Flooring for Healthcare: An Evidence-Based Design Approach Your Name Your Title Account Name
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Flooring for Healthcare: An Evidence-Based Design Approach Your Name Your Title Account Name City, State Date
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Flooring for Healthcare: An Evidence-Based Design Approach Your Name Your Title Account Name City, State Date. Agenda. Flooring Issues in Health Care Environments Different Floor Covering Options - PowerPoint PPT Presentation
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Flooring for Healthcare:An Evidence-Based Design Approach
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Flooring Issues in Health Care Environments
Different Floor Covering Options
Evidence Based Design Approach to Evaluate Flooring (safety, comfort and well being of patients & staff)
Installation Issues
Floor Coverings Strengths & Weaknesses
Agenda
Aesthetic NeedsMoisture ManagementIndoor Air Quality (IAQ)Odor/Infection ControlAntimicrobialsSafety (Slip/Fall)Ergonomics/ComfortThermal PropertiesRoller MobilityAcousticsVisual Comfort/GlareDurabilityEnvironmental ImpactFirst Cost/Life-Cycle CostsMaintenanceInstallation
Flooring Issues in Healthcare
Hard Surface
WoodBambooLaminateTerrazzoStoneMarblePorcelain TileCeramic TileVCT
Flooring Types
Hard Surface Resilient Flooring
WoodBambooLaminateTerrazzoStoneMarblePorcelain TileCeramic TileVCT
Flooring Types
CorkLinoleumSheet vinylLVTRubber
Hard Surface Resilient
WoodBambooLaminateTerrazzoStoneMarblePorcelain TileCeramic TileVCT
Flooring Types
CorkLinoleumSheet vinylLVTRubber
Carpet
Broadloom Carpet (Tufted and Woven)Printed Carpet Axminsters (Woven wool carpets)Performance-Back Carpet
Modular (Carpet Tile)
Hard Surface Resilient
Wood CorkBamboo LinoleumLaminate Sheet VinylTerrazzo LVTStone RubberMarblePorcelain TileCeramic TileVCT
Flooring Types
Hybrids
Flocked Nylon FlooringWoven Vinyl FlooringHybrid Resilient Sheet Flooring
Carpet
BroadloomPrintedAxminsters Performance-Back Modular
Evidence-Based Design
Process of basing decisions about the built environment on credible research to achieve the best possible outcomes.
Evidence-Based Design
Objectives:
Improve patient/resident as well as visitor and staff satisfaction
Improve quality & operational
effectiveness (clinical outcomes) Lower cost of ownership
Issues
1. Volatile Organic Compounds2. Respiratory Contaminants3. Microbial Growth
Indoor Air Quality
How does flooring affect IAQ/Infection Control?
Select floorcoverings that are impermeable to moisture.
Why?
Indoor Air Quality / Infection Control
Spills do not “flow through” to subfloor
Easier to clean with less chemicals
Does not provide food source and environment for micro organisms including mold.
Moisture Management / Infection Control
Flow Through vs.Impermeable
Moisture Management / Infection Control
Impermeable Moisture Barrier
How does flooring affect IAQ/Infection Control?
Select floor coverings that can serve as a “sink” to trap airborne particulates and be easily and effectively removed.
Why?Shiny does not equal “Clean.”It equals “Shiny!”
Indoor Air Quality / Infection Control
Is “shiny” clean?
Hospital-Acquired/Nosocomial Infections
90,000 deaths annually
Most important preventative measure?
Infection Control
Hospital-Acquired/Nosocomial Infections
Surface Sanitation
High-Touch(door handles, bed rails)
Low-Touch(Floors and Ceilings)
Infection Control
Hospital-Acquired/Nosocomial Infections
Infection Control
“Extraordinary cleaning and decontamination of floors in health-care settings is unwarranted.“
Centers for Disease Control
Infection Control - Summary
CDC GUIDELINES:
Extraordinary cleaning and decontamination of floors in health-care settings is unwarranted. Studies have demonstrated that disinfection offloors offers no advantage over regular detergent/water cleaningand has minimal or no impact on the occurrence of health-care–associated infections.947, 948, 977–980
Additionally, newly cleaned floors become rapidly recontaminated from airborne microorganisms and those transferred from shoes, equipment wheels, and body substances.971, 975, 981
Focus on those surfaces in close proximity to patient (e.g., bedrails)and those that are frequently touched (e.g., doorknobs).
FLOORING IS CONSIDERED A “LOW-TOUCH” SURFACE
Antimicrobial Treatments
What are they?Do they work?Are they really needed?
Infection Control – Use of Antimicrobials
CDC INFECTION CONTROL GUIDELINES (2003)
“Over the last few years, some carpet manufacturers have treated their products with fungicidal and/or bactericidal chemicals. Although these chemicals may help to reduce the overall numbers of bacteria or fungi present in carpet, their use does not preclude the routine care and maintenance of the carpeting. ”
Implications of Flooring Selection
Impact of Slip/Fall Incidents Ergonomic/Human Factor Rolling Resistance/Mobility
Safety & Ergonomics
Impact of Slip/Fall Incidents
1800 fatal falls per year innursing homes
29% of injured die with six months
50% do not return home
(Source: Nursing Times Magazine)
Safety & Ergonomics
Impact of Slip/Fall IncidentsStudy Summary
213 fall/accidents studied
27 Falls (13%) occurred on soft surface (4 injured = 15%)
186 falls (87%) occurred on hard surface (167 injured – 90%)
Safety & Ergonomics
Effects on Staff
Safety & Ergonomics
Safety & Ergonomics
Most common injuries experienced by nurses.
Together, knee and ankle injuries (sprains/strains) account for 10% of workers’ compensation claims.
Ergonomic/Human Factor
Univ. of Pittsburgh StudyConclusions:
Safety & Ergonomics
1. Cushion and carpet pile density affect muscle response.
2. Firm cushion provides lowest muscle responses (less muscle fatigue).
3. Low pile height has the lowest muscle response (less muscle fatigue).
4. Low pile height in conjunction with a very firm cushion provided lowest muscle response of all samples tested.
Rolling Resistance/Mobility
Safety & Ergonomics
Hard wheel rolling on and deforming a soft surface, resulting in the reaction force from the surface having a component that opposes the motion
Rolling Resistance/MobilityGurney + 200 lbs.
Safety & Ergonomics
Movement of Gurney + 200lbs. VCT Modular Carpet/ Hard Backing
Hybrid Resilient Sheet Flooring
Effort Required to Initiate Movement 10.6 lbs 14.6 lbs 17.85 lbs
Effort Required to Sustain Movement 8.2 lbs 11.8 lbs 13.3 lbs
Effort Required to Push Around Corner 11.0 lbs 14.7 lbs 14 .0 lbs
Rolling Resistance/MobilityWheel Chair + 200 lbs.
Safety & Ergonomics
Movement of Wheel Chair + 200lbs. VCT Modular Carpet/ Hard Backing
Hybrid Resilient Sheet Flooring
Effort Required to Initiate Movement 2.0 lbs 4.6 lbs 7.85 lbs
Effort Required to Sustain Movement 1.2 lbs 3.8 lbs 5.3 lbs
Effort Required to Push Around Corner 3.4 lbs 4.7 lbs 7 .5 lbs
R-Values (h2 – F/btu)
Thermal Properties
Acoustics
Better acoustics Lower stress Lower blood pressure Improved sleep Higher patient satisfaction Increased visitation Lower error rates Higher staff moral
Rise In Hospital Noise Poses Problems For Patients And Staff, Science Daily 2005
Acoustics
Since 1960, daytime sound levels have risen from 57 decibels to 72; nighttime has jumped from 42 decibels to 60.
All exceed the World Health Organization's 1995 hospital noise guidelines, of 35 decibels. The measurements vary little among different types of hospitals, indicating the problem is universal.
Closed Cell Cushion reduced reverberation times from 8% - 25%1.
1LEE SOUND DESIGN, Inc.Consulting Engineers in Audio, Acoustics and Video Acoustical Report.wpd (classroom analysis)
Acoustics
Glare plus compromised vision can create eye pain
Wet/slippery appearance has paralyzing effect
Resident can become immobile due to fear, anxiety, confusion
Result is “passive restraint” Glare can be measured – Light Reflectance Value (LRV)
Visual Comfort/Glare
Visual Comfort/Glare
Visual Comfort/Glare
Visual Comfort/Glare
Installation
24/7 Occupancy Floor Prep/Moisture Limits VOCs (Adhesives & Sealers) Adhesive set-up and “cure” time Downtime/Lost Revenue
Hard Surface Flooring
STRENGTHS WEAKNESSES
Lowest level of roller resistance Increased incidences of slips/falls and related injuries
Easy to clean & disinfect High glare (waxed VCT / Marble)
Most Durable Maintenance costs (equipment, man power and chemicals when waxed)
Impermeable to moisture Poor acoustical properties/increased noise
Low thermal insulation value
Undesirable ergonomics/comfort
Installation limitations
Resilient Flooring
STRENGTHS WEAKNESSESLow level of roller resistance Potential for slips/falls and related injuries
Easy to clean & disinfect Varying levels of glare (when waxed)
More Durable Maintenance costs (equipment, man power & chemicals when waxed )
Impermeable to moisture Increased Airborne Particulates
Creative flexibility for inlays Varying levels of thermal value
Varying levels of ergonomics/comfort
Scuffing and scratching of no-wax finishes
Installation limitations
Carpet
STRENGTHS WEAKNESSES
Lower incidences of slips/falls and related injuries
High Level of roller resistance
Eliminates glare Less durable
Better acoustics Difficult to Maintain
Some thermal benefits Moisture permeable / Flow-thru
Better ergonomics/comfort Stains easily / Harbors Odors
Microbial Growth / Infection Control
Installation Limitations
Hybrid Resilient Sheet Flooring
STRENGTHS WEAKNESSES
Lower incidences of slips/falls and related injuries
Medium level of roller resistance
Eliminates glare Textile surface restricts use to non-clinical spaces in acute care facilities
Improved acoustics
Maximum thermal benefits
Impermeable moisture barrier / Welded seams
Comfort under foot / Reduced fatigue
24/7 Installations / Immediate Occupancy
Thank you
Flooring for Healthcare:An Evidence-Based Design ApproachCourse: TANHC1011 (AIA) 40411 (NCIDQ)
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