Since jumping into the world of commercial flooring in 1992, I’ve been involved in a lot of resilient floor projects in healthcare from the specification, installation and inspection side, and seen both failures and successes. Here are some key areas to pay attention to.

Specification. Depending on the use and the budget, resilient flooring in healthcare varies from Vinyl Composition Tile (VCT) to heat-welded, flash-coved sheet goods and a lot of products in between. Two different hospitals I’ve spoken to recently in New York said they prefer resilient tile in most areas because it’s easier to repair if it gets damaged. VCT offers lowest initial cost, but limited design options and high maintenance cost.

A subcategory of VCT is the higher vinyl content products often sold as “enhanced” or premium VCT, quartz tile, or just “homogeneous vinyl.” These products tend to perform better because of the different composition and also have larger tile sizes and better visuals than standard VCT. The same holds true for the Solid Vinyl Tile (SVT) and plank category, sometimes called “luxury” vinyl. Printed film provides realistic visuals such as wood looks, and the clear vinyl wearlayer is tough and very stain resistant, which can lower maintenance costs.

Many designers are looking outside of the vinyl category to “PVC-Free” products such as rubber, “bio based,” polyolefin and linoleum tile and sheet products. There has never been more variety in resilient floor tile than there is today, and each product has its own unique methodology for installation and maintenance. Vinyl has dominated for decades, but the other categories are seeing growth as “PVC-Free” design is growing.

Most often in healthcare, sheet products have to be heat-welded and often are flash-coved. These are very specialized skill sets for installers, so before you get involved in sheet projects, be sure your installation team is up to the task.

If you are involved in helping someone select resilient floors for healthcare facilities, take the time to get to know what the priorities are. VCT gets used when low initial cost is the priority and aesthetics and/or maintenance costs are secondary. In other cases, owners will pay more for a better looking and/or better performing floor with a lower maintenance cost because over the life of the floor, the overall “lifecycle cost” is less.  

Installation. In many trips to hospitals and healthcare facilities, both as a patient and as an inspector of floor covering failures, I have seen a lot of resilient floors that really made me unhappy. In a lot of cases it was because corners were cut.  Here are a few examples.

I’ve seen more bad resilient floors because of adhesive issues than any other reason. The wrong adhesive and too much adhesive are the top examples.Yes, too much – especially with sheet products. You don’t need much of a good quality adhesive to adhere SVT, rubber or sheet goods, but assuming “more is better” or making a simple mistake like using the same trowel that you did for the VCT or carpet can ruin the job. Indentations from adhesive displacement, tile shifting or adhesive oozing at tile joints are prime examples of what happens.

While we are talking about adhesive displacement, let’s look at adhesive selection. With the stresses put on floors in hospitals, how the floor gets adhered can make a big difference in performance. Hospital beds are heavier and have smaller wheels than ever, which is very tough on floors. There is also a lot of equipment getting rolled across the floors, and in both cases the flooring can usually take the load, but the adhesive may not be able to.

The solution in these cases may be a harder-setting adhesive such as epoxy or spray adhesives. Many manufacturers recommend this, but it may or not make it into the specification. I urge architects to consider this and write it into the spec, but if they don’t the nature of competitive bidding is that the less expensive option gets used, which may not be the best option for these situations. Patient rooms are the number one area to be aware of because that’s where a lot of heavy beds and furniture get parked and sometimes dragged across the floor. That’s also where a lot of the damage occurs. It may not be as much of a concern in corridors where everything rolls through but doesn’t stand in one place for very long.

This is an important conversation to have before you quote a job. Find out how the space will be used, and double check the flooring manufacturer’s specs. If you are not sure, have a conversation with the flooring manufacturer. I’ve inspected more than a few indentation complaints where this recommendation was not followed, and the flooring contractor was responsible. If the floor dents or buckles under this type of stress, it is rarely the fault of the material, and may be preventable with the right adhesive.

Substrates. Right up there with adhesive issues are substrate problems under resilient floors in healthcare. In new construction, it’s most often problems with concrete that is not yet dry. We have covered that topic in this column regularly for almost 10 years, so I am not going to dive into it again, other than to repeat that industry standard language that “All concrete floors shall be tested for moisture regardless of age or grade level.” (ASTM F 710, Standard Practice for  Preparing Concrete Floors to Receive Resilient Flooring.

Another issue on construction sites is contamination on the substrate. Paint and other markings on the floor can stain some flooring materials from the back, and/or act as an adhesive bond breaker. This happens a lot when locations  for plumbing, wiring and equipment get marked on the floor with spray paint or magic marker. However, the number one contaminant to worry about is pipe-cutting oil, and since there is so much plumbing on a lot of these projects, this is not uncommon.

If you see a pipe-cutting operation on the jobsite and the concrete is not protected, do not install over that oily residue, which penetrates into the concrete and can migrate up to the surface months after the floor is installed. Oil and adhesive don’t mix, oil and resilient flooring also don’t mix, and it’s difficult to seal the surface against it. It may be necessary to do an oil removal process or even chop out the concrete. Do not take this lightly!

Renovation projects have their issues also when it comes to substrate preparation. If an old floor is being removed and a new one installed, the old adhesive needs to be removed as well. It’s not enough to just “skim coat” over the old adhesive with a trowelable patching compound; the adhesive needs to be scraped off. Don’t take my word for it – ask the patch manufacturer!

One other thought on substrates regards gypsum underlayments. There was a time when gypsum was pretty much forbidden under resilient, but the right product in the right use is more acceptable today. You’ll probably not see this in hospitals that often but in assisted living or other senior living facilities you may. ASTM F 710 is specific about it, saying “Patching or underlayment  compound shall be moisture-, mildew-, and alkali-resistant, and, for commercial  installations, shall provide a minimum of 3000 psi compressive strength.” If you find out that you will be installing over a gypsum substrate, make sure this standard is followed.

Also be aware that gypsum has to be sealed any time an adhered floor is installed over it because it’s a very porous material. The same manufacturers that produce gypsum underlayments also make the sealer. Sometimes that process is done by the contractor who pours the underlayment and sometimes not. Be sure to clarify all of these issues when you are doing a job over gypsum.

Site Conditions. I’d be remiss if I didn’t mention the challenges of installing flooring in active construction sites. For hospital construction it seems to be worse than any other type of building, probably because there is a tremendous amount of plumbing, wiring, furniture and equipment all getting installed in these spaces, often at the same time as finishes like ceilings, floor and wall coverings.

I was on a hospital job site this year and I could not believe how everyone was working seemingly on top of each other. It made me dizzy just to watch! Somehow, the flooring contractor and the general contractor made it work and the floors were installed and covered with paper and wood panels so they would not get damaged.

It’s important to discuss this when planning the job. Be sure to plan it right, though, or there can still be problems. If the flooring is installed into wet adhesive, it needs some time to set before you do anything. If you cover it right away, somebody is bound to roll something across the floor while the adhesive is still wet, and even if it is covered with wood panels, there can still be denting or shifting. Once you are ready to cover, sweep first so any soil or grit doesn’t get ground in. Also, use brown paper before wood panels on the floor because the panels can be abrasive and may scratch the floor.

Initial Maintenance. Finally, we have the issue of initial maintenance. Many resilient floors require some type of finish to be applied, which we often still call “wax” although wax is no longer used. I’ve gotten pulled into a number of situations where fingers were getting pointed all over the place over who was supposed to be doing the initial maintenance. It’s often assumed that this is part of the installer’s scope of work. If you don’t do maintenance, make sure to exclude it from your bid and if you do, make sure to charge for it, and also look carefully at what the process is. A lot of floors are “no wax” these days, so be sure everyone is clear about that because it may be assumed that you are required to “wax the floor, because that’s what we always do.” In other cases the finish coating may not be a standard acrylic floor finish. Polyurethane coatings are being used more and more frequently and this is a more detailed process.

Healthcare is still a strong market for our industry but there is a lot to know. Pay attention to all of the details, know your products, keep the lines of communication open and you will do well.