Healthcare Surface Cost Analysis

Like the hardworking hospital staff, flooring solutions are driven by performance and endurance – and selecting the best floor and wall surface finishes for hospitals is uniquely important.

Not only are the hospitals operating around the clock, the facility itself must be maintained to a higher standard to minimize Healthcare Acquired Infections (HAI). With the introduction of the mandatory reporting for HAI in combination with insurers’ “no-pay” policies for “preventable events”, hospitals have expanded their focus on maintaining sanitary facilities and practices for healthcare, marketing and financial reasons. 

Unlike most commercial and institutional applications where aesthetics play a primary role in finish selections, hospitals are driven by performance first and aesthetics second. The floors and walls must meet the needs of the specific area of usage, be easily maintained, and provide an extended service life. Each area or department within the hospital must be evaluated for the performance requirements. Typical hospital functional properties considered include:

• Smooth surface to accept wheeled traffic
• Slip resistance
  
• Minimum sound transmission
  
• Low porosity for ease of cleaning and disinfection
  
• Ease of maintenance and disinfection, including transitions
• Chemical resistance to anticipated conditions such as cleaning chemicals, foods, body fluids or trafficked soil 
  
• Long life cycle as measured by abrasion resistance
  

The flooring selection for hospital applications must consider the installation as well as the daily and periodic maintenance as these may affect the hospital operations and the healing environment. Renovation and repurposing facilities with ongoing operations favor products with little or no removal, dust, debris, noise and odor.

Options that meet the requirements can then be evaluated for economic considerations. This evaluation of life cycle cost addresses the initial installation costs, annual maintenance costs, service life and replacement costs. Hospital renovations, and areas being repurposed for specialty care, are conducted while the hospital continues operations. Providing a clean, low odor, quiet, and debris free environment around patients is critical to the overall healing process.

Once the selection process has identified the options that meet the performance criteria and are within the budget, the aesthetic qualities can be evaluated. Aesthetics are important in a hospital and have been shown to positively influence patient’s healing process. Way finding, both an aesthetic and functional property, can be incorporated into a flooring or wall system using colors and patterns.

There are a variety of different use areas within a hospital and no one floor finish is perfect for every environment. Flooring options have changed over the past 50 years and new technology is available that addresses some of the deficiencies of commercial flooring when used in hospitals. Life Cycle Cost compares the various flooring options detailing initial installed cost, annual maintenance costs and replacement cost in a hospital environment.

In most hospitals, the maintenance costs for all flooring finishes will be higher than those experienced in other commercial markets. It is also likely that the life of any flooring surface will be on the low end of the range simply due to the fact that the facility is in constant use and the cleaning regiment is frequent and aggressive.

A quick analysis of this data clearly shows that initial costs are not the best indicator of economy. These numbers vary from one study to the next and actual costs and life will depend upon the usage conditions and area of the country.

Getting the right floor and wall system for the right environment is essential. Each environment has specific criteria that needs to be met for the safety and well-being of the patients, visitors and staff, as well as for operational efficiencies and flexibility in space use.

A well-designed system can actually improve the quality of care and health outcomes of patients, increase staff productivity lower life cycle costs.

The walls and ceilings in a hospital can be divided into typical commercial-like applications that are finished with the desired paint, and high performance applications which require a coating to meet the stringent cleaning and sanitary conditions. Operating rooms, emergency rooms, patient rooms and hallways require a two-component epoxy or polyurethane finish. Areas prone to impact may incorporate reinforcing fabric within the resinous wall system. Installation of a high performance system in these specialty areas will minimize maintenance and sustain a cleaner environment. As mentioned previously, high performance wall systems can be installed over a floor cove eliminating dirt collection point with an overlapping transition. This is especially important in areas that may receive a thorough wash down and stringent disinfection such as surgery rooms.

When considering the patient treatment areas within the hospital including surgery, emergency room, intensive care, patient rooms and hallways, a subjective performance comparison is presented for each finish. These may vary when evaluating individual products versus the class in general. The chart below evaluates the main categories.

The level of importance was assigned to each of the functional properties whereby 5 is the highest importance in patient treatment areas. The finishes were then ranked based upon their performance/importance multiple. The highest score indicates that seamless resinous flooring is, in general, the best option for patient treatment areas.

Hospital kitchens must be designed to handle more volume than most major restaurants. Urethane cement mortar seamless systems have become the industry workhorse because they address all of the variables present within this workspace:

• Slope to drain
  
• Slip resistance texture
  
• Minimum sound transmission
  
• Thermal shock resistance for fryers, freezers or industrial ovens
  
• High point loading
  
• Excellent abrasion and impact resistance
  
• Optional design and color features
  

Hospital mechanical equipment rooms should also have the concrete floor finished with a resinous coating. Elevated rooms in high rise hospitals will also require a waterproofing membrane and wear surface. This will minimize dusting, maintain good air quality and provide a long lasting, slip resistant surface.  

Most of the other floor and wall surfaces in the “public” areas of the hospital can be selected using the typical commercial finish criteria. However, it is important to design floor and wall selections and maintenance policies when traffic patterns include tracking from “clean” environments to public areas.