Floored!

Hospitals have higher expectations for new flooring these days. They want slip-resistant, natural-looking, soft and easy-to-clean materials. Manufacturers are rising to the occasion with a host of moderately priced products that give hospitals more colorful choices than ever.

Is there another type of building in the world where a floor is expected to deliver so much for so many than in a hospital? Not likely when you consider the lengthy list of demands that flooring products must satisfy every day for as many years as possible in the uniquely sensitive environment of a health care facility.

Hospital flooring needs to stand up to heavy, around-the-clock foot traffic but also medical equipment, carts, beds and more. It's expected to keep staff, patients and visitors as safe as possible from slips and cushion them from injury when falls do happen. Ideally, the flooring will ease the repetitive stresses and strains of walking and standing for medical staff who work on their feet for up to 12-hour shifts.

Flooring is expected to be durable, low maintenance and aid in infection prevention too. Plus, the floor's decorative qualities have become desirable for a growing number of hospitals that want to achieve that "homey" feel for patients and visitors. The greener or more sustainable it is, the better. Of course, all this needs to be accomplished at the lowest price possible.

That's quite a challenge. But it's one that manufacturers continue to work at meeting as they develop flooring that reflects the latest trends and growing customer demands. The result is an array of products, including rubber, vinyl sheet flooring, polyolefin, linoleum and terrazzo, that serve as alternatives to the old standard vinyl composition tile (VCT).

Long-term performance

No matter the material, most hospitals want flooring that offers long-term durability and low maintenance, according to manufacturers, designers and green building advocates interviewed by Health Facilities Management.

Those are the factors facility managers, designers and specifiers need to consider first when purchasing or recommending floor products, says Dave Harris, sales manager, commercial division, R.C.A. Rubber Co., Akron, Ohio.

R.C.A. makes FlexiFlor rubber flooring, which is comprised of synthetic and natural rubbers and clay and offers long life, low maintenance and strong slip-resistance benefits, he says. Those benefits are cause for the growing popularity of rubber flooring in health care facilities.

"The most important thing right now for flooring as a benefit to hospitals is a true no-finish maintenance procedure, where all they do is clean the floor as needed and buff it," says Harris. With rubber flooring, "hospitals do not need to apply extraneous sealers or waxes, which saves labor needed for applying and removing finishes," he says.

Eliminating the need to strip and wax floors as with VCT also keeps volatile organic compounds (VOCs) out of the air and the waste stream, Harris says.

Jeremy Whipple, marketing manager of Roppe Corp., Fostoria, Ohio, and sister company Flexco Corp., Tuscumbia, Ala., agrees that rubber flooring is gaining in popularity.

"The trend is growing exponentially for rubber now," Whipple says. "You have rubber sheet flooring that provides the same aesthetics, same product specifications that vinyl can and in a more durable product."

Though rubber products are typically double the cost of VCT flooring, the cost of VCT adds up quickly after factoring in maintenance, Whipple says. "If a hospital has a facility manager that is forward-looking, he will do a test floor and determine what the maintenance costs are for that floor. He will find out that dollar per square foot for VCT isn't that cheap when it costs you $2 per square foot to maintain it."

Robin Guenther, FAIA, a principal at Perkins+Will, also says that low-maintenance flooring that is less chemically intensive in the cleaning process is an important factor for hospitals purchasing new flooring. It improves indoor air quality and cuts maintenance costs, she says.

Comfort and sound absorption are additional factors in choosing flooring such as rubber or linoleum, Guenther says. "Hospitals are looking for softer, more cushioned flooring for occupational safety and health reasons. Hospitals are trying to find flooring that is more ergonomic and cushions people's feet and legs from the hardness of the concrete slabs that are generally underneath the flooring surface," she says.

Rich Campbell, executive vice president, sales and marketing, ECORE International, Lancaster, Pa., echoes the belief that "a durable, long-lasting flooring product that is easy to maintain" such as rubber are top priorities for many hospitals. The company's ECOsurfaces Commercial Flooring makes it easy to transport rolling loads and provides sound-dampening characteristics, both important features for hospitals, he says.

Linoleum is also gaining in popularity with health care facilities. Forbo Flooring Systems, Hazleton, Pa., makes a product called Marmoleum that is the company's trademarked name for linoleum. Made of natural resources such as linseed oil, pine rosin and wood flour, the highly durable material rates high on the sustainable product scale, according to designers and green building experts.

In addition, linoleum has strong antimicrobial properties, says Casey Johnson, national sales manager, at Forbo. He points to a study by the North American Science Associates Inc. (NAMSA) that linoleum performed the best in preventing antimicrobial growth compared with other flooring products.

Besides offering luxury vinyl tile (LVT) that can be customized for health care facilities, Amtico, Atlanta, offers a polyolefin flooring product called Stratica. It has strong slip- and fall-resistant features, is polyvinyl chloride (PVC)-free and requires no stripping and waxing. Plus, it's extremely durable, says Paul Eanes, vice president of sales, Amtico.

West Coast-based health care system giant Kaiser Permanente likes Stratica so much that in 2004 the health organization mandated the installation of either Stratica or rubber flooring in all of its new or renovated health care facilities.

The goal was to improve patient and staff safety by reducing the number of falls and slips that was costing Kaiser Permanente millions of dollars in compensation, according to the summary of a resilient-flooring white paper the health care orga­nization issued in May 2009. The new flooring also eliminated the need for cleaning chemicals used with prior vinyl products.

Just like home

While perhaps not the highest priority in choosing products, the trend to make hospitals as "homey" and comfortable as possible through interior design continues to grow. Manufacturers have adapted their products to fill this need by expanding color lines and offering products that mimic natural elements such as stone or wood.

"Flexibility and function are key components of design in hospitals," says Michael Raskin, president and CEO, Metroflor Corp., Darien, Conn., which makes low-maintenance, slip-resistant and antibacterial sheet vinyl and vinyl planks and tiles that resemble wood grain. The trend toward warmer colors and natural-looking flooring and increasingly in single-patient rooms reflects what hospitals see as desirable for their patients.

"Patients prefer not to share rooms and would prefer to have their own rooms, but regardless they want the rooms to be nice," Raskin says. "Warm wood makes it look less institutional and more like a home."

Hospitals are striving to be more natural and homelike with design in areas such as patient rooms, corridors, maternity wards and public spaces—and flooring materials support that trend. "Hospitals are going for natural-based palettes and colors," Guenther says. "Even if the material isn't actually made from natural materials, clients select materials that resemble natural."

Shannon Weir, senior marketing manager, Armstrong, Lancaster, Pa., agrees that flooring that offers low-maintenance cleaning and is available in colors and styles that create a homelike atmosphere are important factors for hospitals, especially those that support evidence-based design studies that claim soothing physical environments promote healing and safety. Weir says the company's heterogenous sheet vinyl is perfect for patient rooms.

"A heterogeneous floor is great because it's hard surface and it's very easy to clean," she says. "They come in different visuals like woods and stones and they give the environment that more homey or spa-like feel. It fits in with the evidence-based design trends in health care now."

Eanes says he sees health care facilities putting more emphasis on interior design than they have in a long time by duplicating the look of home for outpatient spaces as well as for inpatient areas. "We see more style in the things that hospitals are asking for," he says.

Baffling choices

Despite the obvious and generally positive trends, it's frequently difficult to understand and sometimes downright baffling why hospitals choose a specific flooring product over another, says Jennifer DuBose, research associate, Georgia Institute of Technology.

That's what she has learned as she finishes a report based on a survey of architects, installers, facility managers, designers and others involved in the purchase of health care facility flooring systems. The survey was done in collaboration with Practice Greenhealth, Health Care Without Harm and the Green Guide for Health Care.

"Some of the interesting results that we found are even though this group we surveyed is more concerned about sustainability, they're still using VCT and sheet vinyl a lot," she says. "Those are standard products that are still being used even by people who want to get away from them. In many cases, people who love rubber or linoleum flooring products are still using vinyl products in some areas."

For some hospitals, low first cost and aesthetics—as in the colors available and the ability to simulate natural materials or create a homey environment—are still the main factors when buying a flooring product, DuBose says.

"Cleanability is a big driver for choosing flooring, both the ability to get it clean and does it look clean," she says. "People love the shine of VCT because they think rubber never gets the same high-gloss look. Then there are those who prefer rubber because VCT can create glare."

Jeff Ferenc is senior editor for Health Facilities Management.