The selection of resilient flooring materials for healthcare environments requires consideration on multiple levels, including outcomes in the built-environment, positive indoor air quality, occupant safety, aesthetics, durability, maintainability and total life-cycle costs. While the flooring product’s first cost addresses initial project budget limitations, it is important to understand that the costs associated with the projected lifespan of the product are considerably impacted by the materials and man-hours required to maintain the flooring.
A life-cycle cost analysis (LCCA) is the method used to assess the economic impact of materials with similar functional performance criteria, but varying costs, over the service life of a building (Fuller, 2016). The LCCA method accounts for costs associated with acquiring, installing, operating and maintaining over the products useful life and can have a significant financial influence on the total cost of ownership (Fuller, 2016).
According to a 2015 survey conducted by the American College of Healthcare Executives (ACHE), the current financial climate, including reimbursement challenges and government mandates, produces an environment where healthcare systems must do more with less. Therefore, the need to assess material purchases, its associated cleaning and maintenance protocol with a long-term view has become even more imperative as health systems are demanding more from a floor.
Role of Flooring in Healthcare
The selection, specification and procurement of resilient flooring in a hospital environment should not be taken lightly. Flooring comprises a significant portion of a healthcare facility, occupying every square inch of a building’s measured space (Nanda, U., Malone, E., and Joseph, A. (2012). Achieving EBD Goals through Flooring Selection & Design. Concord, CA: The Center for Health Design). It also contributes to a facility’s structural integrity, healing aesthetic, infection control and indoor air quality (IAQ).
Additionally, evidence-based design research from the Center for Heath Design (CHD) shows the physical design characteristics of a hospital environment can have a significant impact on patients, visitors and staff. Factors such as enhanced ergonomic properties and noise reduction qualities can contribute to patient safety while reducing staff stress and fatigue.
Because flooring contributes to a building’s footprint, it must be durable and resilient enough to stand up to the ever-changing demands of the facility. Spills, heavy foot traffic and rolling loads such as wheelchairs, gurneys and carts dictate the need for flooring that’s both durable and sustainable.
Understanding Life-Cycle Costs
The protocol for executing LCCA is defined by the National Institute of Standards and Technology and includes defining the problem, identifying feasible alternatives, establishing common assumptions and parameters and acquiring financial information.
Data collection for healthcare facilities focuses on identifying flooring materials typically specified for hospital environments and then comparing their performance, maintenance and safety standards as defined by The Facility Guidelines Institute (FGI). Premium rubber floors have extremely dense, closed surfaces that are inherently dirt-repellent due to a special production process that ensures optimum material cross-linking. Advantages of greater surface density include:
- Reduced susceptibility to soiling
- Improved hygienic properties
- Lower outlay for maintenance
- Improved IAQ for patients and caregivers
- No exposure to cleaning chemicals
Performance characteristics such as ease of maintenance, slip, wear and stain resistance, durability, acoustics, underfoot comfort, infection control, health and wellness and IAQ are key considerations. Specific to healthcare are concerns related to the transmission of pathogens, mitigation of risk of infection for patients, visitors and staff without the addition of antimicrobials. Rubber’s inherent resistance to bacteria and fungi is achieved without the need for chemicals or additives.
Resilient Flooring and LCCA
Those tasked with specifying flooring in a healthcare environment typically gravitate to resilient flooring materials due to their relative ease of maintenance, hygienic properties and durability. The flooring industry does not categorize the diversity of resilient flooring materials in terms of initial and long-term costs based on the level of maintenance required. LCCA provides a method for evaluating the economic impact of alternative materials with similar functional performance criteria.
This method of transparency includes calculating the life-cycle cost for all flooring products under consideration, enabling the project team to generate a side-by-side comparison in the areas of first cost, aesthetics, acoustics, cleanliness, comfort, maintenance, durability, installation and useful service life. Taking total cost of ownership and dividing it by the number of years the flooring is expected to last results in the total cost per square foot per year.
Many resilient products, such as vinyl and linoleum flooring, have a factory-applied coating that initially suggests a non-wax protocol. However, typically these coated products will require a maintenance regimen of stripping, coating and refinishing at some point over their usable life. Based on the application, location and amount foot traffic the wear layer will inevitably fail due to abrasion from dirt. In contrast, premium rubber flooring has no factory-applied coating and never needs stripping or waxing to maintain both its aesthetic quality and functional integrity during its usable life. This not only supports total cost of ownership and operational optimization but health and wellness in the built-environment.
Factoring in Maintenance
The Whole Building Design Guide (WBDG) from the National Institute of Building Sciences (NIBS) states, “Operations and maintenance costs over the typical 50-year life cycle of a hospital can contribute up to 80 percent of the equation, so anything to facilitate maintenance and reduce total life-cycle cost will have tremendous returns on a relatively small up-front investment” (Source: Federal Facilities Council). This includes the cost to purchase and install the floor (labor, material, adhesive and prep) as well as cleaning and maintenance protocols (man hours, labor rate, material, equipment size, cleaning frequency and cost of chemicals).
A comprehensive analysis of both first-time and life-cycle costs is necessary to make an informed decision when specifying floor materials. LCCA can provide data to determine whether a floor is financially sustainable from a long-term maintenance perspective and, depending on the findings, support the decision for selection or de-selection. Using this model, flooring selection is now based on evidence as defined by both operational and budgetary goals.