Interior Finishes and Furniture
The interior design of a medical or dental office is critically important to the patients’ assessment of the physician or dentist and the level of anxiety patients experience. Patients can rarely assess the quality of the clinical care provided. Nevertheless, a judgment is made based on interactions with staff and an evaluation of the interior environment. Visible attention to detail in office design generates feelings of confidence about the healthcare professionals who work there and the services that are provided.
This chapter will discuss specifications of interior finish materials and furniture items that are particularly well suited to medical and dental offices. Photographs of individual rooms displaying a great attention to detail are scattered throughout the chapters of this book and in the color plates.
Occasionally, medical and dental interiors are designed to residential standards, with materials not intended to withstand the stress of a high-volume office. A door that, in a residence, may be opened and closed 3,000 times a year, or, in a medical office, may be opened and closed 100,000 times a year. Similarly, cut pile carpet designed for residential use does not hold up well. It is difficult to clean and may show wear sooner than a commercial or healthcare-type carpet.
Certain high-profile suites such as plastic surgery may demand unusual interior finishes to achieve their marketing goals; however, sanitation and flammability considerations must not be overlooked. There are two issues here. First, if a product specified does not meet the minimum flammability standard for a particular usage, the physician may be denied Medicare reimbursement or the facility may be denied state licensing. For example, putting a hardwood floor in the operating room of an office-based surgery suite will prevent that physician from getting reimbursed for the use of the facility and may also prevent accreditation. In order to gain Medicare certification and reimbursement from many of the third-party payers, the surgery suite must meet NFPA 101® Life Safety Code, which stipulates fire ratings, among other things, for all areas of an office-based surgery suite.
The second issue is potential liability in case of fire faced by the designer who specifies interior finish materials. If, after a fire, it is determined that any of the materials within the office did not meet the minimum flammability requirements, the designer is certain to be included in the lawsuit. These are the two main reasons that designers should be extremely cautious and diligent in determining which, if any, local or state codes apply to the selection of interior finishes for their specific medical or dental project.
The International Building Code (IBC), adopted in all states, classifies medical office buildings as Group B occupancy. As of this writing, interior finishes having a flame-spread index of 75 or less would be suitable for all areas within the suite (with the exception of surgery suites, where patients may be unconscious). Some areas of the suite may have finishes with a flame-spread rating in excess of 75, provided the area is not an enclosed vertical exitway (stairway) or an exit corridor. However, in the IBC, textile wallcoverings must be Class A (flame spread of 25 or less) in any part of a suite.
A suspended acoustic tile ceiling is more functional than a gypsum board ceiling because it gives access to the electrical and mechanical equipment above it and is easier to clean. Where sanitation is of extreme importance, a vinyl-coated acoustic tile or an enameled gypsum board ceiling should be used.
Flooring may be carpet, vinyl composition tile (VCT), sheet vinyl, linoleum, rubber, luxury vinyl tile, ceramic tile, or a combination of all of these. The least expensive flooring is VCT, which is very durable, but it does need to be waxed and buffed. Sheet vinyl is recommended for wet areas such as bathrooms if the budget does not allow for ceramic tile. Sheet vinyl is also recommended in minor surgeries or anywhere sanitation is a concern because it has fewer seams than VCT and may be installed with a self-cove base. Tarkett, a Swedish manufacturer, markets several high-quality sheet vinyl floorings suitable for operating room suites and other treatment areas where cleanliness is important. It also offers a cushioned sheet vinyl that does not compress under the weight of heavy equipment. The Tarkett products are extremely flexible and malleable, allowing them to be coved up and around inside and outside corners, pipes, floor sinks, or other obstructions, creating a seamless floor. Similar products by Mannington and Armstrong are also excellent. Seams should be heat-welded to protect against the penetration of dirt and moisture.
Sheet vinyl used in high-traffic areas or where considerable pivoting takes place, such as in an operating room, should have color that is integral throughout the entire thickness of the material, as opposed to a thin layer of color laminated to a backing material. Suitable products include Armstrong Medintech, Mannington BioSpec®, and Tarkett iQ Eminent.
Wood-look floors are very popular in commercial applications as they provide a more sophisticated look without the maintenance of a real wood floor. Wood-look floors are available in both plank or sheet goods. Planks are anywhere from 3 to 9 inches wide and typically 36 to 48 inches long. A wide variety of wood species and finishes are available from manufacturers such as Amtico, Parterre®, and Centiva. A wood-look sheet good product provides a seamless installation although a self-cove base on a wood-look floor can look peculiar. Care must also be taken to specify a heat weld rod that coordinates with the wood tone. A great number of wood-look sheet vinyl products are on the market, including Toli® Mature Wood, Armstrong® Rejuvenations Timberline, Lonseal Lonwood, and Gerflor® Nera Contract Wood.
Products such as sheet vinyl, vinyl composition tile, and luxury vinyl tile contain polyvinyl chloride (PVC) and phthalates, or plasticizers, used to make the vinyl more malleable. The manufacturing of PVC has been linked to health problems such as cancer and endocrine disruption. Phthalates are also endocrine disrupters and have been linked to asthma and allergies. To avoid the use of such chemicals in an interior environment, PVC-free options are available including linoleum and rubber flooring. Forbo and Armstrong® offer linoleum in a variety of colors and patterns. Mondo® and Nora® offer rubber flooring in either tile or sheet goods. PVC-free options from Johnsonite® include both rubber tile and linoleum. CERES offers Sequoia, a wood-look plank floor, and WELS Sheet, both manufactured without the use of PVC.
For an authentic wood floor, an attractive product from Nydree Flooring meets Class 1 flame-spread rating, although does not create a seamless installation. Nydree is an engineered wood composed of a wood veneer wear layer impregnated with liquid acrylic making it a stronger floor and easier to clean. Armstrong® Performance Plus™ is another commercial hardwood floor that meets Class 1 flame-spread rating.
It is not uncommon to find entire medical or dental offices carpeted although exam rooms, treatment rooms, and dental operatories—due to spills—should be hard-surface. Apart from any considerations previously discussed regarding infection control, carpet, if selected properly, is easy to maintain and adds warmth to the office appearance. It provides a much-needed acoustic function as well, and it prevents serious accidents caused by people slipping. Acting as an air filter, carpet actually improves indoor air quality by holding on to dust particles, which might otherwise become airborne, until vacuum cleaners equipped with environmental airbags remove the dust from the carpet.
When discussing carpet construction, it is important to keep in mind the fiber composition of a carpet style is only one of several performance factors to consider in the specification process. Backing, yarn weight, pile height, camouflage, texture, and color can have as great a combined impact on the suitability and performance of carpet as fiber selection. However, these factors can never compensate for a budget-priced fiber that lacks the physical structure or stain-resisting additives of quality healthcare carpet. Therefore, careful evaluation and comparison of all specifications should be made prior to selecting a specific carpet.
Nylon is the fiber of choice for most healthcare facilities. Superior performance characteristics such as resiliency, abrasion resistance, cleanability, stain resistance, and texture retention have virtually eliminated other fibers such as polyester and acrylic in the commercial setting.
In commercial carpet, the two types of nylon most prevalent are nylon 6,6 and nylon 6. Type 6,6 nylon (Antron®, Ultron®) is a harder and more resilient fiber than type 6 due to the construction of the fiber and a tighter molecular structure. According to the manufacturers of Ultron®, nylon 6,6 fiber has a 12 percent harder fiber surface and a 20 percent higher resilience than nylon 6. All other things being equal, this could affect performance characteristics accordingly; however, pattern, camouflage, color, and other factors can help to compensate. Piece-dyed and yarn-dyed solids or tonal colorations are often constructed with type 6,6 nylon. Piece-dyed means that the carpet is made in what is called greige goods (undyed, neutral gray/beige yarn color) and dyed after it is woven as a “piece” of carpet. For obvious reasons, there can be variability in dye lots when piece-dying carpet. Yarn-dyed refers to the yarn being dyed before it is woven into carpet.
Type 6 nylon is manufactured by a variety of vendors and often by carpet mills themselves. In response to a growing demand for green building materials, more and more carpet is being manufactured using type 6 nylon with recycled content. Aquafil produces Econyl®, made up of approximately 50 percent postconsumer content, and is used in many Interface carpet patterns. Shaw’s Eco Solution Q type 6 nylon fiber contains approximately 45 percent recycled content, including 25 percent postconsumer recycled content from reclaimed carpet.
Solution-dyed nylon carpet is available in both type 6,6 (Antron® Lumena) and type 6 fiber construction. In areas where the use of caustics and bleaching agents is common, solution-dyed nylons may be the best option. In solution-dyed fabrics, the color is integral to the manufacturing process when the fiber is extruded; hence, there is never a dyelot color-matching problem. These yarn systems do not necessarily have better general stain resistance, but are substantially more colorfast than conventionally dyed nylons and permit the use of cleaning agents containing bleach. Some yarn-dyeing methods rival the colorfastness of solution-dyed yarns by using cationic dyes and other proprietary methods. Colorfastness warranties and stain-removal warranties are well worth consideration when evaluating the real benefits offered by these systems. Focus on the details of these warranties in this important area.
Carpets well suited to the maintenance and durability requirements of healthcare settings have never been more plentiful. The industry has reached a high state of achievement whereby extraordinarily beautiful carpets, in rich colors, that meet rigorous standards for flammability, durability, and ease of maintenance are widely available and at moderate cost. Despite this, it is difficult for the consumer to evaluate the technical properties of carpet, as thicker pile is not necessarily better. A wise buyer will consult a design professional or competent commercial (not residential) carpet dealer to evaluate and select an appropriate product. All too often, a residential product is installed which gives disappointing performance.
Treatments to Inhibit Soiling and Microbial Growth
Antimicrobial treatments, such as Intersept® from Interface, Inc., inhibit the growth and reproduction of microorganisms and should be considered for most hospitals and other medical facilities where patients may be highly susceptible to these pathogens: allergists’ offices, chemotherapy areas, surgery centers, oral surgery offices, and pulmonary specialty clinics. When applied to carpet yarn and backing, molds, mildew, fungi, and other microorganisms cannot multiply, cause odors, or discolor the carpet. Potential infection and allergic reaction to these organisms are significantly reduced. The control of odor and mustiness is perhaps the most notable advantage of these treatments.
Fluorochemical treatments for enhanced soil resistance, such as DuraTech® from Invista, are an important aspect of any specification for carpet in a medical environment. These treatments, which may be effectively applied at several points in the manufacturing process, greatly reduce the surface tension of the fiber and thus its propensity to attract soil. This enhancement may be the most important in the medical environment, since much more carpet is replaced each year because of food and protein stains than for most other reasons combined. Remember, nylon fibers do not wear out; the appearance just deteriorates. Maintaining the appearance of the carpet through good maintenance can make a significant difference in the useful life of the carpet. DuraTech is available only on Antron® Legacy nylon and Antron® Lumena solution-dyed nylon.
Static control “branded” nylons, such as Antron® and Ultron®, will contain a small percentage of conductive filaments capable of reducing static dissipation charge to below the level of human sensitivity (3.5 kilovolts). Antron® uses a carbon core that is extruded through the nylon fiber, making the antistatic property inherent in the yarn. Increased static control can be added through a custom specification that requires extra carbon bundles to be extruded in the nylon. Some mills offer additional static control by using a conductive backing and latex. This extra static control can be important for use with sensitive computer equipment.
Several commercial carpet backings offer improved seam strength, lamination integrity, moisture resistance, texture retention, and cleanability. There are two issues with respect to moisture: moisture being wicked up into the carpet from the concrete slab and moisture penetrating through the backing into the slab from a spill on the surface of the carpet. When liquids seep through the backing into the slab, they are virtually impossible to remove when the carpet is cleaned and, over time, undesirable odors develop. With all backing systems, most manufacturers recommend the use of chair pads in order to enhance appearance retention, although an editorial comment here: They sure look awful.
Enriched latex systems