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Choosing Interior Surfaces that are Appealing and Hygienic
Today, patients, families, physicians and staff expect quality care to be rendered in a safe, clean and inviting environment. Therefore, modern health care facilities must transform their sterile, unappealing environment into a place that enhances their marketing and recruitment efforts.
To assist with this endeavor, technological advancements have provided more options for carpets, fabrics and hard surfaces. There are far more choices of colors and patterns. This, in turn, has lessened the requirement for large quantities of special orders of custom designs or color. Today, attractive patterns and colorful designs can be obtained more affordably and in lower quantities in both flooring and fabrics. However, the primary measure of performance for interior finishes is hygiene.
Performance Guidelines
No national performance specifications exist for finishes. Instead, there are guidelines and research from a variety of organizations, such as the Center for Health Care Design, The Robert Wood Johnson Foundation, Health Care without Harm, and the Coalition for Health Environments Research.
One example of performance research is a study of infection by the Coalition for Health Environments Research. The study, conducted at Northwestern Memorial Hospital, Chicago, focused on infection as related to commonly used materials in the health care environment. It included laboratory analysis of 14 frequently used products for upholstery, wall surfaces and flooring.
In terms of references available in the marketplace, there is the new 2006 Guidelines for Design and Construction of Health Care Facilities. Since 1947, the Guidelines for Design and Construction of Health Care Facilities has set minimum standards for American health care facility design. Today, these performance-oriented requirements give health care providers and design professionals guidance on good practice and emerging trends. The Joint Council on Accreditation of Healthcare Organizations (JCAHO), and federal agencies and authorities in 42 states use the Guidelines either as a code or a reference standard when reviewing, approving and financing plans; surveying, licensing, certifying or accrediting completed facilities; or developing their own codes.
Often called the “AIA Guidelines,” the Guidelines provided a number of recommendations for preferred finishes and surfaces. This set of principles also addresses issues such as ease of maintenance, durability, patterns/colors, fire and smoke resistance, slip resistance, sustainability, antistatic behavior and acoustic performance—all of which may also affect the achievement of a hygienic environment. Additionally, the Guidelines identify the following as positive characteristics: non support of microbial growth, smoothness, seamlessness, resilience and nontoxic/nonallergenic.
Ease of Cleaning is Essential
Designers should generally opt for finishes with solid surfaces, minimal joints and no seams in the upholstery that might absorb and retain dirt and stains. Flat surfaces and coves that can be easily cleaned are preferred. Some materials naturally impede the spread of infection, such as wood, cork and recycled rubber.
Infection control is such an important issue that some applied finishes contain antimicrobial agents, mold inhibitors, fungicides or infection-resistant agents. Textiles, carpets and furniture can be treated; however, the life of the product and finish should be given consideration.
When selecting finishes for any renovation or new construction project, the infection control and housekeeping staffs should be part of the team from the early design phases. The housekeeping department can also provide feedback on any layout issues that would impact their operations.
If a replacement facility is involved, staff members should be tested on cleaning the products as they would normally clean a soil or spill. The cleaning techniques being used should also not discharge volatile organic compounds (VOCs) into the patient care areas. Designers should avoid using flooring that must be waxed and stripped with hazardous chemicals, and they should choose paints and other coatings that have no or low VOCs. Similarly, blood, urine, coffee, gum and soft drinks should be tested over a 72-hour period on all finishes being considered. The finishes should be able to resist aggressive cleaning such as solvents and steam processes.
Ideally, designers and facility professionals should try to standardize the maintenance of materials. This is important, given the high turnover of maintenance hospital staff. Having consistent cleaning procedures and products can help minimize the destruction of the materials or their ability to fight infection. As an important note, the life-cycle cost of a design finish should also include maintenance costs.
Cleaning Furniture and Upholstery
In general, designers should select furniture that is especially created for health care settings.
Fabrics and finishes on upholstered pieces should be constructed of noncombustible or flame-retardant materials. In addition, fabrics should pass the tests of the National Fire Protection Association’s NFPA 701 Standard Methods of Fire Tests for Flame Propagation of Textiles and Films.
Additionally, all furniture—finished in vinyl or fabric—should contain a protective moisture barrier between the upholstery and cushioning. Often, antimicrobial ingredients are added in the production of fibers to slow down the growth of bacteria. It is also added to applied finishes to minimize soiling.
Cleaning is an important weapon in preventing the spread of bacteria, as well as in providing an attractive atmosphere. Many manufacturers have cleaning solutions and equipment especially for their products. If specific procedures must be followed beyond the routine housekeeping services, furniture manufacturers should provide the proper cleaning instructions. The cost of special cleaning methods should be carefully considered when selecting products for a healthcare facility.
Fabrics for Windows and Cubicles
Newer health care facilities typically have tinted, energy-efficient windows that require little shading. Windows with built-in blinds provide better alternatives for infection control. They also enable designers to add decorative elements to convey a variety of design concepts. However, if the cost of integral blinds is outside the budget, blinds or woven shades that can be easily taken down and cleaned are excellent alternatives.
The trend toward private rooms is restricting privacy curtains mainly to treatment areas. Therefore, these curtains tend to receive greater contact from patients, visitors and staff. This makes fabrics with antimicrobial properties prime choices for privacy curtains. Thankfully, current fabrics and the designs for cubicle curtains have become more attractive to the eye and touch—allowing them to become major elements in design themes.
A popular fabric for cubicles is Crypton, which is engineered to provide extreme stain, moisture and microbial resistance. Manufacturers that offer fabrics with special coatings and finishes include DesignTex of New York, Maharam also of New York and Miami-based CMI Enterprises. In addition, Newark, Del.-based W.L. Gore & Associates Inc.’s Gore-Tex has applied finishes to fabrics for non-patient care areas. However, the recommended cleaning procedures must be followed to maintain the protective properties of the finish.
Flooring Options
With an array of choices available, designers can select floor coverings in appealing patterns and exciting colors. Aside from aesthetics, flooring choices require special consideration during selection. When choosing sealed sheet goods for flooring, designers and facilities professionals should specify chemically welded or heat-welded seams and sealed bases. This will keep spilled liquids from penetrating the flooring and damaging the sub floor.
If choosing sheet vinyl, designers should select the highest quality that their project can afford. This product is durable and can withstand rolling carts and other heavy equipment. The negative quality of sheet vinyl is the visibility of the seams. The least costly flooring option is vinyl composition tile, but it also has seams and the tiles can crack under the pressure of heavy rolling carts.
As hospitals lean toward home-style interiors, wood is becoming a popular choice for presenting a warm, noninstitutional atmosphere. Solid rubber, linoleum and vinyl flooring offer resilient, dent-resistant alternatives. Rubber floors are more comfortable and quiet to walk on, and they wear well—although they tend to show grease stains more than vinyl. Linoleum has natural bacteria-resistant qualities. Designers should keep in mind that patterns in the mid-color range show fewer marks while dark, solid colors show dust and footprints.
The Upside and Downside of Carpeting
Carpet offers the benefits of noise reduction, ease of walking and—as some research shows— a reduction in the number of falls and fall-related injuries. Carpet provides a less institutional ambience and ease of cleaning than vinyl. Overall, carpeting can be more difficult to maintain than other floor finishes and should not be placed in high-risk areas because cleaning methods for carpeting may discharge fungal spores in the air.
The Carpet and Rug Institute reports that advancements made in carpet technology have made it a more user-friendly floor covering for a wide range of areas. But many health care designers and users prefer nonporous finishes in certain areas, particularly patient rooms. Carpeting is generally the best option for waiting rooms and other areas that require warmth and soothing quiet.
Choices for Ceilings and Walls
There have also been improvements in the type of paints available for use in health care environments. Wall paints now come in low-VOC formulations, and new water-based products are available with durable satin finishes that wash and wear well. However, wall coverings are a source of concern because of VOC emissions from the material and adhesive.
Many facilities are using solid surfaces and laminates typically used on horizontal surfaces on high-traffic walls. Wood, which creates a warm, inviting element, is also a good choice. However, it must be properly cleaned and maintained to achieve the best appearance. Synthetic wood patterns for walls and flooring can also be used to invoke warmth. Stone walls can be an attractive option for public areas if matched with warm, complementary materials.
Ceiling design is an area where many health care facilities fail to provide a hospitality-oriented feel. However, blending indirect lighting and coves in the ceiling can minimize the institutional appearance as well as enhance acoustics. Major considerations for choosing ceiling products include ease of continuing maintenance, replacements and speed of repairs.
No Need for Opposition
Historically, hygiene and aesthetics have been conflicting issues for health care designers and facilities professionals. With all the product choices that are available today, these two values need not be in opposition.
This article was reproduced for educational purposes from the January 2007 HFM Magazine article entitled “Finish Line” by Sonya Odell, ASID, AAHID.
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