Materials Selection in Healthcare Design

SURVEY RESULTS

Methodology
In order to better understand the products being specified in the healthcare marketplace, a survey was distributed by mail to 980 members of the International Interior Design Association's (IIDA) Healthcare Forum. About 20 percent (194) were returned. The survey was distributed by JSR Associates on behalf of The Vinyl Institute, a trade association. The purpose of the survey was to identify which materials designers are specifying for healthcare projects and why. In addition, designers were asked to list the two most frequently specified manufacturers in each product category. The survey results will be used for continuing education and to provide a baseline for designers in this field. The designers' comments also will be helpful to manufacturers who develop products for this market. A complete copy of the survey instrument is available at: jsrassociates.net or vinylbydesign.com

DATA

Question 1: What type of Healthcare Projects do you work on? (Check all that apply.)

Choices were: acute care/hospitals (emergency rooms, surgical suites, waiting areas, etc.), long-term care (senior independent living, CCRC), acute care/specialty hospitals (children, women, etc.), long-term care/skilled nursing facilities, ambulatory care (outpatient clinics, doctors' offices, dentists' offices, etc.) and (alternative healing, wellness spas, chiropractic, etc.), long-term care (dementia care facilities), ambulatory care specialty care (rehabilitation, children day care, senior centers, adult day care, etc.), long-term care/assisted living facilities

Designers are working in more than one area of healthcare design. The top three types of projects are ambulatory care (outpatient centers, doctors' offices, etc.), acute care (hospital settings) and assisted living (private pay).

Question 2: What flooring materials do you specify for public or community spaces for healthcare projects? (Check all that apply.)

Choices were: broadloom carpet, carpet tile, vinyl-backed carpet, ceramic tile, linoleum, poured flooring, rubber flooring, sheet vinyl, vinyl composition tile (VCT), vinyl plank flooring, other (please specify)

Overall, vinyl products are the most frequently specified in community/public spaces in healthcare facilities. In descending order, the most frequently specified materials are: VCT, sheet vinyl, broadloom carpet, vinyl-backed carpet, ceramic tile, carpet tile, vinyl plank flooring, linoleum, rubber flooring and poured flooring.

Question 3A: What flooring materials do you specify for patient rooms or long-term care resident rooms? [Check top two and rate #1 (1st choice) and #2 (2nd choice).]

Choices were: broadloom carpet, carpet padding/cushion back, vinyl-backed carpet, linoleum, sheet vinyl, vinyl composition tile (VCT), vinyl plank flooring, other (please specify)

Sheet vinyl flooring was the overwhelming favorite in this category, followed by VCT. Vinyl plank flooring, broadloom carpet and vinyl-backed carpet were the next favorites, in that order. Carpet with padding or cushion back and linoleum were the least frequently specified.

Question 3B: What flooring materials do you specify for patient bathrooms or long-term care bathrooms? [Check top two and rate #1 (1st choice) and #2 (2nd choice).]

Choices were: ceramic tile, linoleum, sheet vinyl, vinyl plank flooring, vinyl composition tile (VCT), other (please specify)
The predominant first choice of materials selected for patient and long-term care bathrooms is ceramic tile. Sheet vinyl was the next highest specified product for this use, followed by VCT.

Question 4: What base do you specify for public spaces within healthcare facilities? (Check all that apply.)

Choices were: paint grade wood base (please specify species), stain grade wood base (please specify species), rubber base (please specify straight or cove), vinyl base (please specify straight or cove)

The most frequently specified base materials are, in descending order, rubber cove base, vinyl cove base, stained grade wood base, paint grade wood base, straight rubber base, and straight vinyl base. Stain grade wood base is used more frequently than paint grade wood base, with preferred species being oak, maple and cherry. Paint grade preferences are pine, oak, poplar and maple.

Question 5: What wall finishes do you specify for public spaces within healthcare facilities?

Choices were: water/latex-based paint, solvent/oil-based paint, other paint, Type I vinyl wallcovering, Type II vinyl wallcovering, wallpaper borders, other (please specify).Also, wall and corner protection (check all that apply): plastic sheet/corner guards, rigid vinyl sheet/corner guards, other (please specify)

The top materials used for wall finishes in healthcare public spaces are, in descending order, Type II vinyl wallcovering, water/latex-based paint, rigid vinyl sheet and corner guards, Type I vinyl wallcovering and plastic/sheet corner guards.

The survey results indicate that interior designers are limiting their use of solvent/oil-based paints and predominantly specify water/latex-based paint. When solvent-based paints are specified, respondents do so because of color availability.

Question 6: What wall finishes do you specify for patient or long-term care resident rooms?

Choices were: water/latex-based paint, solvent/oil-based paint, Type I vinyl wallcovering, Type II vinyl wallcovering, wallpaper borders, other (please specify); plastic sheet wall and corner protection/corner guards, rigid vinyl sheet wall and corner protection/corner guards, other (please specify)

The top materials specified for wall finishes in healthcare patient or long-term care resident rooms are, in descending order, water/latex-based paint, Type II vinyl wallcovering, rigid vinyl sheet/corner guards, wallcovering borders, Type I vinyl wallcovering and plastic sheet/corner guards. Similar to public spaces, survey results indicate that interior designers limit the use of solvent/oil-based paints and predominantly specify water/latex-based paints.

Respondents also mentioned spray paint systems, Xorel™ and glass textile wallcoverings, and wall protection systems including stainless steel/metal protections, chair rail/bumper guards, bed bumpers, wood trim and door protection.

Those who use paint use it often. When asked how frequently they specify these products, 73 respondents specify paint more than half the time.

Question 7: What upholstery materials do you specify in healthcare facilities?

Choices were: laminated fabrics, solution-dyed fabrics, printed Crypton, woven Crypton, vinyl, Xorel and other (please specify)

The most frequently specified upholstery materials were, in descending order, woven Crypton, vinyl, solution-dyed fabrics, printed Crypton, laminated fabrics and Xorel. Many additional materials were listed in the "other" category, including non-woven (printed) fabrics, woven nylon, custom materials, corporate/contract fabrics, wool, poly/cotton/wool blends, nylon and cotton fabrics. Designers also mentioned special coatings on fabrics and moisture-resistant backings.

Question 8: Check the category and rate the top five characteristics (1-5 with 1 being the most important) that influence your decision on product specifications for the following products.

Choices were: aesthetics, ease of installation, infection control, access for wheelchairs, ease of maintenance, initial cost, client preference, environmentally preferable, life cycle cost, cost of maintenance, flame resistance, off-gassing, durability, indoor air quality, recyclable, other (please specify). Materials are listed below in order of most frequently specified, followed by the percentage of respondents who indicated they specify this product.

Carpet (86% of respondents indicated they specify this product)
In descending order of importance, carpet is specified because of aesthetics, durability, ease of maintenance, client preference and access for wheelchairs. Other significant reasons include initial cost, flame resistance, cost of maintenance and infection control. Characteristics that were of minimal or no importance include off-gassing and indoor air quality. Designers also noted "other" factors influencing their decision to specify carpet, including acoustics, fiber content/construction, solution-dyed yarn, and the availability of vinyl backing, which provides moisture resistance. Others noted that it meets applicable codes, and is part of a hospital's facility buying program.

Sheet Vinyl Flooring (84%)
The reasons vinyl sheet goods are specified, in descending order of importance, are aesthetics, ease of maintenance, durability, client preference and infection control. Other significant reasons include cost of maintenance, initial cost, access for wheelchairs and ease of installation. Issues that were minimally or not important include off gassing, product can be recycled and indoor air quality. Designers also noted "other" factors influencing their decision to specify sheet vinyl, including slip resistance and resident safety issues. Others noted that sheet vinyl serves as a moisture barrier. It was also mentioned that vinyl sheet goods are specified because the material complies with health department regulations.

Vinyl Composition Tile (81%)
The reasons VCT is specified, in descending order of importance, are initial cost, durability, aesthetics, client preference and ease of maintenance. Unlike other products, designers did not single out one or two overwhelming characteristics that influenced their decision to specify VCT. Instead, the top characteristics received very close ratings. 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 choose it for its durability, 69 percent for aesthetics, 68 percent because it is the client's preference, and 51 percent for ease of maintenance. VCT is also specified, to a lesser extent, for the cost of maintenance and wheelchair accessibility.

Vinyl Wallcovering (81%)
Overwhelmingly, the number one reason designers specify vinyl wallcoverings is for aesthetics - 99 percent of respondents who specify this product said that is their primary reason. They also listed durability, ease of maintenance, client preference, initial cost and cost of maintenance, in that order. Designers also noted the flame resistance qualities of vinyl wallcoverings over other materials (31 percent) and life cycle cost (24 percent).

Ceramic Tile (79%)
Ceramic tile is the most frequently specified flooring material for patient bathrooms and long-term care resident bathrooms because of aesthetics, durability, ease of maintenance, client preference and initial cost, in that order. Designers also list access for wheelchairs, infection control and life cycle cost as additional reasons they specify carpet. Notably, in the "other" category, several designers mentioned slip resistance as an important feature related to resident safety, compliance with the Americans With Disabilities Act (ADA) and coefficients of friction ratings.

Water-based Paint (77%)
Water-based paint is specified because of aesthetics, ease of maintenance, client preference, initial cost and durability, in that order. Other significant reasons include ease of installation and cost of maintenance. Of all the materials, water-based paint received more ratings for indoor air quality and off-gassing - that is, when designers choose this material, 28 percent said that indoor air quality is one of the top five characteristics that influences their decision, and 12 percent say the same about off-gassing. (For every other material, these characteristics were well below 10 percent.)

Woven Crypton (75%)
The primary reasons that designers specify woven Crypton for upholstery, in descending order of importance, are durability, aesthetics, ease of maintenance, client preference and initial cost. Other significant reasons include infection control, flame resistance, cost of maintenance and life cycle costs. When asked for "other" reasons, designers noted that woven Crypton acts as a moisture barrier and is a readily available product.

Vinyl Upholstery (71%)
Designers specify vinyl upholstery fabrics because of their durability, ease of maintenance, aesthetics, client preference and initial cost, in that order. Other significant reasons include infection control, cost of maintenance, flame resistance and life cycle cost. Designers noted in the "other" category that vinyl is specified because it is moisture-proof and bleach-resistant.

Rubber Flooring (58%)
Although rubber flooring was not within the top three products frequently specified, the primary reason designers specify it is its durability, followed by aesthetics and ease of maintenance. Designers also highlighted its cost of maintenance as important, as well as client preference. Other reasons included initial cost, access for wheelchairs, life cycle costs and infection control. As "other" reasons they specify rubber flooring, designers listed function, comfortable to stand on, meets ADA coefficient of friction, is slip resistant and acoustics.

Linoleum (51%)
While fewer designers specify linoleum than other flooring materials, the primary reasons it is selected are aesthetics, durability, ease of maintenance, client preference and cost of maintenance. More than any other product, designers say they specify linoleum because it is environmentally preferable. In fact, 31 percent of the designers who specify linoleum ranked this in their top five reasons. The only other material that had a similar rating (26 percent) was water-based paint. In the category of "other" important characteristics, designers said they specify linoleum because of function, flexibility of design applications, acoustics, slip resistance and its ability to meet all applicable codes.

Solvent-based Paint (42%)
Solvent-based paint is the least frequently specified of all the materials included in the survey. When specified, designers select it for its durability, ease of maintenance, aesthetics, client preference and initial cost, in that order. Other significant reasons include cost of maintenance, ease of installation, indoor air quality and infection control. Designers also listed color availability in the "other" category.

Question 9: If you specify the following products, what top two manufacturers do you specify the most?

Listed are the most often mentioned manufacturers in each category:

• Carpet (Broadloom): J&J, Lees, Mannington, Patcraft, Shaw
• Carpet (Tile): Collins & Aikman, Interface, Lees, Shaw
• Ceramic Tile: American Olean, Crossville, Dal-tile
• Linoleum: Armstrong, Forbo
• Paint: Benjamin Moore, Sherwin Williams
• Vinyl-backed Carpet: Collins & Aikman, Interface, Lees, Mannington
• Vinyl Sheet Flooring: Armstrong, Mannington, Tarkett
• Vinyl Upholstery: Architex, Designtex, Maharam, Momentum
• Vinyl Wallcovering: Genon, JM Lynne, Koroseal, Seabrook, Versa, Wolf Gordon
• Woven Crypton: ArcCom, Architex, Designtex, Fantagraph/Standard Textile, Maharam, Mayer, Momentum, Valley Forge

Question 10: Additional Comments
Following is a summary of noteworthy comments:

• Although initial cost was one of the product characteristics listed, budgets were not included in the survey. Depending upon the project, budgets can have a wide range. For example, a private pay assisted living facility would have a larger interior finishes budget than a public housing facility for seniors, and a specialty hospital that focuses on plastic surgery would have a larger interior finishes budget than an acute care facility serving a large rural or urban population.
• Several designers commented on the need to improve healthcare materials and the lack of selection in products, including woven Crypton and flooring. In addition, they recommend testing product colors for perception and psychological impact within the healthcare environment.
• For the long-term care market, incontinence and dementia are the two most important elements that influence the products and designs of the physical environment for the elderly. The industry is moving forward with aesthetically pleasing products for incontinence; however, products that help with way finding are needed. In addition, it was suggested that manufacturers work with other manufacturers and their related products to coordinate color schemes.
• "Access for wheelchairs" is not the only mobility issue. For example, flooring specifications may have a greater impact on patients who use walkers than those using wheelchairs, due to shuffling and other difficulties in ambulating.
• Facility/building standards are being developed to improve maintenance by limiting the variety of products used within a facility. In addition, shrinking operational budgets have forced many hospitals to drastically reduce their maintenance staffs, placing ever greater emphasis on the selection of materials that are easy to maintain.
• Client "preferred" vendors are being specified due to budgets or relationships; however, designers still want to push the design "envelope" whenever possible. Designers want products that help them push the envelope and provide creative solutions.