Rolling it out

Choosing the right carpet type and style will have much to do with the success of the application, vendors say. Here's what to consider.

Carpeting can help hospitals improve sound-absorption, indoor air quality, staff and patient safety, and aesthetics, but it also poses many challenges.

Health facility professionals must choose carpet types and styles wisely to ensure that they can be maintained appropriately for the particular application.

Additionally, they must enlist their hospital's infection prevention experts and environmental services managers to ensure there are no infection control or cleanability issues.

Carpeting advantages

Carpet vendors and many interior design professionals say that carpeting offers several advantages in the health care environment. These include the following:

Acoustics and sound absorption. Carpet is a proven sound absorber, according to Paul Young, director, health care markets, Shaw Contract Group (www.shawcontractgroup.com), Cartersville, Ga. "Hospitals can be noisy, when you consider the various monitors, foot and rolling traffic and HVAC systems," he says. "Carpet absorbs sound 10 times more effectively than hard-surface flooring, which contributes to a quieter, more healing environment."

Michele Woodard, CID, EDAC, principal, Jain Malkin Inc., San Diego, says the use of carpet in hospital corridors and at nurse stations helps reduce ambient noise, thereby improving patients' ability to sleep. The acoustical properties of carpet improve verbal privacy for both patients and staff.

"Accuracy in communication is improved when background noise is diminished," she says. "Research has shown that medication and charting errors also are reduced."

Indoor air quality. Although carpet is perceived to be a collector for pathogens and contaminants, evidence has shown that the entrapment of these contaminants is actually beneficial.

"Carpet reduces the amount of airborne microorganisms," says Roseann Pisklak, IIDA, AAHID, LEED, a senior interior designer and associate with WHR Architects Inc., Houston. According to pages 92 and 93 of the Centers for Disease Control and Prevention's (CDC's) Guidelines for Environmental Infection Control in Health-Care Facilities issued in 2003 (www.cdc.gov/hicpac/pdf/guidelines/eic_in_HCF_03.pdf), Pisklak notes, there is little empirical evidence regarding the impact of carpet on the rates of health care-associated infections.

Young agrees, adding that some data have shown that carpet reduces the number of breathable airborne allergens and irritants, compared with smooth-surface floors.

Ergonomics. Tests have shown carpet to be an effective anti-fatigue surface, according to Keith Gray, director of technical marketing for the Mohawk Group (www.themohawkgroup.com), Marietta, Ga. This is especially important given the aging population of hospital caregivers who spend long hours on their feet. "However, these tests also have shown that carpet with a cushion, either attached or installed separately, does not offer a significant added advantage as an anti-fatigue surface," he adds. "This is important because recent data show that cushioned flooring in general hinders mobility by increasing the rolling resistance of hospital beds, wheelchairs and other equipment."

Safety. Carpet may be the safest surface available for preventing slip-and-fall accidents and for reducing the seriousness of injuries suffered when falls do occur, Gray notes.

"Research has shown that a significant number of slip-and-fall injuries occur on wet hard-surface flooring," he explains. "Tests of static coefficient of friction show that wet carpet is less slippery than other types of flooring. Additional research has shown that 17 percent of people who fall on carpet require medical care, whereas 46 percent of people who fall on noncarpet surfaces require medical care."

Aesthetics. Clarence Porch, marketing manager, Milliken Floor Covering (www.millikencarpet.com), LaGrange, Ga., says carpet is experiencing a resurgence in health care environments because it helps create interiors that embrace wellness and promote feelings of well-being. Even when surrounded by sterile surfaces, carpet projects a warm and inviting atmosphere.

Cathy Frial, vice president of marketing, Bentley Prince Street (www.bentleyprincestreet.com), City of Industry, Calif., agrees. "Carpet brings a more residential, warm feeling to the design of a hospital, which improves the morale of both patients and employees," she says.

Carpet also improves aesthetics by minimizing glare, according to Sheila Semrou, AAHID, a consultant based in Milwaukee. "Carpet prevents harsh glare and visual stress caused by reflections on smooth, hard-surface flooring," she says. "This is especially important in corridors, lobbies, lounges and waiting areas — where there may be an abundance of natural light from large windows or skylights."

The right choice

Many experts believe that nurses' stations and corridors are suitable for carpeting, as are lobbies, waiting rooms, cafeterias and children's areas. These high-traffic areas benefit from carpeting's safe qualities as well as from its noise- and glare-reduction attributes.

In contrast, laboratories, intensive care units (ICUs), operating rooms, burn units and food prep areas are not appropriate locations for carpet.

Carpet long has been used in lobbies, common areas and administrative suites, according to Young. Moreover, in recent years, broadloom and carpet tile also have been used in corridors and patient rooms. "Carpet designed specifically for health care can handle rolling traffic and moisture management — both issues that have hindered its use in the past," Young says.

Many factors should be considered when determining what type of carpet to use in certain areas of a hospital. It is important to specify the correct carpet in terms of construction, fiber content and backing system — one that is appropriate for health care use, Woodard advises.

"The pile height should be dense and low to minimize the drag on rolling traffic," she explains. "The backing should also be low and moisture-impervious to prevent stains from soaking into the backing where bacteria and odor can grow. Also, it is important to select colors and patterns that are suitable for the patient population."

Ridley Kinsey, vice president of sales, health care, Tandus Flooring (www.tandus.com), Dalton, Ga., says carpet should be selected with consideration given to aesthetics, color, pattern and construction, amount and type of traffic, soiling, maintenance and expected life cycle.

"High-traffic areas require a closed-cell cushion construction to maintain resiliency, appearance retention, ease of maintenance, moisture management and acoustical performance," he explains.

"Moderate-traffic areas can utilize synthetic backing systems that stop moisture, at least where there are no seams," Kinsey says. "Modular tile can be used in these areas as long as they are not subject to continuous maintenance or spills where moisture can affect seams. Low-traffic areas can utilize any product with a synthetic backing that impedes moisture intrusion."

Material innovations

Over the years, vendors have developed technologies that allow carpet to be cleaned easily, even with cold water. These features benefit health care and maintenance staff.

"Products constructed using a solution-dye method are resistant to bleach and other harsh chemicals," explains Howard Elder, director of research and environmental affairs, J+J/Invision (www.jj-invision.com), Dalton, Ga. "Special backings prevent liquids from seeping beyond the face fibers by providing an impervious barrier. In addition, many backings offer anti-microbial treatments to protect the carpet from both bacterial and fungal growth."

Gray says construction of carpet for health care environments has evolved considerably over the years. Advances include dense-face construction that uses premium fibers and durable dyeing technology, with low pile heights, moderate face weights and wear-resistant fibers, and performance backing systems that resist moisture, and facilitate mobility and comfort.

According to Kinsey, key innovations include advances in fiber and tufting technology that enable a wider variety of designs targeted at health care environments.

"Solution-dyed nylon remains the yarn of choice, but some areas where carpet is installed are not subjected to the same rigorous maintenance details found in patient rooms and corridors," he explains. "Therefore, more hospitals are using combinations of solution-dyed yarns with up to 30 percent space-dyed or skein-dyed yarns. This provides greater design flexibility as hospitals increase their focus on enhancing interior aesthetics."

In addition, now there are environmentally friendly innovations in carpet materials. "This can be seen in materials ranging from recycled backing to carpet fiber that includes recycled content," says Elder. "Both backing and fiber are created to provide high performance and offer a sustainable design choice." Young adds that yarn innovations — smaller sizes, more colors, recycled content and recyclability — are driving the development of carpet into higher-performing areas.

When it comes to selecting colors or patterns, experts agree it is important to determine who will utilize a particular area. Bright colors and bold shapes are appropriate for a children's wing, while warm colors and organic motifs are better suited for a waiting room or a rehabilitation wing.

"Patterns should not be too distracting or literal," Kinsey advises. "Generally, medium-range colors work best in health care settings where the ideal product should enhance the lighting of the space while being dark enough to help hide traffic patterns and soiling."

Making it last

How can facility managers prolong the life of carpet in hospital environments?

Choosing the right backing is essential, says Pisklak, because it is the foundation of the carpet that determines the stability of the fiber as well as the ability to prevent yarn pulls and edge raveling. "In addition, select a high-performance yarn system," she advises. "This will ensure the carpet's color and overall appearance will remain brilliant over time."

Proper care is the key to maintaining carpet in health care environments, according to Ashleigh Pfluger, LEED AP, AAHID, an interior designer with TJNG Partners, Maitland, Fla., who says dirt should be extracted, not cleaned with a pad. "That is the biggest issue we find with some hospitals," she explains. "Maintenance staff often clean carpet the same way they clean a hard-surface floor, with a scrubber pad. This destroys the fiber, which in turn causes the carpet to underperform."

Another key issue that facility managers face is how to clean carpet without promoting infection, or keeping a room out of commission for long periods of time while it dries. Gray emphasizes that a properly maintained carpet will not promote the spread of infectious diseases. "Chemistry, concentration and contact time are the key ingredients to effective cleaning," he explains. "The sanitizing cleaner should be proven effective against whatever microorganisms are of concern, applied at the proper strength and allowed to remain wet long enough for the sanitizer to work."

Recent advances in cleaning technology allow hospital rooms to be cleaned, dry and ready for use in 30 to 40 minutes.

Should carpet be restricted from use in areas where bodily fluids likely will be spilled? According to Young, the CDC recommends that carpet not be installed in laboratories, custodial closets and around sinks — areas where heavy and frequent spills likely will occur. The CDC also includes burn wards, ICUs and operating rooms on this list.

Kinsey says that in areas where spills and bodily fluids are prevalent, only products with an impermeable construction and welded seams should be used. Unless a wall-to-wall moisture barrier is created, fluids can pass through to the backing or subfloor where they can cause odor and bacterial growth.

Elder says the decision depends on the type of dye methods used in the carpet chosen, in addition to factors such as the product construction, advanced backing selections or antimicrobial treatments.

A range of factors

"It's all about the challenge of providing a healing environment while keeping the bottom line solid," Porch says. "When choosing floor coverings, hospital administrators must balance a range of factors unique to their situation — aesthetics and performance, ergonomics and style, cost and image, all while creating a more home-like environment for healing."

Neal Lorenzi is a freelance writer based in Mundelein, Ill.