expectations. However, Corcoran advised to "consider a holistic approach to product selection—one that takes into account all performance attributes."

Ultimately, each space is unique with specific needs, which flooring can help to accomplish. So, when selecting flooring, Hoelscher said, "The key is not so much the building, but the applications within the building and the performance requirements of the various areas within the facility."