Materials Selection in Healthcare Design
For immediate release:

Arlington, Va., April 15, 2002—Interior designers specializing in healthcare facility design say the most important criteria driving their material choices are aesthetics, durability and ease of maintenance, according to a recent survey. The next most important characteristics, in declining order, are client preference and initial cost, followed by cost of maintenance, infection control, ease of installation, access for wheelchairs (specifically regarding flooring materials) and life cycle cost.

The survey was conducted by JSR Associates, Inc., on behalf of the Vinyl Institute. Nearly 1,000 surveys were distributed to members of the International Interior Design Association (IIDA) Healthcare Forum members, with a return rate of 20 percent. Designers from 39 states completed the surveys, with a broad geographical representation.

The purpose of the survey was to identify which of a variety of commonly specified materials are most often specified for healthcare projects, as well as why those materials are selected. (Designers were given a list of materials and attributes from which to choose.) The survey results will be used to provide a baseline for designers who specify materials for healthcare environments and information for manufacturers who develop products for the healthcare market. The information also will be used in continuing education programs.

Overview
The three most common projects among the respondents were ambulatory care, acute care and assisted living. Overall, designers are using a number of vinyl products, including flooring and wallcovering, in both patient rooms and community spaces. Other frequently specified products/finishes include carpet, water- or latex-based paint and rubber wall base. Some relatively new products, including vinyl plank flooring and woven Crypton® upholstery fabrics, received high marks from the respondents.

For some products, like vinyl composition tile (VCT), there was no single dominant attribute to explain its popularity. Rather, designers gave nearly equal weight to what they indicated were its most important attributes—initial cost, durability, aesthetics, client preference and ease of maintenance.

In explaining their product selections, some designers factor in the environmental performance of materials, but those attributes received the lowest ranking by respondents. These properties included whether the material is considered "environmentally preferable," whether it can be recycled, whether it off-gases and/or has an impact on indoor air quality.

Materials of Choice in Public/Community Healthcare Spaces

Flooring
According to the survey results, vinyl floors are the most frequently specified in public or community healthcare spaces. Vinyl composition tile (VCT) is the most frequently specified, followed closely by sheet vinyl and broadloom carpet. When asked to rate the top five characteristics that influence their decision to specify VCT, 75 percent of designers said it was the initial cost, 73 percent chose it for its durability, 69 percent for aesthetics, 68 percent because it is the client's preference, and 51 percent for ease of maintenance. This indicates a material with a strong balance of characteristics. VCT is also specified, to a lesser extent, for the cost of maintenance and wheelchair accessibility. One respondent commented, however, that wheelchair access is sometimes not the most critical factor in selection of flooring materials, adding, "I have found that people using walkers and (those) who can walk alone but may not be able to lift up their feet far from the floor have more floor issues to be dealt with."

Wall Finishes
The foremost materials for wall finishes in healthcare public spaces are Type II vinyl wallcoverings, followed by water- or latex-based paint, and rigid vinyl sheet and corner guards. Of the designers who specify vinyl wallcoverings, 99 percent said the primary reason is aesthetics. The next most important quality was durability, then ease of maintenance, client preference and initial cost. Designers also noted the flame resistance qualities of vinyl wallcoverings over other materials (31 percent).

Upholstery
For upholstery, the first choice was woven Crypton, followed by vinyl and solution-dyed fabrics. The designers chose Crypton because of its durability, aesthetics, ease of maintenance, client preference and initial cost - the same reasons designers also selected vinyl. Designers mentioned the woven look and feel of Crypton as preferable to vinyl. Those who preferred vinyl mentioned infection control, cost of maintenance, flame resistance and lifecycle cost as significant reasons for their choice. Others mentioned moisture resistance as significant.

Materials of Choice in Patient/Resident Rooms

Flooring
Overall, sheet vinyl is the flooring material of choice for patient and long-term care resident rooms, followed by VCT. Vinyl plank flooring, a relatively new product, is making inroads into this market and ranked third among materials of choice. Both broadloom carpet and vinyl-backed carpet tile are less frequently specified.

Sheet vinyl is the material of choice because of its aesthetics, durability, ease of maintenance, client preference, infection control and cost of maintenance, in that order. Because the seams on sheet vinyl floors can be chemically sealed or heat welded to keep out moisture and dirt, they help maintain hygienic conditions in healthcare environments, and receive high ratings where infection control is an issue.

Ceramic tile remains the most popular choice for flooring in patient bathrooms, followed by sheet vinyl. Ceramic tile is preferred because of aesthetics, durability, ease of maintenance, client preference and initial cost. Because many healthcare facilities feature roll-in showers for accessibility, flooring materials must be slip-resistant, and the floors must slope to drain without curbing that would impede wheelchair accessibility. Ceramic tile is selected because of its consistent performance in wet areas, according to respondents.

Wall Finishes
For walls in patient rooms, water- or latex-based paint is most frequently used, followed by Type II vinyl wallcoverings. The survey results indicate that interior designers are limiting their use of solvent/oil-based paints. Designers also are using wallcovering borders, Type I vinyl wallcoverings and plastic sheet/corner guards for wall protection in patient rooms.

Opportunities for Product Manufacturers
Healthcare design represents an important market for product manufacturers, since healthcare construction is expected to grow by 6.5 percent this year, according to Building Design & Construction. Designers indicate that their work in the long-term care market is primarily in assisted living (private pay). As the population of older adults grows, additional opportunities in the long-term care market include facilities catering to dementia and dementia-related illnesses. Additional new and growing areas of opportunity include medical adult day care in conjunction with assisted living housing, as well as public senior housing facilities.

The acute care market is also strong, with projects being completed in emergency rooms, surgical suites, waiting areas and other conventional hospital spaces. Specialized areas such as hospitals designed specifically for children or women represent another growth area. Meanwhile, growth in ambulatory care includes outpatient clinics, physicians' and dentists' offices, and facilities offering specialty outpatient services.

Designers responding to the survey commented on specific needs not being addressed which offer opportunities for manufacturers. For example, some pointed to the need for more patterns and imaging in flooring, especially in facilities for patients with dementia where products could assist with way finding. Others commented that infection control is critical in acute care and long-term care, so flooring products such as sheet vinyl and linoleum that offer seamless moisture protection via heat welding and self-coving flooring are preferred over ceramic tile or VCT that require grouting. One designer wrote that incontinence and dementia are "the two most important elements that influence the products and designs used" in interior settings for older adults. "The industry is moving forward with aesthetically pleasing products for incontinence. Products that help with way finding are needed."

"Healthcare materials have a long way to go!" wrote one designer. Limitations in color and pattern selections, lack of unity in the color schemes among collections, and even a lack of appreciation for the psychological importance of color in healthcare were among the frustrations expressed. Other designers commented on how current trends affect their product selection. Maintenance issues are increasingly driving material selection, they said, as hospitals slash budgets and employ fewer maintenance workers.

Survey results indicate confusion among designers about product categories. Some designers' confusion of sheet vinyl flooring with linoleum and Crypton with vinyl upholstery fabric, as indicated by the top manufacturers they listed, points out the need for continuing education from manufacturers to help designers clearly understand their products. Overall, materials and resources are key to the interior design industry, and education about types of materials and their manufacturers could improve the quality of design and the built environment.

JSR Associates, Inc. is a consulting firm providing services primarily for the senior housing and healthcare marketplace. Jane Rohde, FIIDA, AIA, ACHA, NCARB, is the principal of JSR Associates, Inc.

The Vinyl Institute (VI) is a U.S. trade association representing the leading manufacturers of vinyl, vinyl chloride monomer, vinyl additives and modifiers, and vinyl packaging materials. Founded in 1982, the Institute has a dual charter to promote and protect the industry and the markets it serves. The VI has been an industry member of IIDA since 2000.