Specifying a floor for a healthcare facility comes with a number of complexities. With new products and systems continuously entering the market, designers and specifiers are exposed to an increasing number of options that need to meet acoustic, maintenance, aesthetic, demarcation and hygiene requirements. Architects, similarly, have their own set of challenges.

Heloïse Urry from Geyser Hahn Architects, which specialises in designing and developing healthcare facilities, says there are many considerations when designing a building for this sector.

“The patients’ needs should be paramount when designing a hospital – a private, pleasant environment with access to natural light will attribute to a faster recovery time. The flow of the hospital also has to be optimal and is vital to enabling patients and staff to move freely and efficiently. Regulations we have to adhere to apart from The South African National Standard (SANS) 10400 are the IUSS guidelines and those stipulated by the Department of Health,” says Heloïse.

She says that the quality of the specified flooring products is of utmost importance. “The quality of the flooring has to be very high as some hospitals do not change their flooring for 30 years,” adds Heloïse.

Hygiene and infection control are critical in a healthcare facility, as is patient safety, comfort underfoot, durability as well as maintenance. Hospital staff spend a lot of time on their feet and research has shown that an ergonomic floor can alleviate discomfort. Careful consideration must also be made as regards costly downtime or repairs in wards and operating theatres, which is why the maintenance schedule needs to be considered when specifying a floor. With a number of patients recovering from illness and operations, ensuring their safety through a non-slip surface is also imperative.

Where are we getting it wrong?
With all these high-priority items in the market, flooring manufacturers continue to produce systems that meet many needs. This doesn’t mean that failures in the market don’t exist. FLOORS in Africa magazine asked a few industry experts about what designers and specifiers typically get wrong and what the common pain points in the sector are.

Incorrect product choice
“Choosing products that are not fit for purpose is the most common reason for flooring failures in the healthcare industry,” says Wendy Mitrovich, Brand Manager at Polyflor.

“Professionals can be tempted to choose a floor based on aesthetics without having a solid understanding of the functionality of the product. Other flooring products aren’t well-suited to areas that require the strictest hygiene controls,” adds Wendy.

Hugh Krog from Traviata says that besides having limited options for products that meet the stringent requirements of ensuring sterile environments in high care areas such as operating theatres and recovery wards, there are often special requirements that designers may not have considered when they took on the project.

“Specialised equipment in hospitals means that requirements related to electrical conductivity or static dispersion may need to be considered. Different sections of the hospital, such as the general wards, doctors’ rooms, reception areas and general areas will have their own set of requirements. In specialised areas, the problem usually boils down to matching functionality with design. Knowing which products function as a high-tech hospital floor without looking like a sterile old hospital surface requires some research,” says Hugh.

Jenny-Lee Williams, Communications Manager at the Flooring Industry Training Association (FITA), agrees that poor installation remains a major pain point in the industry.

Poor installation
“The problem with a poorly installed floor in a healthcare environment is that it leads to hygiene and maintenance issues because this surface is much more difficult to clean and puts already vulnerable people even more at risk. It is also not aesthetically pleasing and a recovering patient shouldn’t have to notice poor workmanship while they are supposed to be focusing on their recovery. Flooring in healthcare environments are specialised systems and require very skilled installers to do a good job. Make sure that your installation team are experts in this market,” advises Jenny-Lee.

Other pain points in the industry include poor workmanship and fast-tracked building timelines, which result in sub-standard screeds, moisture issues and sub-par installations.

“It’s important to have a committed supplier who can help mitigate project risks. Not only can flooring failures in healthcare environments be costly, they can have a major impact on the health and wellbeing of patients,” says Wendy.

Jenny-Lee adds that the installation standard needs to be uniform so that a healthcare facility doesn’t have one section with a properly installed floor and other pockets where the flooring installation has failed.

“With multiple contractors, it can happen that people working in different sections of a large facility are using different approaches. FITA is introducing a new training module that intends to become a benchmark for vinyls, LVTs and ceramics, all of which are commonly installed in healthcare environments. The training module is currently being verified by the South African Qualifications Authority and once approved, there will be a uniform standard produced by industry experts to ensure that contractors who have completed the training are installing the products according to the benchmark that has been established,” says Jenny-Lee.

Infection risk
Healthcare facilities have a particular duty to protect patients, staff and visitors from air pollution, bio particles and airborne infection. According to the World Health Organisation, indoor air pollution plays a significant role in the general state of health of people who spend a considerable amount of time indoors, and the organisation has identified children, elderly and other vulnerable groups as being particularly at risk from biological and chemical indoor pollutants. Flooring products with anti-microbial properties, as well as flooring options that are comprised of materials that are resistant to mould and fungus, are crucial in healthcare environments.

“Specifiers need to check the Group rating of the floor covering very carefully to ensure their choice meets the expected traffic in the specific area. A hygiene critical area demands a floor covering that is impervious and without exposed joins/welds that can harbour germs. Volatile organic compound (VOC) emissions are also an important consideration for maintaining air quality,” says Wendy.

“The flooring product that you are specifying for a healthcare environment should contain no heavy metals, PBB’s or phthalates, which were typically found in older generation vinyl-based floors. A good way to check that the product is free of these elements is to see whether it carries a Floor Score certification for use in hospitals,” says Hugh.

Form and function
While colour and aesthetics may seem like a nice-to-have in a project, they are equally crucial elements in a healthcare environment. Staff performance and patient recovery are impacted by the quality of the visual environment and it can also influence a patient’s feeling of wellbeing. The colour, patterns and demarcation need to be considered during the design phase as they can provide healthcare facilities with a number of practical advantages.

“Way finding is also very important, particularly for dementia and psychiatric patients. We recently assisted with a lovely project at Chris Hani Baragwanath where flooring and wall protection were used very successfully to identify various consulting rooms, assisting patients struggling with literacy,” says Wendy.

Dee Naicker from FloorworX points out that light floor colours are more sought-after in healthcare environments with bright colour inserts used as patterns.

“Designers are typically drawn to light colours for healthcare environments as it is perceived that light colours give off a more clinical look. Designers are always looking for floor ranges that are different and have a fresh look thus allowing them to be creative but at the same time ensuring the floor meets the functionality requirements. Floorcovering ranges that offer more variety in colours, designs and surface treatments (polyurethane), will continue to do well in this sector,” says Dee.

The latest trends
The current trend is to make healthcare environments more welcoming, homely and comfortable, as this type of aesthetic is more conducive to healing. Modern hospitals are moving away from the cold, clinical colours and designs and incorporating everything from bright colours to stone and wood effects.

“Historically, matrons still insist on a shiny floor which causes a glare that the human brain perceives as being slippery and unsafe, but there is a shift towards a more matte floor. We are also seeing more innovative and non-traditional floorplan designs coming through,” says Wendy.

“Essentially, healthcare facilities no longer have to look drab,” agrees Hugh.

“The biggest change in the industry has been the availability of products suitable for use in hospitals. Both interlocking and glued down LVT ranges, for example, have improved dramatically in terms of functionality and aesthetics. There are now designer ranges in a variety of styles and colours,” says Hugh.

Specialised tip: The comfort of patients, their privacy and how a building can help their recovery, are all things that architects need to consider when designing floors for the healthcare sector.

Full thanks and acknowledgement are given to www.polyflor.co.za, www.fitasa.co.za, www.traviata.co.za, www.gharchitects.co.za, www.floorworx.co.za and www.gerflor.com for some of the information contained in this article.

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