Clinic flooring, wall protection and antimicrobial labels

What a clinic floor has to withstand

A clinic floor takes rolling loads from carts, wheelchairs and exam stools all day, is wet-mopped with disinfectants several times a week, and has to stay slip resistant at the entry and in toilet rooms. Seams and edges are where dirt collects and where failures start, so the fewer seams in clinical rooms, the better.

Slab moisture is among the most common reasons resilient floors fail: the adhesive breaks down, seams open and tiles lift. We test the slab with in-situ relative humidity probes (ASTM F2170), the test most resilient flooring manufacturers specify, before ordering material and include a moisture mitigation system in the scope when readings exceed the manufacturer's limit.

Sheet flooring with integral cove, and where LVT is enough

Sheet vinyl or linoleum with heat-welded seams and the flooring turned up the wall as a cove base leaves no joint at the floor line for liquids and debris. We specify it for exam rooms, procedure rooms, the lab, soiled utility and toilet rooms. In offices, the consult room and the staff room, LVT or carpet tile costs less and is easier to replace in sections.

• Plan seam layout before installation so seams avoid doorways and the turning points of carts, where heat-welded seams fail first.
• Inside and outside corners of a flash cove are formed by hand. A poorly formed corner cracks and traps dirt, so we inspect them before the cap strip goes on.
• Ask the manufacturer for its chemical-resistance chart and test samples with the practice's actual disinfectants. Quaternary ammonium, hydrogen peroxide and bleach products affect materials differently, and some rubber floors and LVTs stain from iodine or certain cleaners.
• Read the finish warranty. Several manufacturers condition it on approved cleaning products and maintenance.

Slip resistance and the DCOF number

ANSI A326.3, the current dynamic coefficient of friction (DCOF) test for hard surface flooring, assigns each product a use classification: Interior Dry, Interior Wet, Interior Wet Plus, Exterior Wet, and Oils and Greases. A tile rated Interior Wet has a wet DCOF of at least 0.42, or meets the value the manufacturer declares for that use. Clinic entries and toilet rooms should be specified at Interior Wet or higher. The Tile Council of North America (opens an external site) offers a free copy of the standard.

A326.3 is written for hard surfaces such as ceramic and porcelain tile. Resilient sheet and LVT manufacturers report other slip tests, and numbers from different methods cannot be compared. A rating also describes the product as manufactured: wax, sealers and cleaning residue change the friction of the installed floor. Walk-off matting at the entry reduces the water that reaches the floor in the first place.

Walls, corners and counters

• High-impact gypsum board or vinyl wall protection along cart routes, and corner guards at every outside corner in corridors.
• Crash rail or handrail in corridors where carts and wheelchairs pass.
• Washable paint: eggshell in exam rooms and offices, semi-gloss or epoxy coatings in wet areas.
• Solid surface or quartz counters with an integral backsplash at sinks. Laminate edges near water swell once the seal breaks.

What an antimicrobial label is allowed to say

Many flooring, countertop, paint and hardware products are treated with a registered antimicrobial additive. Under the treated-article exemption in 40 CFR 152.25(a) (opens an external site), such a product does not need its own EPA registration as long as it claims only to protect the article itself. EPA's Pesticide Registration Notice 2000-1 (opens an external site) explains the limits. Claims against odor-causing bacteria, or against mold and mildew that stain or degrade the product, are acceptable when clearly qualified. The exemption does not cover explicit or implied public-health claims against human pathogens. EPA treats words such as antibacterial and germicidal as implying a public-health benefit regardless of context, and allows the terms antimicrobial and mildew-resistant only when properly qualified and not displayed prominently.

A product that claims to kill or reduce germs that affect people must be registered with EPA as a pesticide in its own right. Some copper alloy surfaces have been registered with public-health claims, and those registrations require the label to state that the copper surface is a supplement to, and not a substitute for, standard infection control practices. The current status of any registration can be checked in EPA's pesticide product label system.

When we compare spec sheets with a practice, we report the manufacturer's claim as written and note whether it is a treated-article claim. We do not describe any finish as protecting patients or staff.

A starting finish schedule by room

Many clinics in Queens, Brooklyn and Manhattan occupy buildings constructed before 1978. Federal lead-safe work rules (opens an external site) apply to housing and to child-occupied facilities, which a practice becomes only if the same young children spend regular, extended hours there, as in early-intervention or day-treatment programs. In every older building, OSHA's lead in construction standard governs sanding, cutting and demolition of painted surfaces. We are an EPA RRP certified firm and check the building's age and use before any painted surface is disturbed.