The bottom line on floors
Focusing solely on durability and price during a hospital remodel or construction could leave you on shaky ground.
A practice manager contacted me recently with a problem. Her hospital’s client areas had been renovated six months earlier, but the new floor emitted a pervasive odor. She wanted to know what to do.
I knew the cause as soon as I saw the product specifications. On paper, the flooring was a fine material: an aesthetically pleasing, granulated, heat-formed rubber sheet made from recycled content and with an optional factory sealant applied. It looked great during the factory rep’s presentation.
We water-tested a sample. In less than a minute, moisture appeared on the underside. The reason why was that the manufacturing process had created tiny voids between the granules, allowing a path for liquids to leak through. The factory sealant failed to fill the voids.
The practice was faced with having to install a costly replacement floor.
A good veterinary hospital floor is defined by five primary attributes: durability, appearance, slip resistance, cleanability and cost. Let’s go over them one by one.
- A durable floor looks good not only when installed but after many years of frequent cleanings. It holds up to a range of chemical agents, is relatively unaffected by spills and client accidents, and resists staining by things commonly found in hospitals. The surface texture tolerates mild acid and base exposure.
- Appearance addresses the aesthetics. These floors are important in client areas where, right or wrong, clients may perceive the floor quality as a reflection on the quality of the medical care and the practice overall. Clinical spaces that a client never sees are less important from an appearance perspective. Utility areas have little need for pretty flooring.
- Slip resistance is most important in places where the potential for client or employee slip and falls is high. Less obvious and often overlooked for this type of flooring are areas where geriatric or mobility-impaired patients walk. You may not get an accurate evaluation of gait if the patient feels tentative about a walking surface. Related to slip resistance is the shine or gloss of the finish. Many pet owners equate shiny with clean, but some dogs balk at walking on a high-gloss surface.
- Cleanability is a measure of the effort needed to maintain the surface. There’s no such thing as a self-cleaning floor, so the question is how much upkeep is needed? Old VCT (vinyl composition tile) floors are said to be both cheap and expensive. While economical at first and durable, they require an inordinate amount of maintenance.
- Cost is always a consideration. Beautiful, virtually bulletproof floors are available for $18 to $25 per square foot, but they are not practical at most veterinary facilities. Common clinic floors will fall in the $5 to $12 range.
Except in special cases, floor material falls into three main categories: tile and stone, resilient and resinous.
- Natural stone, while beautiful, fails three of the five attributes above, so it is rarely used as a hospital floor, but it may appear on walls or as an accent. Tile, on the other hand, is a great consideration in client areas. Tile generally is ceramic or porcelain. While we use ceramic on walls, we never use it on floors. Ceramic tile is a softer and surface-glazed material, so a glaze chip or a crack will permanently absorb liquids. Any resulting stain cannot be removed.
A better choice, and one that is sometimes less expensive, is porcelain, especially the unglazed version known as through-body color tile. Even if a glazed tile cracks, the body is virtually nonabsorbing. Through-body color tile is monolithic, so there is no color difference should a corner chip off.
Of course, all tiles have grout joints, which take more effort to clean. We minimize the work by using 24-by-24-inch tiles, narrow one-eighth-inch joints and nonstaining grout. Even with high-end grout, care must be taken during mop cleanings. If the rinse water is not changed frequently, the dirt will lie in the joints and build up over time. Darker grout will camouflage the effect, but there is no substitute for a rigorous cleaning protocol.
Porcelain tile is available in a wide selection of colors and textures. It works in most interior schemes and remains slip resistant.
- Resilient refers to a range of sheet and plank-type plastic or rubber products. Vinyl, PVC and natural or modified rubber are the most common.
Medical-grade sheet vinyl is the workhorse for new clinics. Perhaps not the first choice aesthetically in waiting rooms, it is an excellent choice in clinical spaces when properly selected and installed. Six-foot-wide rolls minimize seams, which are usually welded. We prefer solvent, or chemical, welding over heat welding. These floors have an easy-to-clean, slip-resistant polyurethane top layer.
Rubber sheet products are a bit pricier but excel at slip resistance, even in hydrotherapy, bathing and other frequently wet rooms.
One sheet product we often avoid is linoleum, which is made of natural materials and is recyclable. Sustainably designed hospitals may choose linoleum, but it is not inherently stain resistant. Affordable versions are softer, so heavy furniture like file cabinets can leave permanent indentations.
A relatively new entry in the resilient category is luxury vinyl tile or plank (LVT). Like vinyl composition tile, it has frequent seams, but the difference is in the quality of the edges. LVT is manufactured to tight tolerances. When installed with the right adhesive, LVT becomes virtually watertight. Offered commonly in plank widths and a woodgrain surface, it is one of the least expensive choices. LVT is appropriate in client, feline and light clinical areas that are usually not wet-cleaned. We would not use it in surgical, ICU, isolation or dog areas.
- Resinous floors are essentially a durable coating applied most commonly over concrete. The types include epoxy, acrylic, urethane and, most recently, a class called polyaspartic. They are single-layered or multilayered systems applied to a prepared substrate. If the concrete is not properly prepared, the finish will not stick or will look terrible.
Resin floors are among the most bulletproof available, but they cure properly only within a defined temperature and humidity range. During new construction, the realities of the job site can make those conditions difficult to control.
The main lesson here is that resin finishes should not be installed by an inexperienced crew or a contractor lacking proper equipment. Beware the too-low bidder.
What Will It Cost?
When it comes to construction, I know of no other industry with more pricing variables. Predicting what a specific application will cost is impossible if accurate and detailed data is absent. I know that’s not a very satisfying statement.
Our build company has developed average budget ranges based on actual installed costs from projects across the country. The only way to get accurate numbers is to have your work bid by several competent and capable installers. The following ranges, by square foot, are for informational purposes only:
- Porcelain tile (price group 1 and nonstaining grout): $11 to $13. More economical choices can range from $7 to $12.
- Resilient PVC sheet flooring: $9 to $11.
- LVT (luxury vinyl tile): $5 to $7.
- Resinous flooring (urethane flake system): $6 to $10.
- Moisture mitigation (if tested preinstall values are too high): $4 to $5.
Note that costs are typically higher on projects of less than 1,000 square feet and that regional differences and market fluctuations can be substantial.
Constructive Criticism columnist Paul Gladysz is the principal architect at BDA Architecture. The firm specializes in the planning, design and construction of animal care facilities.
Keep it clean
The best pathogen and odor control for any floor is a strict cleaning protocol. It is far easier when the entire veterinary team learns the value of immediate spot cleaning.
On resilient surfaces, using a neutral pH cleanser — never a detergent — and the correct applicator will clean and extend the useful life of the finish. Never use chlorine-based cleaners or chemical concentrates. I repeat: Never use Clorox. Yes, it will disinfect, but it also will eat away the surface finish, leading to premature failure. This is true for all types of finishes.
Some excellent sanitizers are made specifically for clinic use. While they cost more, they cover a reasonable area if dispensed properly.
What about concrete?
I often am asked about polished or sealed concrete. You may have heard it is cheap, sustainable and durable. Our testing shows that much of the hype is unfounded. For example:
- Polished concrete can be expensive.
- Polishing is a dusty, multipass process.
- Depending on how much aggregate you want exposed and the level of sheen, as many as eight grindings may be necessary.
Untreated concrete acts like a sponge and is susceptible to damage, even by weak acids. Urine left standing for as little as 20 minutes can leave a permanent etch, ruining a polished surface.