Flooring for Healthcare: An Evidence-Based Design Approach Your Name Your Title Account Name

1. Flooring for Healthcare: An Evidence-Based Design Approach Your Name Your Title Account Name City, State Date

2. 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

3. 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

4. Flooring Types Hard Surface Wood Bamboo Laminate Terrazzo Stone Marble Porcelain Tile Ceramic Tile VCT

5. Flooring Types Hard SurfaceResilient Flooring Wood Bamboo Laminate Terrazzo Stone Marble Porcelain Tile Ceramic Tile VCT Cork Linoleum Sheet vinyl LVT Rubber

6. Flooring Types Carpet Broadloom Carpet (Tufted and Woven) Printed Carpet Axminsters (Woven wool carpets) Performance-Back Carpet Modular (Carpet Tile) Hard SurfaceResilient Wood Bamboo Laminate Terrazzo Stone Marble Porcelain Tile Ceramic Tile VCT Cork Linoleum Sheet vinyl LVT Rubber

7. Flooring Types Hard SurfaceResilient Wood Cork Bamboo Linoleum Laminate Sheet Vinyl Terrazzo LVT Stone Rubber Marble Porcelain Tile Ceramic Tile VCT Carpet Broadloom Printed Axminsters Performance-Back Modular Hybrids Flocked Nylon Flooring Woven Vinyl Flooring Hybrid Resilient Sheet Flooring

8. Evidence-Based Design Process of basing decisions about the built environment on credible research to achieve the best possible outcomes.

9. Evidence-Based Design • Objectives: • Improve patient/resident as well as visitor and staff satisfaction • Improve quality & operational • effectiveness • (clinical outcomes) • Lower cost of ownership

10. Indoor Air Quality Issues Volatile Organic Compounds Respiratory Contaminants Microbial Growth

11. 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.

12. Moisture Management / Infection Control Flow Through vs. Impermeable

13. Moisture Management / Infection Control Impermeable Moisture Barrier

14. 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?

15. Infection Control Hospital-Acquired/ Nosocomial Infections 90,000 deaths annually Most important preventative measure?

16. Infection Control Hospital-Acquired/ Nosocomial Infections Surface Sanitation High-Touch (door handles, bed rails) Low-Touch (Floors and Ceilings)

17. Infection Control Hospital-Acquired/ Nosocomial Infections • “Extraordinary cleaning and decontamination of floors in health-care settings is unwarranted.“ • Centers for Disease Control

18. 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-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

19. 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. ”

20. Safety & Ergonomics • Implications of Flooring • Selection • Impact of Slip/Fall Incidents • Ergonomic/Human Factor • Rolling Resistance/Mobility

21. 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)

22. 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%)

23. Safety & Ergonomics Effects on Staff

24. Safety & Ergonomics Most common injuries experienced by nurses. Together, knee and ankle injuries (sprains/strains) account for 10% of workers’ compensation claims.

25. Safety & Ergonomics Cushion and carpet pile density affect muscle response. Firm cushion provides lowest muscle responses (less muscle fatigue). Low pile height has the lowest muscle response (less muscle fatigue). Low pile height in conjunction with a very firm cushion provided lowest muscle response of all samples tested. Ergonomic/Human Factor Univ. of Pittsburgh Study Conclusions:

26. 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

27. Safety & Ergonomics Rolling Resistance/Mobility Gurney + 200 lbs.

28. Safety & Ergonomics Rolling Resistance/Mobility Wheel Chair + 200 lbs.

29. Thermal Properties R-Values (h2 – F/btu)

30. 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

31. 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.

32. 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)

33. 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)

34. Visual Comfort/Glare

35. Visual Comfort/Glare

36. Visual Comfort/Glare

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

38. Hard Surface Flooring

39. Resilient Flooring

40. Carpet

41. Hybrid Resilient Sheet Flooring

42. Thank you Flooring for Healthcare: An Evidence-Based Design Approach Course: TANHC1011 (AIA) 40411 (NCIDQ) Your Name Your Email Address