Designer Forum - May 2012

By Rebecca Donner

The design of Loma Linda University Medical Center (LLUMC) of Murrieta, California, about 80 miles southeast of Los Angeles, is a perfect blend of healthcare and hospitality design elements in which every design detail helped achieve a well rounded, evidenced-based design scheme. Realizing the vision of the client, designers worked within a white-dominated color scheme to create a high-end healthcare facility—a controversial move in healthcare design, as white more easily shows wear and soiling than darker colors.

The design was envisioned to be a bright, contemporary facility that looks more like an exclusive resort than a hospital. Overall, LLUMC is an elegant mix of modern and contemporary design elements that evoke a feeling of warmth and luxury.

Over the last decade, healthcare design standards have been transformed. Designers are now blending healthcare and hospitality design elements to create more comfortable patient-centric healing spaces that also comply with healthcare codes. Increased knowledge of evidenced-based design theories and infectious diseases as well as the growing availability of low maintenance products has changed the way that healthcare design is interpreted.

Interpreting a design scheme that meets the needs of a healthcare facility and its patients requires thoughtful attention to every design element, including flooring, color scheme, lighting, wallcoverings, architectural details, outdoor interaction, noise control installations, artwork and spatial layout.

In healthcare design, flooring is one of the most important design elements of any project because it is, quite simply, everywhere. Healthcare designers choose flooring based on its ability to meet the needs of safety and healthcare code compliance, design appeal and visual interest, maintenance and cleanability, work flow efficiency and durability, and infection control. To meet these needs, eight different types of flooring were used throughout LLUMC—vinyl, carpet, rubber, porcelain, terrazzo, resin, cork and ceramic.

FLOORING TO ENHANCE PATIENT SAFETY
Of course, flooring within a healthcare facility must meet healthcare design regulations. Each state has differing regulations that must be followed to ensure patient safety. When considering the safety associated with flooring, think about the function of the area. Flooring within means of egress areas, such as a lobby or corridor, should not only resist pathogens but also should be Class A material. Class A products protect occupants and ensure a safe facility exit route.

In order to decrease static interference around electronic equipment housed in the LLUMC imaging department, designers used a static dissipative tile that had a lower KV rating, which is a measurement of a product’s electrostatic voltage or its propensity to convey electrostatic charge. This type of flooring is standard in healthcare facilities as it protects medical equipment from static electric discharge that could lead to equipment malfunction.

AN EFFICIENT WORKFLOW STARTS WITH DURABLE FLOORING
Healthcare flooring endures high amounts of stress from patient and staff foot traffic and medical equipment roller traffic, such as wheelchairs, stretchers, beds, walkers, IV poles and more, so designers should choose a durable flooring that can withstand above average wear and tear over the years. To prevent wearing out and replacing flooring, designers typically use hard surface flooring such as tile, wood and rubber in high traffic areas, since these flooring types are more resilient to damage.

To accommodate the above average wear and tear done to operating room surfaces, for LLUMC operating rooms the designers chose flooring that is commonly found in commercial kitchens, a resinous flooring with an added anti-microbial agent that can resist regular operating room stains, such as iodine, and can be aggressively cleaned after operations to meet terminally clean standards. In addition, the floor has a textured grip to ensure staff safety, and it has a higher PSI (pounds per square inch) rating, which allows almost anything to roll over the floor without causing it to damage or warp.

Flooring should also boost work efficiency and provide comfort to staff members. At LLUMC, planners developed a floor layout that requires fewer steps for caregivers, physicians and staff in carrying out their duties. In the LLUMC nursery and neonatal intensive care unit, where nurses are typically standing for long periods of time, designers used a rubber flooring to provide more cushion and comfort to attending nurses. Additionally, within the corridor areas, designers used a hard-surfaced luxury vinyl flooring instead of a soft-surfaced material, which helps decrease staff fatigue from pushing medical equipment throughout the hospital.

KEEP IT LOW ON MAINTENANCE, HIGH ON CLEANABILITY
The overall maintenance and cleanability of a product is a key factor in determining whether to use a hard or soft surface flooring within a certain area. Healthcare designers look for low-maintenance flooring that will be easy and inexpensive for the facility to clean and maintain. Once designers narrow down the best flooring options for a space, facility maintenance staff will often test flooring samples with their cleaning products to make sure the product can withstand their normal cleaning regimen.

In choosing flooring for LLUMC’s lobby and reception area, designers used a custom, multicolored pattern terrazzo, which naturally helped camouflage the dirt brought in by patients and made it easier for staff to wipe up spills. The white-colored terrazzo also produced a brilliant shine to keep the floor looking clean and fresh.

REDUCE AND CONTROL INFECTION
Meeting healthcare standards and reducing exposure to infection is the primary concern in healthcare interior design. The Centers for Disease Control estimates that 1.7 million hospital-acquired infections occur annually nationwide, and that infections are most likely to arise from disease-causing pathogens that survive on high contact surfaces for extended periods of time. Durability and cleanability play a huge role in mitigating the spread of these germs in infection prone areas, such as flooring in the common areas and patient care areas. Designers must select or create custom flooring that has built-in antimicrobial agents and is able to withstand the standard healthcare cleaning products that consist of a 10% bleach solution.

Within LLUMC, patient bathrooms and public toilet areas feature porcelain tile with epoxy grout, because its non-porous surface fights the absorption of bacteria and infectious disease carrying pathogens. The porcelain tile can also easily withstand high bleach content cleaning solutions.

CREATING A HIGH VISUAL IMPACT MOMENT
On top of all these functional considerations, healthcare interior designers want to create an aesthetically pleasing space that stimulates healing. Patients have high expectations for their overall healthcare experience, and it’s becoming more common for patients to shop around for the right health facility before undergoing a medical procedure. For this reason, visual impressions are more important than ever.

To select the right flooring for a specific area, designers should ask: how will this visually enhance the space? How will it affect visitors’ first impressions of the facility? Does this clearly define an area? Will this help the facility stand out from the competition?

Branch-patterned broadloom carpet in the LLUMC lobby seating areas complements the overall lobby design scheme by mimicking the espresso wood and soft nature theme, which, coupled with birch branch dividers, creates a playful interpretation of a restful, wooded vale. The carpet not only clearly defines the seating area for patients and creates a stunningly beautiful entrance but also serves as a soft surface to buffer echoes produced from within the two-story space.

Furthermore, the lobby’s multicolored patterned terrazzo is arranged in a lined pattern to add extra design interest and serve as a wayfinding tactic to direct a more natural flow of patients to the reception desk, through corridors and to various areas of the hospital.

STRIVE TO ADD FUNCTION AND VALUE
The standards of healthcare design have changed and the hospitality-inspired Loma Linda University Medical Center is proof that, more than ever, designers are challenged to create an appealing, patient-centric environment that stands out from the competition. Flooring choices, like all design elements, should be selected based on their characteristics to meet the needs of a facility and should simply add value and function to a space.