By Jeannie Akridge

The purchase of furniture and floor coverings for healthcare facilities is often a balancing act between design issues, maintenance and cleaning considerations, safety and health codes requirements and cost and quality factors. With so many decision-making factors involved in what could potentially be a costly purchase, expert input is well-advised.

Design vs. functionality

Collaboration between housekeeping, facilities and purchasing is important to making the best choices in furniture and floor coverings, said John Mateka, FAHRMM, Southeast region vice president, materials management for Holy Cross/Mercy – CHE in Fort Lauderdale, FL, "Usually in healthcare, if you have a new project, selection of furniture and flooring is done outside of purchasing. When it’s outside of purchasing, it’s done on a more aesthetic basis, and weighs heavily on how the product fits into the interior design of the project. This becomes problematic in that once the outside designer leaves, housekeeping has to clean it and purchasing has to add to or maintain the product line."

Standardization

Mateka advises purchasing managers who are involved in replacement and expansion projects to choose a manufacturer that is not only established but that will maintain a consistent line of products with a similar look and feel. "You’re committing to a furniture line that you may have to add to later." By the same token, Mateka noted that standardization throughout several areas of the hospital can accommodate the evolving healthcare environment. In other words, as room layouts and functions change, chairs can be moved to a different part of the hospital and not compromise overall design continuity. He added that many hospitals are now using modular office furniture and cubicles that can be easily rearranged as opposed to building new offices. To that end, KI has introduced its easy-to-install Genius Full Height Movable Wall with exceptional acoustic properties; and the WireWorks Panel System, a flexible office workstation system allowing for easy reconfiguration of office furniture and power/data lines. Proximity Systems offers slim, locking, wall mounted, retractable workstations that can be adapted for computers, medications, supplies and medical devices.

Another factor to bear in mind as hospitals increasingly become more design-conscious is how to incorporate style and color trends into the facility. Mateka recommends keeping furniture and carpet neutral. "Let your color and design scheme come from wall hangings and accent pieces. Then when you want to change design or color, you can do that more readily."

Finally, quality and durability are key considerations, according to Mateka, because a broken chair can lead to a lawsuit, and if you buy cheap, you will more than likely end up replacing the piece within the next year anyway.

Multi-functional furniture

Today, many manufacturers are making furniture products that are much more intuitive to the needs of a typical healthcare facility. One such manufacturer, Brandrud, has gathered a team of researchers, industrial designers and engineers who have specialized in healthcare to provide input into new product development. What they’ve come up with are new product lines that have multiple functionalities and incorporate ergonomic and therapeutic properties. Research points to patient guests as key to the healing process. In addition, Brandrud has found that a patient’s sense of control over his or her environment, for example being able to offer guests a convenient place to put their things, is equally important. Therefore the company has designed its Revive Patient Room Suite to lend a more "home-like" feel to the patient room while still maintaining the professional qualities needed for a healthcare facility. Brandrud’s Revive Guest Center easily transforms from a sleeper to a sofa and provides guest storage. The Revive Display system accommodates wall-based items with hooks and holders for magazines, marker boards, greeting cards, flowers and other personal items.

Another example of customer interactive design is BraytonSpaces’ Sieste design, which is a result of a partnering with a major hospital and was an award-winner at the NeoCon 2002 Commercial Interior Design Exposition. The Sieste Sleeper easily converts from a three-seat sofa to a full size bed with the flip of a cushion, and includes a storage drawer.

The Sieste design is also available in a recliner. Versions include a three-position, Trendelenberg and a Wallsaver version, which requires only five inches of space between the seat back and the wall to fully recline.

Patient and worker safety

Ergonomic considerations and caregiver safety also are important. A multitude of options exist to aid the patient in the healing process as well as to aid the caregiver in lifting and treating the patient.

Brandrud’s Revive Patient Chair aids a patient in the interim process between the bed and recovery. Brandrud designed the chair to be ergonomical and therapeutic as well as comfortable in multiple positions. As opposed to a task chair that allows a user to be productive at work, the Revive Patient Chair allows patients to be "productive at sitting", that means the chair is ergonomically designed to aid in the healing process.

Other issues to consider include worker safety in getting patients in and out of chairs. "It’s a classic battle between caregiver and patient," explained Lee Faulk, Brandrud CEO. "If the chair is higher it’s easier to get the patient in and out of the chair, but at the same time, a higher chair is less comfortable for the patient." Consequently, Brandrud is introducing a new patient chair with sides that can be folded down allowing the caregiver 270 degree access to the patient.

Arlington Scientific, Inc. offers its ASI Hampton lounge chair which combines safety, functionality and convenience. The Hampton features a linear actuator motor that moves the patient into a comfortable position as well as the Trendelenberg position for recovery. The chair’s fabric protects against bacterial and fungal micro-organisms, and the seamless cushions reduce exposure to blood-borne pathogens. The Hampton’s height is caregiver friendly with an adjustable armrest for easy access to the patient.

Fabric options

When it comes to upholstery fabrics, a variety of smart options exist. Burlington Contract Fabrics offers its Environ fabrics, which are designed from reclaimed and recycled materials and meet ACT standards for heavy-duty contract upholstery fabrics. The Environ fabrics are compatible with technologies such as NANO-PEL stain repellency, Bioguard anti-microbial treatment and Moisture Bloc moisture barrier. Vinyl options may be appropriate in areas where spills or incontinence issues are likely. BioFit Engineered products offers a laboratory chair that provides ergonomic support and easy adjustability, plus a selection of simple to clean vinyls that are resistant to stains, bacteria and damage from chemicals, urine and blood.

Environ from Burlington Contract Fabrics

Other furniture considerations

Healthcare facilities should also consider the needs of children and bariatric guests in their furniture selection. Both kidzpace Interactive and TMC furniture offer a variety of kid-friendly furniture for healthcare facilities. Kidzpace has designed several cabinets and bedside carts designed to hold video games and other electronic entertainment.

Brandrud worked with Virginia Mason Medical Center in Seattle to develop a line of bariatric furniture that holds up to demanding use, yet integrates into the environment so that it doesn’t stand out as bariatric furniture.

Choosing flooring material

Floor coverings in healthcare facilities offer their own unique set of challenges, among them are maintenance and cleaning, safety issues, environmental concerns and style/design elements.

Of primary consideration is the specific hospital area to be floored. For example, ambulatory areas and many lab areas should incorporate homogenous flooring with heat-welded seams, plus have a four to six inch protective covering over the lowest portion of the wall to stop fluids from penetrating the flooring material and to allow for thorough cleaning. High-quality vinyl flooring is constructed for superior stain and moisture resistance, plus has the ability to be chemically bonded or heat welded to seal out germs and moisture. Vinyl may be an appropriate option for trauma areas, birthing centers, children’s wards or kitchen and laundry areas.

  NeoFloor Talus Collection from Lees Carpets

Carpet can be incorporated into other areas of the hospital to provide a more inviting touch. Carpet also provides the advantage of helping to prevent and reduce the impact of falls, and can aid in noise reduction. Plus, carpet has the ability to trap airborne particles and keep them in place until extracted through cleaning, preventing breathable particles from affecting hospital visitors. Solution dyed nylon fiber provides resilient performance and appearance retention in high traffic areas subject to spills, and is resilient to bleach fading. Healthcare facilities need to look for structured back carpet products, which are impenetrable to moisture. Structured back carpeting is also less susceptible to shrinking, stretching or rippling.

Flooring options that blur the lines between carpet and vinyl provide alternative choices throughout the hospital. The NeoFloor Talus Collection by Lees Carpet combines advantages of both carpet and hard surfaces. This high-density resilient textile flooring line stands up to heavy foot and wheeled traffic. Its layered construction provides a complete moisture barrier, durability, comfort and slip resistance. The vertical fiber orientation without twist, provides superior soil and allergen release. NeoFloor contains a fiberglass-reinforced, closed-cell cushioned backing system that absorbs sound and keeps spills from penetrating, while Bioguard provides a powerful antimicrobial treatment.

Modular "carpet tiles" are another choice. These virtually seamless tiles can be lifted for access to the sub-floor, and provide the advantage of replacing only portions of the carpet that are worn or stained. Interface Flooring Systems’ i2 modular carpet is designed for non-directional placement, resulting in reduced waste during installation. Mondo Flooring offers rubber flooring options that are inherently antibacterial and anti-microbial. The anti-fatigue properties of the rubber flooring products provide cushioned comfort, impact and wear resistance.

Cleaning and maintenance

Labor issues associated with cleaning and maintenance can quickly escalate the cost of any floor covering. In many hospitals, costs of labor and supplies related to floor maintenance make up about 20 to 30 percent of the environmental services department budget. With labor typically the bigger expense, healthcare facilities should consider the use of automated equipment such as floor machines, autoscrubbers and carpet sweepers to alleviate long-term costs.

Special treatments and coatings can help to maintain appearance and provide protection from elements. For example, a water-based polyurethane floor coating can be applied with a roller, doesn’t require burnishing, recoating or stripping, holds its shine and resists scuffing. Products are available in carpeting that contain antimicrobial properties and/or moisture protection either in the carpet itself, backings or adhesives. Intersept from Interface is a low solubility, non-toxic biostat incorporated into the backing to inhibit growth of odor and stain causing fungi and bacteria. Of course, choosing dark colors for carpeting will help camouflage stains. Daily vacuuming of carpet can help to remove eighty percent of dry dirt. A dual motor HEPA filtered vacuum cleaner is recommended. Periodically vacuum extract the carpet with a cleaner/sanitizer.

Other products that can aid in maintaining cleanliness are mats. The 3M Nomad Entrance Matting System, which is designed to stop dirt and moisture at the door, consists of different types of mats that each do a specific job to keep the building clean. CleanStep Contamination Control Mat features 60 layers that can be easily pulled off to capture dirt, dust, grease, paper dust, and other contaminants before it can get tracked throughout the building.

Environmental concerns

Emerging trends include the use of "green" or environmentally preferable cleaning products and processes, and a concern for indoor air quality. Monitoring the use of chemical cleaners, such as restricting the use of disinfectant cleaners to critical surfaces, and reducing the frequency of stripping and refinishing in favor of light scrubbing and burnishing, can help in this area. In addition, micro fibers, flat mops and vapor cleaning systems require fewer chemicals while increasing production.

In employing its "green building initiatives", Kasier Permanente recently questioned carpet manufacturers about the environmental performance of their products. Said Carol Antle, director of capital projects for KP’s National Facilities Services, in an article for Green@Work magazine, "The questions go deep into chemisty and deep into the issues of the content of the carpet fiber and the backings as well as worker safety, recycled content, emissions, energy, waste disposal and end-of-life disposition. One of our carpet vendors, with whom we had a long relationship, didn’t take our environmental query seriously in the questionnaire or in the follow-up interview process, and so we changed providers and awarded the contract to a more responsive vendor."

CleanMed 2004, to be held April 14-15 in Philadelphia will focus on enviromentally preferable products and green buildings in the health care industry. (www.cleanmed.org)

Pulling it all together

Proper planning will prove invaluable when choosing furniture and floor coverings throughout the hospital. Fortunately, many resources exist to aid in the selection process. Donna Clervi, Healthcare Practice Director for contract furniture company Tangram Interiors, holds an annual "Health Care Expo" in Southern California that is attended by hospital representatives, architects and interior designers and features furniture, storage and flooring vendors. Notes Donna, "You should look to a contract furniture and flooring company that is up to speed on the latest government regulations for the healthcare industry. Knowing about the latest privacy issues as mandated by the Health Insurance Portabiltiy and Accountability Act (http://www.hipaa.org), flammability and earthquake readiness from the Office of Statewide Health and Planning Development is crucial when specifying furniture for a healthcare facility."