SPECIAL REPORT
Hygenic Flooring Solutions for Hospital and Healthcare Facilities
The Right Flooring for Healthcare Don’t Look Down on the Floor Getting the Flooring Right for the Long Term A Key Contributor to Patient Health Let’s Get Down to Material Matters Sponsored by
Published by Global Business Media
LOOKING F DURABLE, HYGOR IENIC FLOORING?
HIGH PERFORMANCE SEAMLESS FLOORING FOR HOSPITALS & HEALTHCARE
Flowcrete manufactures high performance epoxy & polyurethane resin flooring solutions, providing exceptional hygiene & resistance properties to transform all areas of healthcare environments. TALK TO THE FLOORING TEAM TODAY +44 (0) 1270 753 000
uk@flowcrete.com
@flowcreteuk
www.flowcrete.co.uk
SPECIAL REPORT: HYGIENIC FLOORING SOLUTIONS FOR HOSPITAL AND HEALTHCARE FACILITIES
SPECIAL REPORT
Hygenic Flooring Solutions for Hospital and Healthcare Facilities
Contents Foreword
2
John Hancock, Editor
The Right Flooring for Healthcare
3
Flowcrete UK Ltd The Right Flooring for Healthcare Don’t Look Down on the Floor Getting the Flooring Right for the Long Term A Key Contributor to Patient Health Let’s Get Down to Material Matters Sponsored by
Published by Global Business Media
Published by Global Business Media Global Business Media Limited 62 The Street Ashtead Surrey KT21 1AT United Kingdom Switchboard: +44 (0)1737 850 939 Fax: +44 (0)1737 851 952 Email: info@globalbusinessmedia.org Website: www.globalbusinessmedia.org Publisher Kevin Bell Business Development Director Marie-Anne Brooks Editor John Hancock Senior Project Manager Steve Banks Advertising Executives Michael McCarthy Abigail Coombes Production Manager Paul Davies For further information visit: www.globalbusinessmedia.org The opinions and views expressed in the editorial content in this publication are those of the authors alone and do not necessarily represent the views of any organisation with which they may be associated.
A History of Innovation and Development A Flooring Solution for a Range of Applications Installation and Long-Term Care Summary
Don’t Look Down on the Floor
6
John Hancock, Editor
Hygiene Depends on a Good Floor What Makes a Good Floor? Where Flooring Matters
Getting the Flooring Right for the Long Term
8
Camilla Slade, Staff Writer
Important Flooring Issues Performing Whatever the Conditions Specifying and Selecting a Hospital Floor
A Key Contributor to Patient Health
10
Peter Dunwell, Medical Correspondent
An Active Component in the Good and Safe Running of a Hospital Selecting, Installing and Maintaining a Floor Fit for Purpose Summary
Let’s Get Down to Material Matters
12
John Hancock, Editor
An Important Role Requires the Best Materials Different Materials Offer Different Properties Future Outlook
References 14
Material in advertisements and promotional features may be considered to represent the views of the advertisers and promoters. The views and opinions expressed in this publication do not necessarily express the views of the Publishers or the Editor. While every care has been taken in the preparation of this publication, neither the Publishers nor the Editor are responsible for such opinions and views or for any inaccuracies in the articles.
© 2020. The entire contents of this publication are protected by copyright. Full details are available from the Publishers. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical photocopying, recording or otherwise, without the prior permission of the copyright owner.
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SPECIAL REPORT: HYGIENIC FLOORING SOLUTIONS FOR HOSPITAL AND HEALTHCARE FACILITIES
Foreword W
HILE THE people and the technology
Hancock then takes a broad view of the hospital and
can often seem the stars of the show
healthcare facility floor, why floors are important and
in any hospital and, of course, they are critical
what capabilities and requirements that importance
components, there is another critical component
dictates. Next, Camilla Slade considers how to ensure
in the modern hospital that rarely gets any attention,
that the floor meets all that is required of it throughout
let alone star billing. That’s the floor, the surface
its lifetime and what priorities should govern the
on which all the people, equipment and processes
specification and procurement of a good floor.
quite literally stand as well as the surface where
Peter Dunwell takes on the task of matching flooring
a very high proportion of any discards, spillage
to its different tasks for various groups, especially
or lost bodily fluids are likely to settle. Therefore,
patients and staff, in a healthcare facility. He also goes
it can honestly be said that the quality of materials,
into the role of maintenance and cleaning and how the
installation and maintenance for the floor are
choice of floor can make those tasks easier and more
critical factors in successful treatments and
effective. Finally, John Hancock, again, looks at the
infection control.
main materials available for health care flooring and
We’ve set out in this paper to look more closely at
how they compare in performance, durability and cost.
the hospital floor, with a first article from Flowcrete,
Far from being ‘just’ the floor, the floor in a hospital
a market-leading manufacturer of seamless resin
or healthcare facility is an integral part of the
flooring and cementitious floor screeds for commercial
healthcare process.
and industrial projects, about a material innovation that looks likely to add value to hospital flooring in several ways – quality, durability and cost effectiveness. John
John Hancock Editor
John Hancock an Editor of Hospital Reports Europe, has worked in healthcare reporting and review for many years. A journalist for nearly 30 years, John has written and edited articles, papers and books on a range of medical and management topics. Subjects have included management of long-term conditions, elective and non-elective surgery, wound management, complex health issues, Schizophrenia, health risks of travel, local health management and NHS management.
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SPECIAL REPORT: HYGIENIC FLOORING SOLUTIONS FOR HOSPITAL AND HEALTHCARE FACILITIES
The Right Flooring for Healthcare Flowcrete UK Ltd A floor that is flexible and easily installed with proven integrity and clinical quality for the most demanding of sectors
F
LOORING MIGHT not be the first component that springs to mind when we think about a healthcare facility. Hardly anybody notices it and yet it is involved in most of the work and would soon be missed if not there or if it couldn’t function as required. The challenge is both in understanding that, like any other part of the facility, the flooring needs to be appropriate to the different activities that take place, and in creating different flooring solutions that can match those various needs.
SO FRESH & SO CLEAN… ANTIMICROBIAL, EASY-CLEAN FLOORING
A History of Innovation and Development
A Flooring Solution for a Range of Applications From the considerable Flowcrete range of solutions, one stands out as suitable for healthcare facilities such as hospitals. Flowfresh, formerly known as Ultrafresh has been in
development since the early nineteen nineties. Over years of development, this product has continuously been improved including with the availability of minimal packaging, as it is possible to bulk produce and use IBC’s for storage and transportation, and decanting on site. We can use IBC’s because Flowcrete products have a stable emulsion, meaning they can be transported, stored and decanted on site without the product splitting or separating. Flowfresh has been engineered to provide better physical properties, and sound strength properties. It is also an ideal solution for healthcare environments where its seamless application, meaning no joints, and therefore less opportunity for dirt and nasty substances to gather, makes it easier to clean. For heavy traffic areas and areas with more risk of slips, a system like SR (Slip Resistant) can be used. SR is a scatter system incorporating aggregate in the product and therefor the concentration of the aggregate infused in the Flowfresh can
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In 1982, Peter Gibbins developed a flooring solution for the food preparation sector that wouldn’t erode when exposed to quantities of sugar. He created a resin flooring solution ideally suited to the task and that led to the formation of Flowcrete, which today provides a range of floors suitable for a wide range of challenging applications. Through a mix of acquisitions and new product developments, Flowcrete has created a range of flooring solutions for most industrial and commercial applications, and for other applications where the quality of the flooring is critical to the quality of activity. That applies particularly to the various branches of the healthcare sector where structural integrity, ease of cleaning, resilience, chemical resistance and safety are all paramount considerations. In tune with the times, these flooring materials are increasingly being developed as environmentally friendly and sustainable solutions with recycled products used wherever practical. Equally, delivery systems, wherever possible, use UN Certified Intermediate Bulk Containers (IBC’s).
FOR HEALTHCARE ENVIRONMENTS
Book your FREE Flooring Consultation with our network of regional representatives… +44 (0) 1270 753 000 uk@flowcrete.com @flowcreteuk
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SPECIAL REPORT: HYGIENIC FLOORING SOLUTIONS FOR HOSPITAL AND HEALTHCARE FACILITIES
These flooring materials are increasingly being developed as environmentally friendly and sustainable solutions with recycled products used wherever practical
be determined depending on the level of slip resistance needed, i.e. ramps, high traffic areas and areas prone to spillages.
Suitable for healthcare As recent times and events have demonstrated, the healthcare sector works around-the-clock in order to stay one step ahead of the numerous harmful viruses and diseases that increasingly threaten us, and they do that through, among other things, the adoption and application of rigorous cleanliness standards. In this perennial process, the floor is a prime area of concern for medical facilities; contaminants can easily move around underfoot and gravity ensures that most dirt, grime and bacteria will inevitably end up on the floor. Getting the finish right is therefore essential for sites determined to maintain the highest standards of cleanliness. The key criterion for floors in such an environment is that they facilitate a fast and effective cleaning regime by being seamless, smooth and impervious. The floor needs to maintain these properties despite challenges such as constant traffic from staff, patients and wheeled equipment, spillages of liquids and potentially corrosive substances, frequent cleaning and physical impacts. If the floor fails then it will become difficult to clean, with the potential for germs to accumulate within unwanted cracks or where the surface has become abraded.
What is available? Flowcrete UK has developed an extensive range of flooring systems for healthcare facilities to ensure that a finish is available which will support the myriad types of activity in the sector, whether it’s within a hospital ward room, surgery, pharmacy, reception area, laboratory or the back of house and maintenance areas. 4 | WWW.HOSPITALREPORTS.EU
This includes hard wearing yet decorative epoxy finishes, fast curing systems that drastically reduce the application time and robust polyurethanes. Additional benefits can even be incorporated within the floor, such as anti-slip aggregates, navigational signage, aesthetically pleasing visuals and even efficient, space saving Isowarm underfloor heating. This underfloor heating option has been used in a number of healthcare facilities including Ryhope General Hospital in Sunderland, UK and Uppsala University Hospital, Sweden. Flowcrete products have also been involved in floor refurbishments at Great Ormond Street Children’s Hospital in London. Floors are available for sectors such as healthcare, where sterility is critical, that actively target bacteria in between cleaning cycles. The HACCP International certified Flowfresh range includes the antimicrobial additive Polygiene®, a silver ion agent that targets bacteria in contact with the floor. Silver is a natural element known for its ability to purify and protect from bacterial infections – and provides an attractive, environmentally friendly alternative to chemically manufactured antimicrobials. This formulation meets the ISO 22196 standard for measuring a surface’s antibacterial effectiveness. Up to now, Flowfresh has been predominantly used in the food and beverage sector where cleanliness and chemical resistance are key requirements. Today, it is also, and increasingly, being found in healthcare or neo-clinical environments where the integrity and cleanliness of the floor is of paramount importance. That’s because, the Flowfresh antibacterial polyurethane flooring range has been developed to service environments looking to satisfy the highest possible hygiene standards. Offering the strength, durability and resilience that have long been associated with polyurethane resin,
SPECIAL REPORT: HYGIENIC FLOORING SOLUTIONS FOR HOSPITAL AND HEALTHCARE FACILITIES
Installation and Long-Term Care As with any structural component, the process and quality of installation will contribute hugely to the quality and durability of the product. Also, the base on which the product is installed will be crucial in those respects. A concrete or screed substrate is required and it will need to be
free from laitance, dust and other contamination. It should also be dry and not subject to rising damp or ground water pressure. A damp proof membrane might be the answer to damp but if no membrane is present, Hydraseal DPM can be incorporated directly beneath the Flowfresh system. With or without the antimicrobial incorporation, Flowfresh is non-hazardous to health and the environment plus the long service life and seamless surface reduce the need for repairs, maintenance and cleaning. That said, cleaning is an important factor in the performance of any healthcare facility, including the floor. Flowfresh should be cleaned regularly using a single or double headed rotary scrubber drier in conjunction with a mildly alkaline detergent. And, as we’ve already said, Flowfresh can be installed in a variety of colours and can incorporate navigation signage.
SO FRESH & SO CLEAN… ANTIMICROBIAL, EASY-CLEAN FLOORING FOR HEALTHCARE ENVIRONMENTS
Summary Flooring requirements in the healthcare sector are demanding and, inevitably, selection will be subject to a number of criteria including the extent to which a product meets those demands and the lifetime cost-effectiveness of the installation. With the experience of Flowcrete to back them up and the range of innovative variations to suit any particular application, Flowcrete products, including Flowfresh, can handle any flooring requirement in hospitals and any other healthcare facilities.
The floor is a prime area of concern for medical facilities; contaminants can easily move around underfoot and gravity ensures that most dirt, grime and bacteria will inevitably end up on the floor
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Flowfresh combines performance with the natural cleaning power of Polygiene® to deliver a surface product that continuously promotes the concept of hygienic, decontaminated and clean floors. With the Polygiene agent – a silver-ion based antimicrobial treatment placed within the resinous flooring material – Flowfresh floor coating system is proven to inhibit the growth of most types of harmful bacteria. Different capabilities for different applications There are several variants of Flowfresh suitable to different priorities and circumstances and, because they are more fluid in texture, installers can cover more surface in less time. According to the durability requirements, users can select MF, the medium duty product, or HF, the heavy duty product. It can be self-levelling at installation, SL, or it can be applied with a rake and trowel, RT. There’s also SR, the slip resistant variant incorporating aggregate which can be tailored for specific areas according to aggregate needed. Because of the liquid nature of Flowfresh, it’s easier to change aggregate and aggregate density according the project needs.
Book your FREE Flooring Consultation with our network of regional representatives… +44 (0) 1270 753 000 uk@flowcrete.com @flowcreteuk
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SPECIAL REPORT: HYGIENIC FLOORING SOLUTIONS FOR HOSPITAL AND HEALTHCARE FACILITIES
Don’t Look Down on the Floor John Hancock, Editor Just because the surface under our feet is not high tech doesn’t mean that it’s not a critical component in hospital efficiency
H
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
OSPITALS AND healthcare facilities are very complex structures but that hasn’t always been the case. Before the nineteenth century, people who needed no procedure might have fared better outside of those institutions, given the standards of hygiene (or rather lack thereof) in them. However, as is often the case, it took a war and a particular individual to start the progress that has defined our hospitals today. I have avoided the term ‘culminated’ because, as in most walks of life, hospitals are constantly improving, the specifications becoming more precise or reacting to new knowledge. The war was the Crimea War and the individual was Florence Nightingale who, among other things, insisted on clean hospital wards, including the floor where much infection causing contamination would end up. There is nothing unimportant about a hospital floor. It might be the part of a hospital or healthcare facility’s fabric of which we take least note but the floor in one of those facilities is much more important than people might initially think. As Healthcare Facilities1 explains, “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.” The article continues to consider not only the role of flooring in ensuring a safe, clean and pleasant environment but also the growing and very contemporary challenge of sustainability and life-cycle issues both in production materials and at end-of-life.
Hygiene Depends on a Good Floor So, returning to day-to-day issues, there are a number of reasons why the floor is a very important component in healthcare facilities. Contaminants can easily be carried around underfoot and, as most dirt, grime, spillages and 6 | WWW.HOSPITALREPORTS.EU
bacteria will probably make their way to the floor, the right finish is essential to ensure easy and, therefore, thorough cleaning. Because of this, flooring for the healthcare sector is a complex area with not only the hygiene performance of the floor being considered but also how it aids the smooth running (no pun intended) of the facility. This can range from its non-slip properties (very important in an environment where people might not be at their steadiest) and the ease with which equipment can move across the floor, to colouring to indicate different routes across what is often a large open plan area in, say, a hospital reception area; and it can include ease of cleaning. The Royal College of Nursing’s (RCN) booklet, ‘Good Practice in infection prevention and control’2 has plenty of information on cleaning, including cleaning floors but it also sets out in detail the range of reasons that make cleaning important and the different products that need to be used for various types of contamination. Whatever material is used for flooring has to be able to cope with all of those products. Scottish Health Technical Memorandum 61, ‘SHTM Building Component Series Flooring’3 adds, “There has been a growing emphasis on ‘designing out’ the potential for slips and trips in the built environment over recent years and this, together with the profile of Healthcare Associated Infection (HAI), has a significant impact over the design layout and specification of floor finishes.” Health Facilities Management4 sums up the multiple demands made on a hospital floor as, “…including safety, comfort, acoustics, mobility, maintenance, infection control, aesthetics and cost of ownership.” The Scottish Health memorandum also includes a helpful guide on hospital floor finishes and performance characteristics required – too long for here but worth reading.
What Makes a Good Floor? Flooring materials choices are one of a multiplicity of materials choices that have to be made when specifying the construction of a hospital and,
SPECIAL REPORT: HYGIENIC FLOORING SOLUTIONS FOR HOSPITAL AND HEALTHCARE FACILITIES
unwanted noise can increase blood pressure, heart rate, respiration rate and blood cholesterol levels. The World Health Organization (WHO) recommends that the average sound level in general hospital areas should not exceed 30 dBA.” Flooring also needs to be jointless, so that there are no cracks or voids in which contaminants can lurk out of reach; impervious, again to minimise infection risks; electrostatic resistant for safety; and hard wearing.
Where Flooring Matters In administrative office areas where clinicians rarely go and patients never go, flooring needs to be selected to suit the purpose and the welfare of the workforce there: so carpets, which would not be acceptable in any clinical areas, are probably the best choice. However, in areas such as Accident and Emergency or Operating Theatres, where spillage contamination is a high risk and where hospital acquired infection is a real risk, or in laboratories where spillage might not be a risk but the consequences could be dangerous, the flooring needs to be sealed, smooth and to not generate electrostatic charges which might risk equipment malfunction. We take hospital floors for granted but a whole range of considerations have to go into enabling that luxury.
Sound affects us both physiologically and psychologically, and unwanted noise can increase blood pressure, heart rate, respiration rate and blood cholesterol levels. The World Health Organization (WHO) recommends that the average sound level in
SO FRESH & SO CLEAN… ANTIMICROBIAL, EASY-CLEAN FLOORING FOR HEALTHCARE ENVIRONMENTS
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of course, will almost certainly need renewing once or more during the lifetime of the building. Many of the properties desirable in any building materials will apply to the floors and one which is probably more important in a healthcare facility might include anti-microbial, protection and resistance to mould or mildew. That will not only work for a cleaner environment but also might add to the floor’s working life. WebMD’s article ‘Germiest things in Hospitals and Doctor’s Offices’5 explains, “The presence of bacteria, mold and mildew contributes to premature product degradation and the development of stains and odors.” But it isn’t only floors’ infection resistance and ease of cleaning that matter. The UK Department of Health ‘Health Building Note 00-01 Part A: Flooring’6 states, “Floor finishes should provide a flat surface without pronounced texturing to allow the passage of wheeled traffic and to assist maintenance.” So much gets ‘pushed around’ in a hospital that a floor that makes movement easier will save time, energy, and wear and tear. Other considerations would include acoustic absorption (hospitals are noisy enough without any unnecessary rumble of moving equipment and footfall). As ‘Building Better Healthcare’ explains, “Sound affects us both physiologically and psychologically, and
Book your FREE Flooring Consultation with our network of regional representatives… +44 (0) 1270 753 000 uk@flowcrete.com @flowcreteuk
general hospital areas should not exceed 30 dBA
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SPECIAL REPORT: HYGIENIC FLOORING SOLUTIONS FOR HOSPITAL AND HEALTHCARE FACILITIES
Getting the Flooring Right for the Long Term Camilla Slade, Staff Writer The hospital floor has to perform well but what should it be able to do and what does it need to meet expectations?
Different parts of a hospital require different flooring solutions although they all share some needs, especially, the need to be able to be cleaned easily which, in turn, will promote regular cleaning
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A
S WE’VE seen in John’s previous article, the hospital floor is as important and as complex a part of a healthcare facility as any other component. To give an idea of the scope of requirements, Health Care Research Collaborative, in their paper ‘Sustainable Resilient Flooring Choices for Hospitals’7 asked a group of healthcare professionals to create a list of attributes that they considered important in choosing a hospital floor. They came up with… “Acoustics, Aesthetics, Antimicrobial properties, Cleanability, Comfort underfoot, Durability, Infection control, Initial cost, Installation requirements, Life cycle cost, Odor, Product quality, Repairability, Rolling resistance, Safety, Stain resistance, and Sustainability.” That’s seventeen things to consider when specifying or selecting flooring materials for a healthcare facility.
heavy rolling loads matters and the colours need to support traffic flow; Accident and Emergency as well as operating theatres are where the highest standards of infection control will be practiced and the floor needs to contribute to that; wards and treatment rooms or clinics also need to be clean and to use colours that will help calm patients; finally cafeterias, retail outlets and general areas need to be resilient against staining and easily cleaned. All areas need to have slipproof floor surfaces. There is a lot more guidance on floors for hospitals in UK Department of Health, ‘Health Building Note 00-01 General design guidance for healthcare buildings’9 including design issues such as, “Floor colours should contrast visually with wall colours… [and] Fittings should contrast visually with the surface to which they are fixed and the surface against which they may be viewed.”
Important Flooring Issues
Performing Whatever the Conditions
Let’s take a closer look at some of those attributes or what they represent. Healthcare Facilities Today in Larry Bernstein’s article ‘The right flooring choices can impact staff efficiency and patient outcomes’8 suggests, “… the time spent in the hospital – whether it be as a patient or visitor – can 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.” adding… “With growing expectations and shrinking budgets in healthcare facilities, the right flooring can help meet challenges… for every space and budget.” Also, different parts of a hospital require different flooring solutions although they all share some needs, especially, the need to be able to be cleaned easily which, in turn, will promote regular cleaning. The main identifiable areas seem to be (judging from a number of sources) the entrance where durability, including for rolling loads, and colours that are both welcoming and relaxing are important; corridors and clinical areas where, again, durability with foot traffic as well as
In hospitals, people might often be distracted and/or preoccupied and so visual differentiation, including for floor surfaces, makes sense. There’s more information on the installation and management of floors at UK Department of Health, ‘Building Note 00-10 Part A: Flooring’10, including, “Before a new or replacement floor covering is specified, the specifier should conduct a risk assessment and the following performance requirements should be considered: environment; contamination; appearance; acoustics; use; footwear; slip and trip potential of foot traffic etc. under different conditions.” That last point about conditions is important because, in a busy hospital on a bad weather day (rain or snow) it’s important that the flooring retains its properties even when foot traffic might bring water and soiling onto the surface. To maintain that performance under all conditions, cleaning is a major element in the management regime for hospital flooring. Flowcrete11 explains, “The key criterion for floors
SPECIAL REPORT: HYGIENIC FLOORING SOLUTIONS FOR HOSPITAL AND HEALTHCARE FACILITIES
in such an environment is that they facilitate a fast and effective cleaning regime by being seamless, smooth and impervious. The floor needs to maintain these properties despite challenges such as constant traffic from staff, patients and wheeled equipment, spillages of liquids and potentially corrosive substances, frequent cleaning and physical impacts. If the floor fails then it will become difficult to clean, with the potential for germs to accumulate…”
Specifying and Selecting a Hospital Floor
Consideration of the environmental impact of disposal at the end of the useful life of the flooring can influence the choice, some materials being inherently more difficult and hazardous to deal with
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Hospitals have a long working life and so getting the specification right at the outset will help to ensure that materials and fittings are not only fit for purpose but also are able to continue performing to the highest standards for as long as possible. In his Thesis,’ Floor finish selection in hospital design: a survey of facility managers’12 Shashank Singh reminds readers that it is at the specification stage that management and maintenance need first to be considered. “However, during decision making in terms of facility design, the topic of facility maintenance of rarely addressed which affects the performance of the organization.” Healthcare without Harm ‘Healthy & Sustainable Flooring’13, introduces a number of considerations around specifying hospital flooring, including: “While the immediate cost of new flooring is inevitably a prime consideration, in recent
years concepts of sustainability and ‘green’ practices have been developing. These are being incorporated into flooring specifications and have become key decision making factors in determining the type of flooring to be installed in healthcare environments.” This extends not only to the carbon footprint of the materials used in manufacture and installation but also, “… consideration of the environmental impact of disposal at the end of the useful life of the flooring can influence the choice, some materials being inherently more difficult and hazardous to deal with.” The ‘Healthcare without Harm’ paper did identify cost as a primary consideration which, of course, it is, especially in a healthcare system that is already challenged where costs are concerned. As Steve Urwin writing in Better Building Healthcare14 explains, “NHS England has identified a £30billion shortfall in the NHS budget come 2020.” Adding, “Long term value, durability and flexibility are, therefore, of utmost importance when specifying flooring for the healthcare environment.” All in all, it’s easy to take something as basic as flooring for granted but, in practice, the materials used for flooring will have an impact on the good running of a hospital and on its patients’ welfare for many years. It is neither simple not should it be taken for granted when specifying any hospital new build or refurbishment.
Book your FREE Flooring Consultation with our network of regional representatives… +44 (0) 1270 753 000 uk@flowcrete.com @flowcreteuk
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SPECIAL REPORT: HYGIENIC FLOORING SOLUTIONS FOR HOSPITAL AND HEALTHCARE FACILITIES
A Key Contributor to Patient Health Peter Dunwell, Medical Correspondent A good floor, properly installed and well maintained, will serve the hospital well in the long-term
The product must be durable, easy to maintain and support patient mobility. With regard to mobility, this includes ambulatory and roller mobility related to heavy roller loads. These givens represent the minimum performance requirement for a flooring product
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As Camilla Slade’s article showed, selecting a hospital floor is not as straightforward as selecting a new carpet for your sitting room and the colour of wood for your entrance hall. A hospital floor has to perform against multiple criteria and do so for many years or decades. Floor Trends ‘Choosing Flooring for Healthcare Environments’15 tells us that, “While each healthcare facility has its own specific needs and requirements, when it comes to flooring in healthcare applications, a few criteria must be met across the board…” In that article, “There are certain givens that we traditionally associate with performance,” said Mark Huxta, director of sales–healthcare for Ecore. “In particular, the product must be durable, easy to maintain and support patient mobility. With regard to mobility, this includes ambulatory and roller mobility related to heavy roller loads. These givens represent the minimum performance requirement for a flooring product.”
An Active Component in the Good and Safe Running of a Hospital Among the more often found issues with hospital flooring are, understandably, the accumulation and harbouring of bacteria. That happens where there is a break or rough spot in the surface and where there might be hard to reach places where the surface is not easily cleaned. Risk elements in flooring include coving where vertical and horizontal surfaces meet. The coving is adhered to the two surfaces and, unless that adhering is one hundred percent thorough, it can leave a perfect hiding place for dust or, worse still, fluids. Equally, the strips used where different floor surfaces are joined, if not thoroughly adhered and sealed, can also provide dust traps and access for spilt fluids. In fact, Health Facility Guidelines has issued a four page guide, ‘Floors’16, on the selection of flooring in hospitals which includes the statement, “The selection of floor finishes is very important. It has direct impact on the safety of patients, staff
and visitors. Floor finishes also contribute to the recurrent costs of a facility related to cleaning and maintenance; a low initial cost of a particular floor finish may have a high ongoing cost impact.” The guide continues to add the need to meet building and fire regulations. Shashank Singh in his thesis ‘Floor finish selection in hospital design’17 adds that the top five selection criteria that were identified for hospitals were, “durability, infection control, ease of maintenance, maintenance cost, and user safety.” The Royal College of Nursing (RCN) gets specific when discussing one of the most important issues for a modern hospital, ‘Essential Practice for Infection Prevention and Control’18, “Spillages of blood and bodily fluids should be dealt with quickly, following your workplace’s written policy for dealing with spillages. The policy should include details of the chemicals staff should use to ensure that any spillage is disinfected properly, taking into account the surface where the incident happened…” which, in the context of this paper, would be the floor. There are numerous papers on the selection of hospital floors but they seem to boil down to three basis factors: 1. Materials and their properties; 2. Performance; and 3. Safety.
Selecting, Installing and Maintaining a Floor Fit for Purpose Of course, it’s not quite that simple because the floor has to be installed and maintained and those processes are just as important. Installation has to ensure that the floor harbours no joints, cracks or spaces where dirt and contamination could be trapped. Maintenance has to ensure that the floor remains clean and retains all the other requirements of being smooth but non-slip, and that means ensuring, among other things that any products used in cleaning are approved for the flooring, i.e. won’t attack or degrade it.
SPECIAL REPORT: HYGIENIC FLOORING SOLUTIONS FOR HOSPITAL AND HEALTHCARE FACILITIES
Floor cleaning
facilities, there are few cleaning techniques that can make an impression like a well-maintained floor. From the moment visitors walk into the facility and glance around, their first impressions of the overall cleanliness are made by how the floors are presented.”
Safety as well as health As well as infection, a poorly installed or maintained floor can be a safety hazard to patients and staff. The UK Health and Safety Executive (HSE) explains21 that, “Slip and trip accidents in the healthcare sector continue to be a cause for concern. Over 50% of RIDDOR [Reporting of Injuries, Diseases and Dangerous Occurrences Regulations] reported major injuries in this sector are related to slips, trips and falls, both to staff and to patients.”
SO FRESH & SO CLEAN… ANTIMICROBIAL, EASY-CLEAN FLOORING FOR HEALTHCARE ENVIRONMENTS
Summary I hope that, so far, we’ve managed to dispel any notion that a floor is almost the last thing that anyone designing, specifying, building or running a hospital should be thinking about. The floor is an integral and important part of the delivery of clinical treatments and a front line in the constant battle against hospital acquired infections (HAIs), and as such a critical component in the healthcare system.
The selection of floor finishes is very important. It has direct impact on the safety of patients, staff and visitors. Floor finishes also contribute to the recurrent costs of a facility related to cleaning and maintenance
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The purpose of cleaning in any healthcare setting is to reduce the density of or eliminate infection risk from contaminants that may be present on surfaces; also to minimise the possibility of infectious risks being transferred from the surface being cleaned or between people, i.e. to cut the risk of cross-infection. There are academic papers that include sections on floor mopping. ‘Floor cleaning: effect on bacteria and organic materials in hospital rooms’19 from Science Direct lists “Floor mopping” at the top of its list of key words and tells us that, “In Norway, ordinary cleaning of patient rooms is traditionally performed with soap and water.” Importantly, the article compares a number of cleaning methods that the authors had subject ted to scientific trial. The technology of cleaning is continually progressing and anyone specifying a hospital floor will need to be alert to the latest developments in order to ensure that the flooring material they choose is compatible with the cleaning technologies to which it will be subjected. Such is the importance of cleaning that Health Care Facilities Management has published a paper on ‘Developing a hospital floor cleaning program’20 which succinctly summarises the value of that process. “In hospitals and health care
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SPECIAL REPORT: HYGIENIC FLOORING SOLUTIONS FOR HOSPITAL AND HEALTHCARE FACILITIES
Let’s Get Down to Material Matters John Hancock, Editor What goes into the flooring solution is an important factor in its performance
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Floors… are the most visible and most used surface in every hospital… They are the first impression when you enter the facility
HILE THE active components of healthcare – the beds, the equipment, the technology, the machines, the support services – are well understood and, usually, well-resourced in developed world hospitals and healthcare facilities, there are other less obvious but no less critical components in the treatment, care and healing process. In his thesis ‘Floor finish selection in hospital design’22, Shashank Singh suggests, “An evidence base has emerged that supports the designing of healthcare buildings for quality, safety and providing a favorable environment could significantly improve patient outcomes, satisfaction and healing process.” He continues to report that other researchers had suggested, “… that the internal environment is most impacted by floor coverings [and that] color and pattern on the finish materials of a hospital affect the behavior of its users.”
An Important Role Requires the Best Materials As ‘All things Flooring’23 puts it, “From cleanliness and accessibility to heavy wear, wayfinding and promoting a healing environment — hospitals face many daily demands. Your flooring is no exception, and it’s a crucial part of creating a quality care setting.” ‘Health Facilities Management’24 goes further, “Floors… are the most visible and most used surface in every hospital… They are the first impression when you enter the facility.” One factor that will determine the performance of flooring is the materials used which, in the case of clinical areas in hospitals, has traditionally included vinyl, vinyl composite tile (VCT), rubber, linoleum and ceramics. All have their qualities and their downsides. For instance, the Health Facilities Management article above explains, “Polyvinyl chloride (PVC) is a type of vinyl surface that is often used in hospitals, clinics and nursing homes. It’s popular because it can be installed in large sheets with few seams and because it has a low cost. On the downside, it requires lots of regular maintenance that is time12 | WWW.HOSPITALREPORTS.EU
consuming, and PVC surfaces typically wear out faster than others.”
Different Materials Offer Different Properties While these traditional materials have undoubtedly served the healthcare sector well in the past, there are newer materials emerging with a range of qualities even better suited to the purposes of Healthcare facilities. The two main types of resin floors are polyurethanes (PU) and epoxies – and understanding which is appropriate for different environments is very important for construction industry professionals. Each flooring system has differing properties suited to particular uses but they do share similarities, such as being twocomponent systems (a resin and a hardener) which results in a seamless, impervious coating that can be applied quickly in large quantities. That said, they are two very different types of materials with specific characteristics and uses. The main difference between these two types of materials is in the molecular structure, which affects how it fuses together during the curing process. Without going too far into the chemistry, PUs have a higher cross-linked density than epoxies, making them the harder wearing of the two. Thanks to this, Polyurethane systems have long been associated with offering strength, durability and resilience when faced with a variety of testing conditions, such as heavy footfall, physical impacts, extreme temperatures and corrosive chemicals. And that sounds very much like a hospital environment. One such material would be Polyurethane Resin which Bansal Trading Company25 tells us are, “…copolymers that form when an alcohol called polyol (each of its molecules contains 3 or more reactive hydroxyl groups) reacts with an isocyanate – (dual or polymeric) when appropriate additives and catalysts are introduced.” That, perhaps, seems quite technical but the key factor is B that, “polyurethane resin uses are many and wide, and cut across a vast range of industries.” The article continues to highlight some of the
SPECIAL REPORT: HYGIENIC FLOORING SOLUTIONS FOR HOSPITAL AND HEALTHCARE FACILITIES
resins also can cope with greater ranges and changes in temperature (such as when being steam cleaned), plus are softer and more elastic. Importantly, “When it comes to epoxy vs polyurethane coatings, the important take-away is to realize that both product technologies work well in conjunction with each other to produce a durable, long-lasting flooring solution.” says the ‘Protective Industrial Polymers’27 article ‘Epoxy vs Polyurethane. That is, both can used in their appropriate functions. Installing a polyurethane resin floor is a more technically challenging job but well worth it for the additional benefits that can be gained.
SO FRESH & SO CLEAN… ANTIMICROBIAL, EASY-CLEAN FLOORING FOR HEALTHCARE ENVIRONMENTS
Future Outlook Population growth, exponentially rising expectations from healthcare systems and the growing mobility of transferrable infections around the world (coronavirus was making waves at the time of writing) will put ever greater demands on all parts of a healthcare facility, not least the floor. And, from a purely market perspective, ‘Future Market Insights’28 suggests, “The global healthcare flooring market is expected to witness significant growth rate… [with] factors such as strong demand for sanitary environments with protection against bacteria and stains, provision of aesthetically pleasing design, and reducing staff fatigue by comfort underfoot.”
The lifespan of the PU system is roughly double that of the epoxy, clocking an impressive ten-year’s compared to the epoxy’s five. PU systems also
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qualities of this newer material: that it’s highly elastic, balanced in hardness capable of adhering well to substrates which, in this context, is the underlying base onto which a floor is laid. Polyurethane resin is lightweight and yet has strength with properties of insulation, durability and flexibility plus it is a cost-effective material. Used as a flooring material, polyurethane resin delivers a smooth and seamless surface with nowhere that bacteria or mould spores can grow. And, like other materials, it’s possible to incorporate a silver-ion antimicrobial agent to protect the surface from degradation caused by microbial growth. ‘All Things Flooring’26 offers a range of comparisons between polyurethane (PU) resin and epoxy resin – the two seem similar but have substantially different performance characteristics as All Things Flooring explains – I have paraphrased below to save space. First thing to tackle is cost with polyurethane resins costing more but, as the article says, “the lifespan of the PU system is roughly double that of the epoxy, clocking an impressive ten-year’s compared to the epoxy’s five. PU systems also benefit from their increased wear, abrasion and impact resistance properties.” The article continues to explain that compared to the limited resistance of epoxy resins PU resins offer unrivalled resistance to, “corrosion, inorganic alkalis, organic alkalis and solvents.” Polyurethane
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SPECIAL REPORT: HYGIENIC FLOORING SOLUTIONS FOR HOSPITAL AND HEALTHCARE FACILITIES
References: 1
Healthcare Facilities Today www.healthcarefacilitiestoday.com/posts/The-right-flooring-choices-can-impact-staff-efficiency-and-patient-outcomes--21392
2
RCN, ‘Good practice in infection prevention and control, Guidance for nursing staff’ www.wales.nhs.uk/sites3/Documents/739/RCN%20infection%20control.doc.pdf Introduction
3
Scottish Health Technical Memorandum 61, ‘SHTM Building Component Series Flooring’ www.hfs.scot.nhs.uk/publications/1478534310-SHTM%252061.pdf page 8
4
Health Facilities Management www.hfmmagazine.com/articles/2423-functional-flooring-designed-for-health-care-facilities
5
Web MD, Germiest Things in Hospitals and Doctor’s Offices www.webmd.com/a-to-z-guides/ss/slideshow-germiest-hospitals-dr-offices 11/13
6
UK Department of Health, ‘Building Note 00-10 Part A: Flooring’ assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/148495/HBN_00-10_Part_A_Final.pdf Page 5
7 Health Care Research Collaborative, ‘Sustainable Resilient Flooring Choices for Hospitals’ practicegreenhealth.org/sites/default/files/upload-files/resilientflooring_paper_r8.pdf 8 Healthcare Facilities Today www.healthcarefacilitiestoday.com/posts/The-right-flooring-choices-can-impact-staff-efficiency-and-patient-outcomes--21392s 9 UK Department of Health, ‘Health Building Note 00-01 General design guidance for healthcare buildings’ assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/316247/HBN_00-01-2.pdf
UK Department of Health, ‘Building Note 00-10 Part A: Flooring’ assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/148495/HBN_00-10_Part_A_Final.pdf
10
11
Flowcrete www.flowcrete.co.uk/our-products/market-sectors/healthcare/
12
Floor finish selection in hospital design: a survey of facility managers a thesis by Shashank Singh core.ac.uk/download/pdf/154406144.pdf
13
Health Care Without Harm https://bit.ly/2ZnZq5w
Building Better Healthcare www.buildingbetterhealthcare.co.uk/news/article_page/The_importance_of_flooring_specification_in_healthcare_environments/111707
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15
Floor Trends www.floortrendsmag.com/articles/100140-choosing-flooring-for-healthcare-environments
16
Healthcare Facility Guidelines healthfacilityguidelines.com/ViewPDF/ViewIndexPDF/iHFG_part_c_floors
17
Floor finish selection in hospital design: a survey of facility managers a thesis by Shashank Singh core.ac.uk/download/pdf/154406144.pdf page iii
18
RCN www.rcn.org.uk/-/media/royal-college-of-nursing/documents/publications/2017/november/pub-005940.pdf page 18 ‘Spillage management’
Science Direct, ‘Floor cleaning: effect on bacteria and organic materials in hospital rooms‘ www.journalofhospitalinfection.com/article/S0195-6701(08)00389-7/pdf 19
20
Health Facilities Management www.hfmmagazine.com/articles/2176-developing-a-hospital-floor-cleaning-program
21
HSE, ‘Investigation of slip resistance and the hygienic cleaning of floors in hospital settings’ www.hse.gov.uk/research/rrpdf/rr889.pdf
22
Floor finish selection in hospital design: a survey of facility managers a thesis by Shashank Singh core.ac.uk/download/pdf/154406144.pdf page iii
23
All things Flooring, ‘Top Hospital Flooring Options for 2019’ www.allthingsflooring.com/2019/03/top-hospital-flooring-options-2019/
24
Health Facilities Management www.hfmmagazine.com/articles/3575-evs-professionals-and-hospital-design
25
Bansal Trading Company, ‘Polyurethane Resin uses, types and advantages’ bansaltrading.com/polyurethane-resin-uses/
26
All Things Flooring www.allthingsflooring.com/2017/06/epoxy-vs-polyurethane-will-choose/
27
Protective Industrial Polymers www.protectiveindustrialpolymers.com/industrial-epoxy-flooring/epoxy-vs-polyurethane/
28
Future Market Insights, ‘Healthcare Flooring Market’ www.futuremarketinsights.com/reports/healthcare-flooring-market
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Notes:
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SPECIAL REPORT: HYGIENIC FLOORING SOLUTIONS FOR HOSPITAL AND HEALTHCARE FACILITIES
Notes:
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