The role of flooring as a design element affecting patient and healthcare worker safety

The Environmental Factors Associated With Fatigue of Frontline Nurses in the Infection Disease Nursing Unit

The workload in the Infection Disease Nursing Unit (IDNU) is increasing dramatically due to COVID-19, and leads to the prevalence of fatigue among the frontline nurses, threatening their health, and safety. The built environment and design could fundamentally affect the fatigue of nurses for a long-term perspective. This article aims to extract the environmental factors of IDNU and explore nurses' perceptions of these factors on the work-related fatigue. It would produce evidences for mitigating the fatigue by environmental interferons. A cross-sectional design was employed by combination of focus group interview and written survey. Environmental factors of IDNU were collected from healthcare design experts (n = 8). Nurses (n = 64) with frontline COVID-19 experiences in IDNU were recruited to assess these factors individually. Four environmental factors were identified as: Nursing Distance (ND), Spatial Crowdness (SC), Natural Ventilation, and Light (NVL), and Spatial Privacy (SP). Among them, ND was considered as the most influential factor on the physical fatigue, while SP was on the psychological fatigue. Generally, these environmental factors were found to be more influential on the physical fatigue than the psychological fatigue. Technical titles were found to be associated with the nurses' perceptions of fatigue by these environmental factors. Nurse assistant and practical nurse were more likely to suffer from the physical fatigue by these factors than senior nurse. The result indicated that environmental factors of IDNU were associated with the nurses' fatigue, particularly on the physical aspect. Environmental interventions of design could be adopted to alleviate the fatigue by these factors such as reducing the ND and improving the spatial privacy. The accurate interventional measures should be applied to fit nurses' conditions due to their technical titles. More attention should be given to the low-ranking nurses, who account for the majority and are much vulnerable to the physical fatigue by environmental factors.

Functional Settings of Hospital Outdoor Spaces and the Perceptions from Public and Hospital Occupant during COVID-19

Hospital outdoor spaces play an important role for the safety and well-being of users (patients, visitors, and staff), particularly during a pandemic. However, the actual needs of these spaces are often overlooked due to the design and management process. This study investigates the perceptions of the public and occupants on the functional settings of outdoor spaces, and provides evidence for building a safe and resilient hospital during (and after) COVID-19. A multi-method approach of web content analysis (WCA) and a web-based survey was employed. Reports were collected from three mainstream websites; keywords were extracted and then categorized, pertaining to the functional settings of outdoor spaces. Three groups of occupants from Southwest Hospital (staff n = 47, patients n = 64, visitors n = 73) participated in the survey to identify their perceptions of these functional settings. Based on the 657 reports and 33 keywords selected, 7 functional settings were identified: health check (HC), quarantine and observation (QO), food and delivery (FD), healing and restoration (HR), waiting and rest (WR), transportation and parking (TP), load and unload (LU). From all users, HC (4.13) was thought to be the most expected function setting while FD (2.61) was the least. Regarding the satisfaction level, most users were satisfied with HC (3.22) while WR (2.16) was the least satisfying. The users also showed significant differences regarding expectation and satisfaction pertaining to their groups. The results indicate that the current outdoor space could not fully meet the needs of users, regarding the emerging functional setting, due to the pandemic. Users showed significant different perceptions on the functional setting due to their roles. The mismatch between the outdoor space and the users’ needs on emerging functional settings resulted in low satisfaction and high expectation in the survey. Environmental interventions with adaptive and flexible strategies should be adapted for these functional settings. The differences of users should be fully recognized by administrators, decision-makers, and designers.

Hospital flooring safety and health: knowledge gaps and suggestions

Fall incidents are a leading safety concern in the hospital industry. Whereas roughening the floor surface can reduce fall risks, there remains unanswered controversies between achieving and maintaining hygienic cleaning efficiencies and adequately addressing conditions of flooring safety. Thus, the current study critically overviews the status of research and accepted practices on hospital flooring safety and healthy controls. Salient literature was identified by searching keywords and phrases within the databases of PubMed, Web of Science, MEDLINE, Scopus and ScienceDirect to find answers for the major questions on hospital floorings. A comprehensive review analysis identified that underlying causes of hospital fall incidents and flooring-attributable infectious illnesses mainly comprised floor types and materials, cleaning chemicals, materials and methods, maintenance and slip-resistance properties. Findings from this study suggest several major actions to advance hospital flooring safety and health research and practice.

Floor finish selection in health-care facilities: a systematic literature review

Purpose

The purpose of this paper is to identify, analyze and discuss floor finishes used in health-care facilities and their selection criteria in the form of advantages and disadvantages. The authors also identify the top three health-care floor finishes and selection criteria based on the literature review results. Although flooring materials have a considerable impact on the life-cycle cost and indoor environment of health-care facilities, what criteria may be used for such flooring choices is not thoroughly studied.

Design/methodology/approach

The authors performed a systematic review of the literature on certain flooring systems currently used in health-care facilities and the criteria applied for their selection. Peer-reviewed studies and articles published after Year 2000 consistent with the research design were included.

Findings

Sixteen different selection criteria that influence the choice of floor finishes in health-care facilities were determined and discussed. The results show that the top three-floor finish materials preferred in health-care facilities are sheet vinyl, rubber and carpet, and the top three selection criteria for floor finishes are indoor air quality, patient safety and infection control.

Originality/value

The results of this study will assist building owners, architects and interior designers with implementing an informed design decision-making process, particularly in relation to floor finish selection. The findings will also provide guidance to floor finish manufacturers to improve their products based on facility managers’ preferences.

Floor finish selection in the design of healthcare facilities: a survey of facility managers

Purpose

The purpose of this study is to create a knowledge base for decision-making in healthcare design by seeking, analyzing and discussing the preferences of facility managers of healthcare facilities regarding floor finishes and their selection criteria. The goal is to enable a simplified and holistic selection of floor finishes based on multiple criteria. The authors studied floor finish selection in three healthcare units: emergency, surgery and in-patient units.

Design/methodology/approach

The authors completed a literature review to identify types of floor finishes currently used in healthcare facilities and the criteria applied for their selection. Using the literature survey results, a questionnaire was designed and administered to healthcare facility managers. The descriptive statistical analysis and the Friedman and Wilcoxon signed-ranks tests were used for reporting and analyzing the survey data.

Findings

The top five floor finishes used in the healthcare sector were identified as vinyl flooring, vinyl composite tile (VCT), rubber, linoleum and ceramic flooring. The top five selection criteria for floor finishes were durability, infection control, ease of maintenance, maintenance cost and user safety. The non-parametric test results show that the floor finish rankings and selection criteria were similar in the three healthcare units under study.

Originality/value

The most significant contribution of this research is to the design decision-making process of healthcare facilities. These results offer an understanding of what floor finishes are preferred by healthcare facility managers and why. This knowledge is crucial for designers and facility managers to make informed choices and floor finish manufacturers to keep their product line relevant to the industry.

Pathology and Rehabilitation of Vinyl and Linoleum Floorings in Health Infrastructures: Statistical Survey

A statistical survey on the pathology and rehabilitation of linoleum and vinyl floorings is presented. It is based on the visual inspection of 101 vinyl and linoleum floorings, in six health infrastructures in Lisbon, Portugal, which enabled the validation of the classification/nomenclature previously proposed, as well as the corresponding correlation matrices. It was also possible to identify the most common types of anomalies, their probable causes, the most adequate in situ diagnosis methods, and the most useful repair techniques. Anomalies, diagnosis methods, and repair techniques files were also validated. The obtained data enabled anomalies to be related to their causes, in situ diagnosis methods, and respective repair techniques e.g., a high number of scratches/wear were detected associated with dragging of equipment. The conclusions drawn intend to raise awareness among the industry actors and minimize the development of anomalies and their causes at the design and application stages. Furthermore, the main sensitive issues of the cladding system during its service life were revealed, highlighting the importance of a correct maintenance plan to minimize the surface’s susceptibility to various degradation mechanisms.

Optimizing the patient-centered environment: results of guided tours with health care providers and employees

OBJECTIVE

To examine providers' perspectives on the care environment and patient-centered care (PCC) through the eyes of the veteran patient, using guided tours qualitative methodology.

BACKGROUND

Environmental factors, such as attractiveness and function, have the potential to improve patients' experiences. Participatory qualitative methods allow researchers to explore the environment and facilitate discussion.

METHODS

Guided tours were conducted with 25 health care providers/employees at two Veterans Affairs (VA) health care facilities. In guided tours, participants lead the researcher through an environment, commenting on their surroundings, thoughts, and feelings. The researcher walks along with the participant, asking open-ended questions as needed to foster discussion and gain an understanding of the participant's view. Participants were asked to walk through the facility as though they were a veteran. Tours were audio recorded, with participant permission, and transcribed verbatim by research assistants. Three qualitative researchers were responsible for codebook development and coding transcripts and used data-driven coding approaches.

RESULTS

Participants discussed physical appearance of the environment and how that influences perceptions about care. Overall, participants highlighted the need to shed the "institutional" appearance. Differences between VA and non-VA health care facilities were discussed, including availability of private rooms and staff to assist with navigating the facility. They reviewed resources in the facility, such as the information desk to assist patients and families. Finally, they offered suggestions for future improvements, including improvements to waiting areas and quiet areas for patients to relax and "get away" from their rooms.

CONCLUSIONS

Participants highlighted many small changes to the care environment that could enhance the patient experience. Additionally, they examined the environment from the patient's perspective, to identify elements that enhance, or detract from, the patient's care experience.

Life-cycle cost analysis (LCCA): a comparison of commercial flooring

Purpose

The business case for facility expenditures is grounded in the knowledge that life-cycle economics is significant to the continued viability of the facility. The aim of this study is to develop an algorithm for life-cycle cost analysis (LCCA) and evaluate flooring products to inform decision makers about the long-term cost of ownership.

Design/methodology/approach

The protocol for executing an LCCA is defined by the National Institute of Standards and Technology, including defining the problem, identifying feasible alternatives and establishing common assumptions and parameters, as well as acquiring financial information. Data were provided by an independent third-party source.

Findings

The results of this study are twofold: assess functionally equivalent flooring alternatives to determine the best financial value and develop a replicable protocol and algorithm for LCCA. The study found that modular carpet was the best financial solution. As a tool for decision makers, this LCCA informs asset management about the long-term cost of ownership, providing a protocol for making practical, informed decisions for the lowest cost solution for functionally equivalent alternatives.

Research limitations/implications

Projecting LCCA beyond 15 years may have limited value based on potential changes in the financial climate. Further research should focus on the implications of changes in the discount rate over time and testing the algorithm on other building systems.

Practical implications

Maintenance costs are considerable when compared to initial cost of flooring. Equipment costs have a significant impact on long-term cost of ownership. Using LCCA to inform specifications and to determine the best solution for a building system such as flooring provides an evidence-based process for building design and facility management.

Social implications

Life-cycle costs have a significant impact on the financial health of an organization. Using LCCA to make informed decisions about facility design and specifications may contribute to increased financial stability and resources to benefit the organization’s long term goals.

Originality/value

This study contributes an algorithm instrument for buildings and building systems. The flooring tested with this protocol provides evidence to inform flooring selection based on lowest cost while considering other factors that inform appropriate selection of flooring materials.

The Influence of Flooring on Environmental Stressors

Objective:

Three flooring materials, terrazzo, rubber, and carpet tile, in patient unit corridors were compared for absorption of sound, comfort, light reflectance, employee perceptions and preferences, and patient satisfaction.

Background:

Environmental stressors, such as noise and ergonomic factors, effect healthcare workers and patients, contributing to increased fatigue, anxiety and stress, decreased productivity, and patient safety and satisfaction.

Methods:

A longitudinal comparative cohort study comparing three types of flooring assessed sound levels, healthcare worker responses, and patient Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings over 42 weeks. A linear mixed model analysis was conducted to determine significant differences between the means for participant responses and objective sound meter data during all three phases of the study.

Results:

A significant difference was found for sound levels between flooring type for equivalent continuous sound levels. Carpet tile performed better for sound attenuation by absorption, reducing sound levels 3.14 dBA. Preferences for flooring materials changed over the course of the study. The HCAHPS ratings aligned with the sound meter data showing that patients perceived the noise levels to be lower with carpet tiles, improving patient satisfaction ratings.

Conclusions:

Perceptions for healthcare staff and patients were aligned with the sound meter data. Carpet tile provides sound absorption that affects sound levels and influences occupant’s perceptions of environmental factors that contribute to the quality of the indoor environment. Flooring that provides comfort underfoot, easy cleanability, and sound absorption influence healthcare worker job satisfaction and patient satisfaction with their patient experience.

The role of flooring as a design element affecting patient and healthcare worker safety

OBJECTIVE

The objective of this study was to review, identify, and synthesize the literature on patient and healthcare worker safety related to flooring. The topic of flooring in the design of healthcare facilities is complex: healthcare associated infections, push/pull limitations, falls and fall injuries, and noise as a contributing factor to quality of care.

BACKGROUND

Most hospitals have not been explicitly designed to enhance patient safety. Recommendations from the Agency for Healthcare Research and Quality (AHRQ) include preventing patient falls, reducing infections, and preventing medication errors as the areas of emphasis of evidence-based design to improve patient safety and quality of care.

METHODS

A review of the literature was conducted through search engines using a predefined list of keywords to identify studies about flooring and the safety of patients and healthcare workers. Inclusion criteria included peer-reviewed theoretical and empirical studies published in English from 1982 to 2012. Final inclusion was obtained based on an analysis of research design.

RESULTS

Of those 27 articles that met inclusion, 7 focused on healthcare associated infections; 9 focused on slips, trips and falls; 7 articles focused on noise; and 4 focused on fatigue. The studies are profiled in tables and organized by environmental variable.

CONCLUSIONS

Though a limited number of studies met the criteria for this review, the evidence base is emerging to design for safety. Recommendations for future research and practical application of design are provided.

KEYWORDS

Evidence-based design, literature review, patients, safety, staff.