By Sandra Soraci, EDAC, LEED AP, NCIDQ
From the June 2020 Issue
Infection prevention has always been at the forefront of health systems safety drivers, impacting patient outcomes and caregiver safety. Seeking to fill the gaps in infection prevention will continue to be critical amid the COVID-19 outbreak. Infection prevention mitigation and safety protocol will continue to advance as we are faced with new viral and bacterial outbreaks. Each individual material in the built environment, such as surfaces and interior finishes, can foster or improve hygienic efforts for staff and patient safety.
More than ever, it is vital for organizations to leave no detail of the built environment overlooked. Flooring, which covers every square inch of a space underfoot, is no exception. According to the American Journal of Infection Control in 2017, hospital floors are often excluded as a potential source for infection; however, pathogens can spread from the floor to hands and other high-touch surfaces throughout a hospital room. Additionally, 41% of the 100 rooms surveyed in the study by Abhishek Deshpande, MD, Ph.D. of the Cleveland Clinic and colleagues had one or more high-touch objects in direct contact with the floor, including personal items, medical devices, and supplies.
Protecting From The Floor Up
In the medical field, the Hippocratic Oath states, “first, do no harm.” Therefore, the safety of patients, caregivers, and family members is imperative to consider when specifying, procuring, designing, and constructing healthcare facilities.
Flooring selection is key, given its reach and that it supports all activities in the healing environment. Not only does it impact total cost of ownership, research now shows flooring has an actionable impact on safety by reducing ambient noise, staff fatigue, and surface contamination. Flooring is an essential choice when specifying materials—yet, it can be overlooked for infection prevention. Though not a high-touch surface, flooring can be a reservoir for pathogens that could lead to adverse patient outcomes due to cross-contamination.
Given the current global pandemic crisis, a shift in the design of built environments is unavoidable, and cross-contamination is likely to be at the forefront of discussion. Monolithic flooring made of premium rubber is homogenous and has an extremely dense nonporous surface, which inherently repels dirt and does not serve as a medium to the propagation of microorganisms. This premium rubber material does not encourage or produce bacteria, in turn, supporting infection control drivers in the healing environment.
Staff at Nemours Alfred I. duPont Hospital for Children in Delaware specified rubber flooring for its dimensional stability, minimal seaming, and heat-welding capabilities as a way to prevent contamination. In tandem with a perception of clean increase in HCAHPS scores, caregivers felt confident the floors were free of infectious materials, easing the worry of family members who climb into beds with their children. Overall, the concern of cross-contamination from infections picked up from the floor was mitigated.
The Centers for Disease Control (CDC) provides guidelines for environmental infection control in healthcare facilities, newly updated in July 2019, that reviews and reaffirms strategies to minimize adverse patient outcomes in healthcare facilities. To maintain the efficacy of materials, such as premium rubber flooring, against contaminates, facilities must follow standard operating procedures for cleaning blood-borne spills and any contaminates spilled on the floor surfaces. When explicitly protecting against bacteria and pathogens, it is essential to clean surfaces thoroughly, regardless of material. By following proper cleaning guidelines, biofilms cannot form without a protein source—ultimately, preventing contamination.
Patient safety and outcomes are at the forefront of design. As health systems have shifted from volume-based to value-based patient-centered care, interior finish specifications hold more weight regarding return on investment and reimbursement to the health system.
Designers and end-users can feel secure specifying a resilient flooring surface for a health system’s space-specific needs. Premium rubber flooring is naturally bacteriostatic and bactericidal in behavior, meaning it can both eliminate and prevent bacteria growth, and does not require a layer of artificial protection. Through this material choice, a second level of defense is present against bacteria and fungi, and air quality benefits by eliminating the need for harsh cleaning chemicals.
When designing a facility with a holistic and human-centered approach, the day-to-day impact of material choice is just as crucial as life cycle implications. By taking a critical look at materials chosen, facility managers and their design partners will aid in lessening cross-contamination as well as promote an overall safer environment.
Soraci is strategy lead, healthcare and education for Interface. She is a thought leader and designer with more than 20 years of experience in healthcare and learning spaces. Soraci works to collaborate with clients to provide viable product solutions that embrace the principles of evidence-based and human-centered design.
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