An Interview with Kathy Griffel
When people walk into a hospital or an acute care facility, the flooring isn’t the first thing they notice, but as one of the largest surfaces, it’s a critical aspect of the overall healthcare environment’s safety.
Deciding what type of flooring for healthcare is critical from a cleanliness perspective and a safety perspective. For example, using a seamless floor helps to create a more sanitary environment and making sure hospital beds have appropriate wheels to avoid point load damage to flooring are two areas that need to be considered.
I sat down with Kathy Griffel, Director of Healthcare at Mannington Commercial to talk about the 10 decisions that you need to make when selecting flooring for healthcare spaces. Kathy comes from a family of doctors, nurses and builders and she herself has decades of flooring experience.
As a start, she spent a lot of time in hospitals when her twins were born with serious complications and spent time in the NICU and hospital system during their early days and years as they developed. That was a pivotal event in her life for many reasons, but she says on the career front, it caused her to become even more passionate about focusing on the importance of safe, clean, well-designed healthcare facility, which brings us to our first point.
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Tip #1 Use seamless flooring such as sheet vinyl to create a more sanitary environment where needed.
You recently released Top 10 Flooring Tips for Acute Care and with where to use seamless flooring and how it can help maintain a sanitary environment. Can you explain why seamless flooring is so crucial in a healthcare environment?
That actually crosses over directly to the article I co-wrote about why sheet vinyl is the best choice for infection control. With the current COVID-19 pandemic, infection control is top of mind and I believe people are thinking of putting seamless flooring in areas where maybe they didn't before. Trends in flooring are like a pendulum and hospital spaces used to be predominantly sheet vinyl. LVT grew in popularity and took a big chunk out of resilient sales. Now I think the pendulum is swinging back toward sheet vinyl. So that's why we listed this as the first tip.
Do you have any experience where there was an issue with an infection that made seamless the standard in the building industry? How did that come into play?
Facility Guidelines Institute (FGI) recommends areas in a hospital that must have a monolithic or seamless floor. These are places like operating rooms and other spaces that must be designed with that requirement. But not every space must meet these conditions. Patient rooms, for example, don’t have to be seamless, according to FGI guidelines.
Now more than ever, isn't it more mindful for end users to consider all patient spaces as critical for infection control? Environmental Services (EVS) is challenged to deep clean a floor when the patient room is in use. Occupancy rates are so high that there's almost always patients and caregivers in the rooms. Yes, maintenance can do a terminal clean between patients, but daily traffic from patients, visitors and staff may prevent the patient room from being deeply cleaned everyday. So, with today's pandemic situation, I would rather be on a floor now that is seamless versus one that has lots of cracks and crevices that could harbor bacteria.
Tip #2: High-performance adhesives should be specified under heavy rolling load locations such as hospital beds or operating room tables.
Could you explain why rolling loads need to be taken into account with flooring and, specifically, high performance adhesives?
One of the issues we typically see is damage caused by heavy rolling loads. Hospital beds have only gotten heavier. The average patient in the U.S. weighs more than in previous decades, so additional stress is being put on hospital beds.
In addition, since hospital staff needs hospital beds to move easily, manufacturers often put a hard or small wheel/tire on a hospital bed because that helps it with it's mobility. But the problem is that the hard wheel puts an extra point load of stress on the floor. So, this becomes a trade-off…bigger wheels disperse the weight over a greater area and put less stress on the floor, but they may make the bed harder to move. Narrower wheels make the bed more mobile but may cause damage to the floors.
The flooring area directly under a patient's bed becomes the biggest area of concern. This is typically a well-defined space as it lines up with the head wall, med gasses, etc. creating a "parking lot." When the nurse locks the wheels, almost all of the beds have wheels that lock on opposite sides. There's a torque that's created thus causing significant, repetitive stress on the floor.
We always recommend as best practices that a high-performance adhesive be used underneath the bed area to create that extra security where you have those extra forces occurring. When I meet with clients, I really underline that point as something the architect and user can take control over and specifically ask for. Following manufacturer's recommended guidelines may not be specific enough to ensure optimal performance.
If it's not a general practice that people put the high performing adhesive under patient beds, then what is the result?
No, it’s not general practice, and so the flooring lifts up from the concrete. When those wheels torque, they create a lateral movement. The floor is supposed to stay in place with the concrete and then there's something on the surface twisting it so the floor ends up lifting, and there's usually these bubbles that occur underneath the wheel area.
Tip #3: Adhesives with high moisture performance should be used to reduce substrate failures and avoid costly moisture mitigation.
So the beds and then the high moisture performance ties together, right? Does that mean adhesives with high moisture performance should be used to reduce substrate failures and avoid costly mitigation?
They are separate issues actually, because moisture can happen anywhere in the hospital at any point in time. Whereas under-bed damage is location specific.
Moisture is a complex concern. In the past, adhesives were much more sensitive to moisture limits. Adhesives are primarily water-based so when you add moisture, the adhesives fail. Moisture mitigation was the standard (and costly) practice to ensure correct adhesive bond. But now the adhesive technology has improved significantly and continues to make advancements. We've gone up to 99% moisture limitations, so
It’s more important than ever for designers and end-users to take control of the adhesive specification and be mindful of the technology advancements.
Most people have a spec that reads “per manufacturer's recommendations” and technically on our product you could use the V-82 adhesive which would be an 85% relative humidity (RH) moisture limitation. Why wouldn't you use V-88 adhesive which is 95% RH and is a similar cost? It's just being mindful of that, and for the specifiers to not worry about calling out a particular adhesive or a particular adhesive rating.
Tip #4: Make sure hospital beds have appropriate wheels to avoid point load damage to flooring.
Then you said, make sure hospital beds have appropriate wheel dispersion to avoid point load damage to floors. Could a designer spec the wheels, knowing where they're going to go and the floor that they're on?
When the specifier specifies a hospital bed, it comes standard with a certain type of wheel. Usually Stryker and Hill-Rom will substitute a different wheel for no charge. The type of wheel can make a big difference on the point load and should be considered as mentioned in Tip #2?
Tip #5: Minimize or eliminate sheet product seams by using wider width material such as 9’ or 12’, especially in corridors (often a high traffic area) where seams can be totally eliminated by the use of 9’ sheet goods.
This tip seems really obvious to us as flooring people. Can you talk through some of the issues of why somebody would want to do that?
The standard corridor size in a hospital is eight feet. Almost every commercial sheet vinyl company manufactures their products in one width, typically 6'6" (2 meter). So with everybody else's sheet goods on the market, you by default have to have a seam offset in the corridor. Some designers try to put the full-size piece down the middle and a one foot border on each side which results in two seams. By using a nine foot width sheet vinyl you will have no seams in the corridor. We are the only company that manufactures commercial heterogeneous sheet vinyl in 6’, 9’, and 12’, so it’s a big advantage to use our sheet product vs a competitor.
Is it because we're an American manufacturer?
Yes, for one reason. Most of our competitors manufacture their sheet vinyl in Asia or Europe where a 2 meter-wide product is standard. Our sheet vinyl plant is in Salem, NJ so we are US designed and produced. We have been able to see the critical need for seamless, infection-controlled spaces, and we are the only manufacturer that can supply a seamless 8' corridor.
Don't have time to read them all? No problem.
Download the full list of the top 10 flooring tips for Acute Care here.
Tip #6: Consider uniform manufacturer’s coating technology across all resilient flooring (sheet, LVT) to avoid different maintenance requirements
So, let’s consider uniform manufacturers, coating technologies. Like our quantum guard technology. Right?
Right. So, this is an environmental services discussion because if the coating is the same across your various types of flooring products, maintenance is pretty much the same. A lot of people specify LVT from one manufacturer and a sheet vinyl from another. Since you are really maintaining the coating it's important to have a consistent coating technology. And then you've got to be very sensitive to Environmental Services Department and their ability to clean a floor thoroughly and quickly.
Tip #7: Use domestically manufactured materials to avoid potential construction delays
With this tip regarding sourcing domestically manufactured products, are there any clear examples of things where you've had that issue, where somebody has specified something and then because of tariffs or other delivery complications, they're not able to get it?
Absolutely. It’s not only longer lead times with non-US produced products that is a concern as many companies keep a decent stock of material. But they can, and do, run out of stock, especially now with COVID-19 financial impacts on companies forcing them to reduce their inventory levels. If a project order ships for 500 cartons and they need 25 more to complete the job, is the material going to be available in the same dye lot and in a reasonable amount of time? At Mannington, we can pivot and make that.
Raw material resource stream also becomes an important consideration. When the product is made in Asia or Europe, there is more uncertainty. Domestic resource streams tend to instill more confidence knowing that we have control to manage it.
We always like to stress that with us, you've got a more secure raw material stream. It's also about employing U.S. workers, keeping jobs in the U.S.
It's that ability to be more nimble, more responsive and more intimate with inventory and resource management. And if we discontinue something, the ability of a U.S. manufacturer to probably make it again is going to be better than somebody in Asia. We probably can be able to be more responsive to those needs.
Tip #8: Use resilient sheet in patient rooms and LVT in corridors and public spaces to deliver an optimal blend of effective cost averaging and infection control
So, resilient sheet in a patient's room and LVT in corridors and public spaces to deliver an optimal blend. So that's more about cost, right?
Right. Some specifiers consider sheet vinyl to be a better product for infection control and it can be used in both patient rooms and corridors. But some end users prefer to either use a combination of sheet vinyl in patient rooms and LVT in corridors or simply use LVT everywhere, other than those spaces dictated by FGI. Today, there is a wide variety of design and performance considerations so we are seeing all combination of product usage to optimize cost.
Given the wide variety of healthcare flooring options and recommended guidelines the decision is ultimately up to the end-user to decide what they feel will work best for their space. LVT is easier to replace should the floor get damaged, so that may become a high consideration in corridors as they are high traffic spaces. And while sheet vinyl products offer more secure infection control, the reality is that we often see Mannington sheet vinyl in a corridor that was installed using the 6’6” wide format and therefore it has a seam so another tip I will slip in here is that it is always important to ask your flooring contractor for a seaming diagram!
Tip #9: Select a low contrast color insert under surgical table to assist in finding dropped instruments during procedures
That's very interesting to assist in dropped instruments. Where did you pick that up?
So, this is a homogeneous sheet discussion only since that product is used in operating rooms where it is underneath the OR table. And what low contrast means is that there's not a lot of disparity between the granules in the colorway.
Virtually all homogeneous sheet products are made with a chip visual. It's important to look at the contrast of those chips within each colorway. Is there both very light and very dark chips together? Or is the color a bit more uniform/solid looking?
When it comes to the area directly underneath the OR table, we recommend using a low contrast or more “solid” looking colorway. The reason is when you go in for a surgery, there's a nurse whose sole job is to do instrument count and she's responsible for making sure that nothing gets left behind in your body from sutures to instruments to everything else.
That is her primary job. So when they do a count at the end of the surgery, they want to make sure they still have three scalpels or whatever and all the sutures that were used are accounted for on the patient and none were dropped. You want to be able to see when something drops on the floor and be able to see it quickly.
If it's a high contrast product, it camouflages what you've dropped. So you want to use low contrast flooring underneath that patient bed area, if not in the whole OR, but at the very least underneath the patient bed area so that when something falls on the floor, it's easily and quickly counted and accounted for. Otherwise, there could be medical complications.
Low contrast flooring makes sense in an OR because that's really where it's needed. Low contrast flooring in senior living is a whole other conversation. You don't want to have high contrast in senior living because they perceive dark spots as holes and voids. But low contrast in the acute care in the OR setting is a very interesting discussion.
Tip #10: Consider using a separate color under surgical table to allow for easy replacement of this heavily used area
So, some design philosophy is that you put a separate color in a patient room, in that parking lot, right? Or a separate color in the OR, again, the OR is a big space. There's usually a parking lot for that bed also.
From a design perspective, some people like this and some people don't. It’s an aesthetic issue but also a functional issue. When we bring this up to designers, most feel this makes a ton of sense. If a separate color, particularly a low-contrast color, is specified underneath the OR table area, and you make it look like part of the intentional design, it’s easier to replace just that section when it wears out from the weight of the hospital beds.
From a functional point of view, you're pre-planning for the reality of replacement rather than replacing the whole room, which is expensive and costs lots of downtime. If you're just replacing your bed area, they can do that overnight. You're pre-planning for the reality that underneath the bed area is a damage-prone space and thoughtful design at the beginning of the project makes the reality of future replacement look much more intentional.
This was super insightful, Kathy. Thank you for walking me through the process behind these tips. I know you have conversations with end users and designers around these topics daily, and I appreciate you sharing your insight with our blog readers.