When it comes to flooring for healthcare facilities, project teams must weigh a variety of concerns including aesthetics, cost, durability, and long-term maintenance.
“Flooring is a big concern because in healthcare, if it fails, it’s so disruptive to their business,” in terms of lost operations and revenue, says Aiko Tanabe, senior interior designer in healthcare at Perkins&Will (New York). “We feel a big responsibility in selecting it.”
Leah Wilkins, project interior designer at CannonDesign (Buffalo, N.Y.), agrees. “Flooring is one of the expected materials to last the longest and probably get the most maintenance done to them,” she says.
And while project teams are often guided by clients’ existing design standards when choosing styles and color palettes, she says it’s also important to bring new flooring lines to the mix. “We always try to offer those ideas to the client, especially with our interest in providing more sustainable solutions in healthcare,” she says.
How can flooring help address HAIs
While maintenance has always been a key driver in flooring conversations for healthcare environments, Stephanie Story, principal and interior design director at Array Architects (Conshohocken, Pa.), says some health systems are beginning to look at the topic from an infection control standpoint.
“In the past, a lot of facilities decided to go with a tile product, such as luxury vinyl tile (LVT), because they wanted the ability to quickly replace them if a tile got damaged,” she says.
However, recent data on healthcare associated infections (HAIs) and lessons from the pandemic are driving some health systems to consider other styles that eliminate seams.
Specifically, some studies show flooring can harbor pathogens that can then transfer to patient socks, bed linens, and other surfaces, as noted in the report, “Timing and Route of Contamination of Hospitalized Patient Rooms with Healthcare-associated Pathogens” published in Infection Control & Hospital Epidemiology.
“There was always this thought that a lot of these HAIs weren’t coming through the flooring material,” Story says. “Everybody was always looking at the privacy curtains and the bed rails as key sources as they are high-touch areas within the room, however the studies show it often starts at the floor as creating reservoirs of infection.”
With new evidence in hand, she says, more project teams are reviewing sheet flooring and poured products in areas, going beyond the Facility Guidelines Institute’s Guidelines for Design and Construction standards, which already require sheet-style flooring in spaces such as procedure, isolation, and operating rooms.
This is driving interest in sheet flooring in patient rooms and poured epoxy flooring products in patient toilet rooms due to their seamless and durable nature, particularly in areas with showers. “I think on the facility side, they still prefer to be able to pop out tiles and replace them, but there’s renewed thought about making sure that we limit the seams and flooring, especially in patient room environments,” Story says.
This shift means proper floor preparation is critical to ensure successful sheet product installations, including correct leveling products and adhesives tailored to healthcare settings to eliminate the potential for adhesive failures that can result in flooring popping out of place.
For example, Story notes that some gypsum-based leveling underlayment products used in light commercial applications are not appropriate for a healthcare setting because they’re inherently weak and not strong enough to handle the weight of equipment.
Sustainable flooring makes a mark
Designers say they’re also seeing more environmentally friendly flooring products, including phthalate- and PVC-free flooring, to meet growing interest in healthy and sustainable materials options.
“Vinyl is such a top-selected element when it comes to flooring,” Wilkins says. “As new PVC-free options come into the market, we try to bring those to clients.”
Tanabe notes that when Perkins&Will introduced material health as a standard practice at the firm more than two decades ago, it was an “uphill battle” to find materials that would support those goals and still meet requirements for healthcare environments. “Now, there’s more PVC-free products that we can show them, and we know they perform.”
Going forward, Tanabe and Story say they’d like to see continued strides in sustainable products, including a move toward more cradle-to-cradle options. “Just knowing how much square footage [of flooring] is getting pulled out every day, I don’t feel like we’re fully there on how to take back material and reuse it,” Story says.
Healthcare aesthetics drive flooring choices
When it comes to how healthcare aesthetics drive the conversation about flooring, Tanabe says that wood-look materials are still a popular choice to add a sense of warmth and support hospitality-inspired interiors.
“We have been in a light oak season for a very long time, and it may be time for warmer, more pronounced wood,” she says. Additionally, designers are seeing healthcare organizations move away from gray shades that were popular a few years ago to warmer tones.
“I’m a big proponent of staying fairly neutral with the floor colors regardless of what the material is,” Story says. “That gives [the client] the ability to update the space without being locked into one specific color.”
However, Wilkins notes that lighter tones can be tricky in healthcare environments because they can show scuff marks and damage from heavy equipment more easily than mid-tone products. When talking with clients, she says she tries to guide them toward products that will age well and that are space appropriate, including lighter wood-like products in public spaces and mid-tones styles and products with some patterning in clinical areas.
“The medication rooms, nurses’ stations, and team workstations are getting so much traffic that it’s not easy to clean into those rooms, so you’re mindful of using a bit of a darker tone to help with that,” she says.
Popular flooring materials for healthcare facilities
Tanabe says healthcare organization often turn to “tried-and-true materials” for facilities, including rubber, linoleum, and terrazzo lines. “They’re comfortable with them, but we love that manufacturers are coming up with more design options,” she says.
Story adds that a lot of flooring choices depend on the client’s overall goals and project drivers. For example, if acoustics and patient and staff safety are top concerns, she says she’ll suggest rubber flooring to help with acoustics and comfort underfoot. Meanwhile, if sustainability is the top focus, she’ll specify PVC-free options.
Cost is another big consideration, Story adds, with terrazzo and rubber flooring having a higher price point than other flooring styles. One strategy is to put high-end, durable materials such as terrazzo in high-traffic areas at main entry vestibules and lobbies and then specify more cost-effective products for clinical corridors.
Ayesha Wahid, interior designer at E4H Environments for Health Architecture (New York), adds that some LVT products are now being offered with a terrazzo or watercolor look, which can be used to bring interest to waiting spaces, circulation zones, and long corridors without the high price tag.
“We’ve been having fun with that to bring a less clinical look to healthcare,” she says. “It makes the space more playful, not only in pediatrics but in all kinds of facilities.”
Designers also note an appreciation for flooring styles that support the growth in renovation work across the sector. For example, Wilkins says she’s seeing a move away from heavy linear and grained styles in resilient flooring to more non-directional visuals that have a lower contrast, making it easier to marry new and existing flooring styles.
“When things are non-directional, it kind of gives you a little bit of grace of how you wrap corners and do some floor patterns,” she says.
Thicker resilient tile and plank materials, including 55mm options, are also a welcome addition to existing product lines to help address level changes between old and new flooring.
“Because the flooring conditions are often unlevel or sometimes [the client] wants to go directly over old VCT [vinyl composite tile] flooring and encapsulate it, some of those thicker options can be a good option for those spaces,” Story says.
Uncertainty over future flooring costs, materials availability
As flooring options for healthcare continue to expand, Wilkins notes the need for more data and research on how new flooring materials perform in healthcare environments.
“We know that homogeneous vinyl sheet is durable, you can test the tires to that on so many projects,” she says. “But as new materials come along, case studies and product data are really important to share with the client to make sure that they understand any differences in maintenance.”
Mock-ups are another aid, whereby manufacturers provide samples of a new product for a client to install in a corridor or back-of-house area to see how it performs. “That way, [the facility] can get comfortable with the [new] material that they’re interested in,” Wilkins says.
In the near future, Wilkins says uncertainty with material pricing might affect flooring decisions on projects. “Current political events are going to be such a huge learning curve as we have project going out to the market,” she says. “Not everything is made in America, so there’s concern about pricing changes.”
Having a clear understanding of lead times and material availability for flooring products is also important. “If the census is high or they’re going into flu season, understanding all those things because you might have a short window to get in there and get the work done,” Story says.
Anne DiNardo is editor-in-chief of Healthcare Design and can be reached at [email protected].
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