Flooring for Healthcare: An Evidence-Based Design Approach

Live Webinar Wednesday, March 28, 2012

Produced with our partners:

Flooring for Healthcare:

An Evidence-Based Design Approach
Joe Martere National Healthcare Sales Director

IIDA March 28, 2012

Agenda

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

Flooring Issues in Healthcare

Aesthetic Needs Moisture Management Indoor Air Quality (IAQ) Odor/Infection Control Antimicrobials Safety (Slip/Fall) Ergonomics/Comfort Thermal Properties Roller Mobility Acoustics Visual Comfort/Glare Durability Environmental Impact First Cost/Life-Cycle Costs Maintenance Installation

Flooring Types

Hard Surface
Wood Bamboo Laminate Terrazzo Stone Marble Porcelain Tile Ceramic Tile VCT

Flooring Types

Hard Surface
Wood Bamboo Laminate Terrazzo Stone Marble Porcelain Tile Ceramic Tile VCT

Resilient Flooring
Cork Linoleum Sheet vinyl LVT Rubber

Flooring Types

Hard Surface
Wood Bamboo Laminate Terrazzo Stone Marble Porcelain Tile Ceramic Tile VCT

Resilient
Cork Linoleum Sheet vinyl LVT Rubber

Carpet
Broadloom Carpet (Tufted and Woven) Printed Carpet Axminsters (Woven wool carpets) Performance-Back Carpet

Modular (Carpet Tile)

Flooring Types

Hard Surface
Wood Bamboo Laminate Terrazzo Stone Marble Porcelain Tile Ceramic Tile VCT

Resilient
Cork Linoleum Sheet Vinyl LVT Rubber

Carpet
Broadloom Printed Axminsters Performance-Back Modular

Hybrids Flocked Nylon Flooring Woven Vinyl Flooring Hybrid Resilient Sheet Flooring

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

Indoor Air Quality

Issues
1. Volatile Organic Compounds 2. Respiratory Contaminants 3. Microbial Growth

Indoor Air Quality / Infection Control

How does flooring affect IAQ/Infection Control?

Select floorcoverings that are impermeable to moisture. Why?
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

Indoor Air Quality / Infection Control

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!

Is shiny clean?

Infection Control

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

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 of floors offers no advantage over regular detergent/water cleaning and has minimal or no impact on the occurrence of health-careassociated infections.947, 948, 977980 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

Infection Control Use of Antimicrobials

Antimicrobial Treatments
What are they? Do they work? Are they really needed?
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.

Safety & Ergonomics

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 in nursing homes

29% of injured die with six months

50% do not return home

(Source: Nursing Times Magazine)

Safety & Ergonomics

Impact of Slip/Fall Incidents

Study 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

Most common injuries experienced by nurses.

Together, knee and ankle injuries (sprains/strains) account for 10% of workers compensation claims.

Safety & Ergonomics

Ergonomic/Human Factor Univ. of Pittsburgh Study Conclusions:

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.

Safety & Ergonomics

Rolling Resistance/Mobility

Hard wheel rolling on and deforming a soft surface, resulting in the reaction force from the surface having a component that opposes the motion

Safety & Ergonomics

Rolling Resistance/Mobility Gurney + 200 lbs.

Movement of Gurney + 200lbs.

VCT

Modular Carpet/ Hard Backing 14.6 lbs 11.8 lbs 14.7 lbs

Hybrid Resilient Sheet Flooring 17.85 lbs 13.3 lbs 14 .0 lbs

Effort Required to Initiate Movement Effort Required to Sustain Movement Effort Required to Push Around Corner

10.6 lbs 8.2 lbs 11.0 lbs

Safety & Ergonomics

Rolling Resistance/Mobility Wheel Chair + 200 lbs.

Movement of Wheel Chair + 200lbs.

VCT

Modular Carpet/ Hard Backing 4.6 lbs 3.8 lbs 4.7 lbs

Hybrid Resilient Sheet Flooring 7.85 lbs 5.3 lbs 7 .5 lbs

Effort Required to Initiate Movement Effort Required to Sustain Movement Effort Required to Push Around Corner

2.0 lbs 1.2 lbs 3.4 lbs

Thermal Properties

R-Values (h2 F/btu)

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.

Acoustics

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)

Visual Comfort/Glare

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

Installation

24/7 Occupancy Floor Prep/Moisture Limits VOCs (Adhesives & Sealers) Adhesive set-up and cure time Downtime/Lost Revenue

Hard Surface Flooring

STRENGTHS
Lowest level of roller resistance
Easy to clean & disinfect Most Durable Impermeable to moisture

WEAKNESSES
Increased incidences of slips/falls and related injuries
High glare (waxed VCT / Marble) Maintenance costs (equipment, man power and chemicals when waxed) Poor acoustical properties/increased noise Low thermal insulation value Undesirable ergonomics/comfort

Installation limitations

Resilient Flooring

STRENGTHS
Low level of roller resistance
Easy to clean & disinfect More Durable Impermeable to moisture Creative flexibility for inlays

WEAKNESSES
Potential for slips/falls and related injuries
Varying levels of glare (when waxed) Maintenance costs (equipment, man power & chemicals when waxed ) Increased Airborne Particulates Varying levels of thermal value Varying levels of ergonomics/comfort Scuffing and scratching of no-wax finishes Installation limitations

Carpet

STRENGTHS
Lower incidences of slips/falls and related injuries
Eliminates glare Better acoustics Some thermal benefits

WEAKNESSES
High Level of roller resistance
Less durable Difficult to Maintain Moisture permeable / Flow-thru

Better ergonomics/comfort

Stains easily / Harbors Odors

Microbial Growth / Infection Control

Installation Limitations

Hybrid Resilient Sheet Flooring

STRENGTHS
Lower incidences of slips/falls and related injuries
Eliminates glare Improved acoustics Maximum thermal benefits Impermeable moisture barrier / Welded seams Comfort under foot / Reduced fatigue 24/7 Installations / Immediate Occupancy

WEAKNESSES
Medium level of roller resistance
Textile surface restricts use to non-clinical spaces in acute care facilities

Thank you Flooring for Healthcare:

An Evidence-Based Design Approach Course: TANHC1011

Joe Martere jmartere@tandus.com

April 29 May 1, 2012

Disney Contemporary Resort | Orlando, FL www.EnvironmentsforAging.com
A conference addressing the latest design strategies for creating attractive and functional living environments that meet the needs of our aging population.

Earn up to 15 CEUs!

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