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The health care sector is a completely unique environment. Hospitals are open 24/7/365, and people are engaged in this environment … walking on the floors, sitting in the furniture, touching walls, cleaning the wards … every minute of every day. It’s a highly used, highly abused environment. Designing for that is a real challenge, but once you’re in that world you learn more; you become more efficient, and you’re more in demand,” notes Marie Lukaszeski, AAHID, IIDA.
Lukaszeski gravitated toward health care when she was selling furniture 15 years ago because she found the field, and the clients, more interesting. “The facilities guys, on one side, want everything to be bulletproof and would prefer it if everything was white and beige. The executive team wants to invite managed care into their facility, so they want it to be aesthetically-pleasing and clean. The maintenance people want to be sure it’s easy to clean. And the public, the consumer, wants to choose between facilities.
“So you’ve got all of these different facets that you design around, and ultimately, you need to have a product that’s safe for the staff to use, and for the public to interact with—and aesthetically-pleasing and clean for patients to heal in.”
A few years ago, Lukaszeski received additional insight into health care design via personal experience. A minor issue during the birth of her second child sent the infant to the neonatal intensive care unit (NICU) at Lafayette General Medical Center (LGMC), in Lafayette, LA. Ironically, she had just started working with LGMC’s neonatologist on redesigning the NICU two weeks earlier.
“I never dreamed that he’d be caring for my child,” she says. “He had trouble regulating his breathing, so the doctors recommended he go to the NICU to stabilize and get stronger. I didn’t get to see him for the first 20 hours after he was born. Finally, at three in the morning I couldn’t take it anymore; I told the nurse I had to see my baby.
“When they wheeled me into the NICU, I was confronted with all these tubes and buttons and machines, and all the babies were lined up against the wall. It’s a frightening experience as a parent—[it’s] even worse if your baby isn’t as healthy as I knew mine was.”
That experience drove Lukaszeski to visit several different NICUs. “I needed to understand how important the healing environment is for babies, and for the families helping these babies to grow. My experience with how people interact with this built environment was very fresh in my mind.”
Her design for LGMC included concealing apparatuses where possible, increasing privacy for families, and getting the omnipresent audible monitor alerts and harsh lighting under control. A pinwheel layout model allows for clusters of three baby areas with half-height walls; decentralized nursing stations minimize staff footsteps.
“Flooring is a big issue for NICUs,” says Lukaszeski. “It’s a challenge to get inside a NICU for a terminal clean. A floor that requires waxing multiplies this challenge, and there’s an odor associated with stripping and waxing floors that you just can’t have in a NICU, which means all the babies need to be moved somewhere else during waxing and drying, for three or four days at least four times a year. Hospital staffs often complain that the chemicals involved give them headaches.
“We chose rubber floors for many reasons. They are naturally antimicrobial;
they provide cushion underfoot for the nursing staff; [they are] durable enough to withstand the constant cart traffic; and, of course, they don’t need to be waxed. They are easily maintained daily with an auto scrubber, and the more you do that a rich patina develops on the surface of the floor, making it look shiny and clean. The enhanced sheen on the surface of the floor looks like a highly polished wax, but there are never any odors or chemicals related to stripping. Rubber’s ease of maintenance was the deciding factor.”
The 14-bed NICU at LGMC was being replaced by a 25-bed facility. Initial plans called for dividing it in half, so when the census was low enough you could move babies to one side for a terminal clean of the other. In reality, the census never dropped enough to allow this to happen. With the new layout and rubber floors, no part of the unit needs to be shut down for cleaning.
The rubber floor also plays a role in reducing the noise in an area like a NICU—absorbing ambient noise and reducing the sounds of rolling carts and footsteps, creating a more peaceful environment in which to visit and heal.
“Color also plays a role in healing,” says Lukaszeski. “We worked with a supplier that had colors that are playful and fun. We used a lot of saturated color … greens and blues … which add a nice aesthetic to that area. You don’t feel like you’re in a hospital ward, but in a baby’s room.”
The NICU project was budgeted at $2.9 million, and the first round of pricing came in at $4 million.
“We had a million dollars to cut, and the contractor was coming back with line items of $30,000 or $40,000. The rubber flooring came up—we would save $30,000 by switching to VCT. I had to stand up and explain to the CEO and COO of the hospital why, not only from an operational standpoint, but from a health and safety standpoint, we needed to leave rubber in the job.”
Architect Suzanne Barnes compares the value and costs of different flooring options for health care installations in her study, “How to Make Business Decisions for Facility Flooring.” The study took several years to complete and it concluded that several floors met the criteria for a high-use installation, including rubber flooring, no-finish vinyls and other low-maintenance floors. These flooring options could also easily be the most aesthetically-pleasing choice if the color and pattern are chosen wisely.
“Rubber flooring was a prime candidate because we knew it lasts longer, looks better, is much more comfortable to stand and work on, safer to walk on, safer to fall on, and it requires much less effort and upkeep,” says Barnes. “It’s more expensive initially, but you definitely get what you pay for; in the long run, it pays for itself.”
Because of the nature of hospitals, the study focused mostly on hard floors. They have the best life-cycle cost results; don’t “ugly out” after five years; don’t retain stains and smells; appear to be more sterile; and don’t take as long to dry. Carpeting was included in the study for comparison’s sake because it is such a familiar option.
In assessing relative costs, Barnes’ research pitted the life-cycle costs of rubber flooring against VCT, linoleum, carpet, sheet vinyl, and simulated wood—all from several manufacturers. Four methodologies were used:
- Initial cost
- Replacement cost
- Maintenance/labor costs
- Total life-cycle cost replacement
To drive the comparisons home, Barnes expressed the life-cycle costs as a multiple of the initial cost of installation.
Click for a larger image
As you can see, VCT had the lowest initial cost at $1.20-1.50 per square foot, but its maintenance costs over 15 years were the second highest overall, and 17 times the initial installed cost. The only flooring that was more costly to maintain than VCT was sheet vinyl. Carpeting had the second highest life-cycle cost multiple at nine times the original investment, followed by sheet vinyl at eight times. The carpeting had to be replaced three times over the 15-year period.
In the end, the “cheapest” floor—VCT—was a very expensive choice; and a more expensive floor— rubber—was actually the cheapest at a little over half the cost of the next closest option. Even at five years, Barnes noted in the study, the payback for some of the more expensive floors had disqualified the cheaper floors.
“Our original methodology had been: design, budget, install, and then suffer—suffer the consequences,” says Barnes. “We thought we were saving $3 a square foot by using VCT everywhere, but our methodology was all wrong. We studied these floors in patient rooms, cafeterias, lobbies, corridors, and nurses’ stations. After the study, we only considered carpeting for lobby areas, corridors (for its acoustic properties), nurses’ stations (for comfort), and cafeterias (for aesthetic reasons). This of course meant we would be paying a higher price for better quality carpet.
“Theoretically, in a large hospital over 15 years’ time, we could save millions of dollars by installing floors that do not require finishing. In the case of VCT, initial pennies saved could mean millions lost. Rubber seems to be the best product overall. It doesn’t move over years, decay or wear like most other products.”
ON TO LARGER THINGS
With the NICU project completed, LGMC hired Lukaszeski to select a truly no-wax floor for a $70 million renovation of its 10-story hospital, including a pediatric emergency room area.
“When I started doing research, the first thing that came to mind is, ‘We’ve already got a no-wax floor in the hospital, why would we look for anything else?’ We’re using a lot of natural color, beige, gray, and charcoal. We have the benefit that every patient room in the hospital has natural light coming in, which is wonderful. We’re using a lot of artwork; privacy curtains add a little bit of texture, and the furniture has complementary patterns and colors. Our rubber flooring supplier worked with us to create some custom colors for this project, which I believe they’ve since added to their standard line.
“Everywhere we’re renovating, we’re using rubber flooring—corridors, patient rooms, patient restrooms, behind nurses’ stations, in closets, in linen closets, and in the pediatric emergency treatment area. It’s tough, it’s slip resistant, and it’s perfect for our design goals,” notes Lukaszeski. “We used a combination of sheet goods and tiles. For the NICU and patient restrooms, we used rubber sheet product. The pediatric ER was a combination of sheet goods and tile, and the patient rooms and corridors are rubber tiles.”
Sheet products require rubber welds to create a monolithic floor, keeping fluids and contamination from getting beneath the rubber floor and coves; in tile installation, the butt joints form a tight enough seal without further treatment needed.
As the project moves forward, Lukaszeski plans to explore the use of preformed wall base corners to speed installation and enhance appearance. (See the sidebar for more on preformed wall base corners.)
“Where we wanted graphics and designs—like in the NICU, the river and lily pads in the pediatric ER, the curve in the patient rooms, or the LGMC logo design in the elevator lobby—we had the rubber tiles cut by water jet before installation. Our contractor seems to be able to cut whatever we can imagine.”
Lukaszeski says by choosing rubber flooring for the 200,000-square-foot project, the hospital will save—conservatively—$150,000 on maintenance in the first year alone.
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