Hospital Reports Europe – Innovations in Rubber Flooring Solutions – nora flooring

SPECIAL REPORT

Innovations in Rubber Flooring Solutions Design and Functionality for the Floor Flooring and the Battle Against Austerity The Evolution of Hospital Flooring Hospital Flooring: Key Issues to Consider Which Flooring Material Should Hospitals Use?

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Published by Global Business Media

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SPECIAL REPORT: INNOVATIONS IN RUBBER FLOORING SOLUTIONS

SPECIAL REPORT

Innovations in Rubber Flooring Solutions Design and Functionality for the Floor Flooring and the Battle Against Austerity

Contents

The Evolution of Hospital Flooring Hospital Flooring: Key Issues to Consider Which Flooring Material Should Hospitals Use?

Foreword

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Tom Cropper, Editor

Design and Functionality for the Floor Nora Flooring Systems UK Ltd

Sponsored by

Published by Global Business Media

Published by Global Business Media Global Business Media Limited 62 The Street Ashtead Surrey KT21 1AT United Kingdom Switchboard: +44 (0)1737 850 939 Fax: +44 (0)1737 851 952 Email: info@globalbusinessmedia.org Website: www.globalbusinessmedia.org Publisher Kevin Bell Business Development Director Marie-Anne Brooks Editor Tom Cropper Senior Project Manager Steve Banks Advertising Executives Michael McCarthy Abigail Coombes Production Manager Paul Davies For further information visit: www.globalbusinessmedia.org

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System Floor Covering Solution for a Healthy-Living Environment Harmonious Environment Excellent Economic Viability Linz Study: Material and Bacteriological Examinations of Resilient Floor Materials Innovative Cleaning System for Rubber Floorings from Nora Systems Easy and Efficient: One Pad for All Occasions - Easy Cleaning with Practically no Chemicals Ideal Hygiene Characteristics Rubber Floors for OT Ergonomics Permanent Resilience Makes Standing Less of a Strain Outstanding Hygiene Qualities More Peace and Quiet Where It Matters Measuring Method Simulates Human Hearing

Flooring and the Battle Against Austerity Tom Cropper, Editor

An Expensive Business A Sustainable Future

The Evolution of Hospital Flooring

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James Butler, Staff Writer

Focus on Rubber Moving to the Future

Hospital Flooring: Key Issues to Consider The opinions and views expressed in the editorial content in this publication are those of the authors alone and do not necessarily represent the views of any organisation with which they may be associated.

Material in advertisements and promotional features may be considered to represent the views of the advertisers and promoters. The views and opinions expressed in this publication do not necessarily express the views of the Publishers or the Editor.

While every care has been taken in the preparation of this publication, neither the Publishers nor the Editor are responsible for such opinions and views or for any inaccuracies in the articles. Š 2018. The entire contents of this publication are protected by copyright. Full details are available from the Publishers. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical photocopying, recording or otherwise, without the prior permission of the copyright owner.

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Tom Cropper, Editor

Battling Infection Issues with Cleaning Slips, Trips and Falls Specialist Designs

Which Flooring Material Should Hospitals Use?

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Jo Roth, Staff Writer

Choosing a Material Assessing Costs Ease of Cleaning The Right Look and Feel

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SPECIAL REPORT: INNOVATIONS IN RUBBER FLOORING SOLUTIONS

Foreword

I

T’S ONE of the most visible and heavily used

pressures on the NHS. At the same time, they must

parts of a hospital. Unsurprisingly, the choice of

meet ambitious targets, improve sustainability and

flooring material is attracting increased attention.

ensure safety. Balancing these demands will increase

It impacts a host of different performance metrics

the importance of details such as flooring material.

including health and safety, patient well-being, infection control and financial sustainability.

James Butler will then look at how hospitals’ requirements for flooring are evolving. They need

Our opening article comes from nora systems, one of

solutions which are long-term, sustainable, effective

the world’s leading providers of hospital flooring. They

and reduce costs. This, he suggests, is encouraging

talk about the challenges the industry faces and why

them to focus on new materials and designs.

they believe rubber represents a solution for the future.

While managers will be asked to take more factors

Elsewhere, Jo Roth will look more closely at the

into consideration when choosing a floor design, they

question of materials. Although PVC and linoleum

must still fulfil their core duties of reducing the risk of

floors have been seen as the most affordable option,

accident and controlling infection. We’ll examine what

he argues that purchasers should recognise the

hospitals must do to achieve both targets.

difference between upfront price and total lifecycle

According to manufacturers such as nora systems,

costs. As he shows, there is a growing body of

rubber represents the future. It is durable, flexible and

evidence which suggest that saving money now will

increasingly affordable.

push costs up in the long-term.

The question of cost is clearly something which weighs heavily on the minds of hospital managers.

This winter has clearly illustrated the financial

Tom Cropper Editor

Tom Cropper has produced articles and reports on various aspects of global business over the past 15 years. He has also worked as a copywriter for some of the largest corporations in the world, including ING, KPMG and the World Wildlife Fund.

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SPECIAL REPORT: INNOVATIONS IN RUBBER FLOORING SOLUTIONS

Design and Functionality for the Floor Nora Flooring Systems UK Ltd Rubber flooring coverings in hospitals make their benefits felt to the full

F

LOORS IN hospitals are required to meet more stringent requirements than floors in almost any other type of public facility. As a 24hour operation where the inhabitants may at any time be contending with life or death scenarios, flooring, as the single surface in which every person in the building will interact with, must, without fail, provide a safe, durable and efficiently maintainable surface day after day, year after year.

As a global leader in providing commercial rubber flooring, nora systems has engineered a system designed to support the purpose of the healthcare environment by providing a rubber floor free of harmful chemicals that can withstand extreme use, meet the highest standard of hygiene required in operating theatres to neonatal intensive care units while providing a safe, slipresistant, ergonomic environment which supports the delivery of care.

Understanding the complexity of replacing flooring in the healthcare environment, nora systems provides a long-term solution by offering a diverse range of durable, environmentally friendly floor coverings designed to contribute to the total health, safety and comfort of the building users while reducing the cost of ownership

through strategic, rapid installation options, ease of maintenance, unrivalled durability and product longevity. With application recommendations based on best practice, as measured over decades of serving in the healthcare environment, an organization can be assured that no matter where nora is installed in the health sector, the benefits of this exceptional flooring will be felt to the full.

Safety and functionality are, of course, a paramount concern. The dense, unbroken surface of the flooring prevents dirt absorption, enabling it to be cleaned easily and economically, without any coating. With high walking comfort and excellent footfall sound absorption properties, these resilient rubber floorings are the ideal guarantee for harmonious visual synergy.

At the same time, nora® floor coverings also score points with contemporary designs, a high degree of economic viability and ideal hygienic characteristics. With a broad colour range comprising over 300 colours in the standard range, various surface structures and the diverse design possibilities offered by inlays, for example, they allow for creative interior design concepts in conjunction with

nora® rubber floor coverings CREATING SAFER SPACES IN HEALTHCARE

www.nora.com EVELINA CHILDRENS HOSPITAL – INLAY DESIGN FOR WAY FINDING

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SPECIAL REPORT: INNOVATIONS IN RUBBER FLOORING SOLUTIONS

With application

nora’s Blue Angel certification for low voc’s we are now able to offer a comprehensive system incorporating flooring, adhesives, screeds and dpms all carrying the Blue Angel environmental award.

Overall, the floorcoverings’ extreme durability, backed up by excellent slip resistance properties ensure lasting safety for generations

recommendations based on best practice as measured over decades of serving in the healthcare environment

Harmonious Environment

an organization can be assured that no matter where nora is installed in the health sector, the benefits of this exceptional flooring will be felt to the full contributing to a feel-good atmosphere. The wide spectrum of colours from pastel shades through to rich, bright hues available for the rubber floor coverings is truly exceptional.

System Floor Covering Solution for a Healthy-Living Environment nora®scores top marks in many ways: as a safe raw material it is free from PVC, phthalates or other plasticizers, and does not contain any organochlorides or halogens. In addition, nora systems has taken yet another step towards building for healthy living and has developed the nora system blue solution. Capitalising on

ST THOMAS HOSPITAL

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Especially popular in healthcare facilities are the rubber floor coverings noraplan® signa and noraplan® sentica with their harmonious colour schemes. As one of the most versatile members of the noraplan product family, noraplan® sentica, even won the Nightingale Award (one of the most prestigious design awards in the U.S. health sector) shortly after its launch in 2012, winning praise for its quality, functionality, wear resistance, design, sustainability properties and the excellent cost-performance ratio. The Nightingale Award is presented to innovative products which contribute to creating an atmosphere in hospital environments that is conducive to patient recovery. The designing of healing environments has become the benchmark in Germany’s healthcare sector as well.

These aims are supported by nora systems with a comprehensive range of system solutions that are specifically tailored to meet the needs of healthcare facilities. Flooring coverings from nora® allow the realisation of integral design solutions. For example, the rubber coverings are available in the same design but with different functional characteristics, be it electrostatic conductivity, enhanced slip resistance or exceptional acoustic properties.

From stairtreads® to hygienic skirtings – they

SPECIAL REPORT: INNOVATIONS IN RUBBER FLOORING SOLUTIONS

NORAPLAN IN OPERATING THEATRE

all look as if they were cast from one mould.

With the aid of the NCS system that is also used by nora systems, the colours of the walls and furniture can be matched precisely with the colour of the floor covering.

Excellent Economic Viability The dense, impermeable surface of nora floor coverings provides a surface free of topically applied coatings making it exceedingly resistant to wear providing a floor system that can maintain a like-new condition even after years of heavy use. In contrast, other commercial resilient floor coverings, have applied coating of varying qualities and durability which will have to be reapplied throughout the useful life of the product, an invasive and costly exercise completely avoided through the use of nora rubber flooring. While calculating the direct costs for chemicals and man hours required to maintain applied coatings is fairly easy, the impact to the overall operational costs goes much further.

The exposure to cleaning products and the subsequent links to illness such as dermatitis, respiratory distress, headaches, nausea and increase incidences of occupational asthma, result in lost work days and an increase in compensation claims, plus the human resources related expenses for finding and hiring replacement workers has motivated leading healthcare organizations to take a proactive approach by investing in materials which are fiscally savvy and protect the health of the buildings inhabitants. Consequently, although the capital outlay may be slightly more expensive at the outset, in the long term nora rubber floor coverings are the most economically viable

solution for hospitals, retirement and nursing homes, and clinics.

The dense impermeable surface of nora’s floor coverings makes them exceedingly resistant to wear and means they can be easily cleaned and continue to look almost new even after many years of heavy use. And in contrast to other resilient floor coverings, they do not need a coating. This means that nora products offer a distinct advantage, since the coatings of other resilient floor coverings wear out and have to be replaced at frequent intervals. This is not only time-consuming and expensive, but also leads to considerable operational disruptions during the refurbishment. Consequently, although the initial cost could be more expensive long term nora rubber floor coverings are the most economically viable solution for hospitals, as well as retirement and nursing homes, as 90 percent of the life cycle costs of a floor covering are maintenance-related.

Linz Study: Material and Bacteriological Examinations of Resilient Floor Materials The study titled “Material and bacteriological tests on resilient floor materials” examines in particular the behaviour of different resilient floor coverings in hospitals and was conducted in collaboration with Linz Technical College and the Linz State Psychiatric Clinic over a total period of ten months.

The usage and cleaning of two linoleum floor coverings, two PVC coverings and two rubber coverings were examined under realistic conditions in a hospital.

The following objectives were set for the project: • Observation of the wear behaviour of floor coverings with an ex works coating.

nora® system blue THE FIRST QUALITY MANAGEMENT SYSTEM FOR THE FLOOR. nora system blue® combines nora’s low-emission rubber floor coverings with low-emission installation materials.

All the system‘s components have been awarded the „Blue Angel“ eco-label and are also tested within the composite system. This eliminates the likelihood of any hazardous interaction between the single components and assures healthy indoor air.

www.nora.com

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SPECIAL REPORT: INNOVATIONS IN RUBBER FLOORING SOLUTIONS

Patient surveys have revealed that noise is one of the most common causes for complaint, and studies have shown that recovery can be delayed as a result

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• C omparison of three different cleaning methods: 1. Manual cleaning (2-stage) using a cleaning additive 2. Machine cleaning using a cleaning additive 3. M achine cleaning using diamond pads without a cleaning additive (just water) • Effectiveness of the respective cleaning method as well as the optical appearance of the coverings, particularly in the absence of additional measures such as care treatment, coatings, etc.

•O bservation of the bacteriological characteristics of the floor covering surfaces.

• Verification of the hygienic suitability of the diamond pads (only with water).

Three different test surfaces were installed to enable the different cleaning methods to be separately assessed.

The results unambiguously and very vividly prove that the surface coatings of both PVC and linoleum floor coverings that are applied at the factory wear out extremely quickly.

Following cleaning using different methods (manual mopping as well as machine cleaning), the surface coatings displayed signs of wear after just a few months. Figures from the “Material and bacteriological tests on resilient floor materials” study conducted between 5/2011 and 2/2012 are shown in the table below: The dense surfaces of nora rubber floor coverings offer distinct benefits here since they can be permanently maintained without coatings.

Overall, the results from the study allow the following conclusions to be drawn:

• All the tested surface coatings displayed an extremely limited life span in a hospital environment. The life span of the surface coatings was shortened even further by the use of cleaning machines.

•S urface coatings are not suitable for cleaning with diamond pads because they wear them out exceptionally quickly (see table, test surface 3).

• Once the surface coatings have been worn down, protective measures have to be taken to achieve satisfactory cleaning results again.

• Uncoated nora floor coverings displayed outstanding cleaning behaviour with all three of the tested cleaning methods.

• The bacteriological examinations proved that cleaning floors using diamond pads – without chemicals – produces results that are comparable with traditional cleaning methods, if not better.

• Cleaning nora coverings with diamond pads leads to a high level of customer satisfaction and allows the choice of anywhere between a high-gloss finish and a matt surface without diminishing the cleaning capability.

We will be glad to personally discuss the study with you in more detail. Please contact our technical consultant from the field organisation.

Innovative Cleaning System for Rubber Floorings from Nora Systems Unlike other public sectors, hospitals must provide safe, hygienic environments whilst contending with the issue of access from high census, crowding in waiting spaces, 24-hour

SPECIAL REPORT: INNOVATIONS IN RUBBER FLOORING SOLUTIONS

nurse stations, chemically sensitive patients and staff combined with staffing challenges and limited funds. Understanding this reality, nora systems delivers a complete solution by providing a hard-wearing, exceedingly dense surface that – unlike other vinyl or linoleum surfaces – resists stains, does not require an applied coating; and can easily be kept clean – mopping with a simple all-purpose cleaner and scrubbing with a standard scrubbing equipment and water is all that is needed.

When it comes to the cost of a floor covering, cleaning is a key factor. This is where floor coverings from nora systems bring all their strengths to bear: They are extremely hardwearing; in contrast to other resilient floor coverings they do not require a coating; and their dense surface means they can easily be kept clean - mopping with a simple all-purpose cleaner is all that is needed. Rubber floors are especially ideal for buildings with demanding hygiene requirements. The sturdy all-rounders are resistant to stains and surface disinfectants, blood and urine, iodine containing products i.e. skin disinfectants (eg Betadin) can be removed easily and surface disinfectants, (for older and more persistent stains nora® offer special cleaning agents).

Easy and Efficient: One Pad for All Occasions - Easy Cleaning with Practically no Chemicals nora systems recently developed an innovative floor care system: nora pads –- cleaning disks that are impregnated with microscopically small diamonds. With nora pads, the use of cleaning chemicals can be kept to a minimum.

They are designed to be used with most commercially available single disk machines and are available in different sizes: the diameters of the diamond pads range from 10” through to 20”, with the standard size being 17”. Pad 1 is used daily for maintenance cleaning. To ensure that the flooring continues to retain its outstanding appearance, it is advisable to clean it intensively with Pad 2 every few weeks.

As well as daily care, the diamond pads are also suitable for repairing the flooring. Heavier soiling or damage to the surface, such as that caused by rolling heavy objects for instance, can be remedied using Pad 3. In addition, the nora pads offer the opportunity to choose between a matt or a gloss finish with an optional polishing process.

The pads have several advantages. One of the most important of these is that they obviate the need for basic cleaning of the floors using chemicals as in the past. All that is required is simple routine cleaning with water mixed with a neutral cleaner. This means that cleaning can be

done during normal daily working hours without having to block off rooms or whole areas, which causes significant operational disruptions particularly in buildings such as hospitals.

Consequently, cleaning with nora pads not only saves time and money but is also good for the environment and the wellbeing of people in the building. Last, but not least, this innovative cleaning process ensures the long-term value preservation of the building.

Ideal Hygiene Characteristics Unique to the healthcare environment as a public space is the reality that in some manner, every patient entering the building is likely to be contending with an injury or illness meaning there is an added vulnerability to additional infection within those persons arriving to seek care. Ensuring that patients do not fall victim to hospital acquired infections (HAI) is a task the entire healthcare organisation is responsible for.

From a fiscal perspective, as reported in Healthcare Financial Management, “HAIs erode the bottom line. Patients with HAI’s stain the hospital three to four times longer than those without HAIs. That’s akin to one patient using four beds instead of one.”

The cleaning and disinfecting capability of all touchable surfaces is a crucial factor in the critical, all-encompassing hygiene concepts for healthcare facilities. According to The HOK Guidebook to Sustainable Design, “Sustainable healthcare design guides call for the selection of highly durable, low-maintenance materials that are low in emissions, prevent the proliferation of molds, fungi, bacteria and other infectious pathogens, and can be maintained to healthcare requirements with low-toxic cleaning products” Naturally bacteriostatic, nora rubber flooring supports the complete removal of contaminates through a surface so dense and robust it resists staining agents commonly found in the healthcare environment such as betadine, silver-nitrate or methylene blue while simultaneously ensuring cleaning and complete disinfection is achieved with ease.

And, unlike vinyl sheet flooring, rubber floor coverings do not contain plasticizers, and are therefore dimensionally stable and can be installed without any joints whilst providing a reliable installation and a surface that is naturally bacteriostatic which is both optically and hygienically beneficial. Tests conducted by the Hygiene Institute at the University of Heidelberg have confirmed that floor areas installed with nora rubber floor coverings without joints, can be fully disinfected.

The extremely dense surface of nora rubber floor coverings makes them resistant to surface disinfectants and stains. Brief exposure to

THE BEST CLEANING AGENT COMES DIRECTLY FROM THE TAP. You expect a clean, healthy workspace. But can you get it without harsh chemicals, noisy scrubbers and high maintenance costs?

We don’t think that‘s too much to ask. Next time you talk about long-term facility plans, meet these issues head-on and ask for unique materials like nora® flooring — which cleans up with little more than water.

You deserve a clean environment without all the side effects.

www.nora.com

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SPECIAL REPORT: INNOVATIONS IN RUBBER FLOORING SOLUTIONS

Just as importantly, low-emission rubber floor coverings guarantee healthy indoor air, which is why they were the first resilient floor coverings to be awarded the “Blue Angel” NORAPLAN IN OPERATING THEATRE

solvents, diluted acids or lyes does not leave any lasting traces either.

Just as importantly, low-emission rubber floor coverings guarantee healthy indoor air, which is why they were the first resilient floor coverings to be awarded the “Blue Angel …protecting the environment and health” eco label as long ago as 2006. A healthy living environment with lowemission building materials is one of the key factors that contributes to the welfare of patients with weakened immune systems, in particular, as well as that of hospital and nursing home staff.

Rubber Floors for OT Ergonomics The operating theatres of a hospital play a key role in its business success. And yet, the strain on the musculoskeletal system of OT staff, standing for long periods, can cause painful tension in the muscles and degenerative changes in the intervertebral discs and the facet joints. A decisive factor for standing comfort lies in the composition of the floor covering as the body tires more easily

on hard surfaces than on resilient floorings. Owing to the high permanent resilience of nora flooring, surgeons and OT surgeons and attending staff find it easier to stand for hours – and there is perceptibly less strain on their backs and joints. this proves a crucial competitive factor for clinics recruiting qualified workers. Recently, the report “OP-Personalreport Pflege” surveyed the workers at over 150 hospitals with operating theatres. The findings show that operating theatres face huge problems filling staffing vacancies. And, in turn, these recruitment difficulties have a considerable effect on OT performance. A strategic, ergonomic layout of workplaces fosters a healthy, positive working environment which is one of the essential factors contributing towards job satisfaction.

This holds true in particular for the floor covering which, in addition, must fulfil stringent hygiene requirements. Rubber floor coverings supplied by nora combine the solutions to all of these diverse requirements. Owing to their extremely dense surfaces, they can be cleaned and completely disinfected with ease.

THE RESULTS

IT IS CHALLENGING TO DEFINITIVELY QUANTIFY THE IMPACT WALKING, OR JUST SIMPLY STANDING, ON CERTAIN SURFACES CAN DIRECTLY HAVE ON THE HUMAN BODY. HOWEVER, BY UTILIZING THE BEST POSSIBLE DATA AND EVIDENCE, INFORMED DECISION MAKERS CAN SELECT THOSE PRODUCTS THAT HELP CREATE THE MOST ERGONOMICALLY SAFE ENVIRONMENT FOR THEIR CUSTOMERS AND STAFF.

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SPECIAL REPORT: INNOVATIONS IN RUBBER FLOORING SOLUTIONS

Permanent Resilience Makes Standing Less of a Strain Workplace ergonomics play a role of growing importance in the fitting out of operating theatres – for a good reason. The strain on the musculoskeletal system of OT staff, standing for long periods, can cause painful tension in the muscles and degenerative changes in the intervertebral discs and the facet joints. A decisive factor for standing comfort lies in the consistency of the floor covering. The body tires more easily on hard surfaces than on resilient floorings. Owing to the high permanent resilience, doctors and OT staff find it easier to stand for hours – and there is perceptibly less strain on their backs and joints. This is how nora floorings promote a healthy working environment. In face of the nationwide shortage of skilled OT staff, this proves a crucial competitive factor for clinics recruiting qualified workers. Recently, the report “OP-Personalreport Pflege” surveyed the workers at over 150 hospitals with operating theatres.

The findings show that operating theatres are faced with huge problems when filling vacancies.

And, in turn, these recruitment difficulties have a considerable effect on OT performance, and hence the cost effectiveness of the whole hospital. The ergonomic layout of workplaces for creating a positive working environment is one of the essential factors contributing towards job satisfaction.

Outstanding Hygiene Qualities How well the floor coverings can be disinfected is also of great significance for a comprehensive hygiene concept in OTs. In this regard, nora rubber floor coverings are impervious to stains and resistant to surface disinfectants listed by the Disinfectant Commission of the Association for Applied Hygiene (VAH) and the German Robert Koch Institute (RKI). Brief exposure to solvents, diluted acids, or lyes does not leave any lasting traces either. A study by the Hygiene Institute of Heidelberg University confirmed that floors fitted free of gaps with nora rubber coatings can be fully disinfected.

The electrostatically dissipative floor coverings from nora have proved ideal for OTs and are available in a range of qualities, colours, and designs.

More Peace and Quiet Where it Matters Study: Rubber floorings are the best at suppressing impact noise Weinheim, September 2015 – The influence of acoustics in the healthcare environment cannot be underestimated. Excessive noise can cause sleep disruption that leads to agitation, decreased tolerance to pain, suppressed immune response,

increasing nursing calls and lengthening hospital stays straining both the care-givers and the organizations limited fiscal resources available to support operations. In hospitals, patient surveys have revealed that noise is one of the most common causes for complaint – even beyond food and studies have shown that a patient’s recovery can be slowed as a result. Excess noise is not only stressful for the patients, it has also been linked to communication breakdowns and subsequent medical errors amongst medical staff. Flooring, in conjunction with walls and ceilings plays a crucial role in a rooms acoustic performance and yet architects, planners and building managers often find it difficult to identify flooring with the optimal acoustic properties.

Scientists at the Intertek research laboratory in Cortland, New York have addressed this dilemma by putting a number of resilient floorings to the test and comparing the impact of the noise levels generated – and their findings are undeniable – rubber floor coverings, such as those provided by nora systems, are the best at suppressing impact noise, thereby contributing to considerable reductions in experience of noise within a confined space.

Noise means stress and can even make you unwell: Prolonged high noise levels can lead to severe health problems such as headaches, lack of sleep and poor concentration. At day care centres, schools, and universities, infants, pupils, and students suffer losses in wellbeing and performance due to high noise levels - this affects the staff at these institutes, also. Loud noise is not only stressful for medical staff and teachers alike, it is also the cause of many misunderstandings and a breakdown in communications.

Measuring Method Simulates Human Hearing ASTM E492 “Standard Test Method for Laboratory Measurement of Impact Sound Transmission Through Floor-Ceiling Assemblies Using the Tapping Machine” is a new, acknowledged test method for measuring the noise levels generated inside a room when people or objects move over the floor, e.g. when people are walking or running or moving chairs, tables, trolleys, or beds.

The usual standard test methods, on the other hand, measure only the impact sound, i.e. the sound that is transmitted through the intervening structure to the room below or next door.

The tests were conducted on conventional resilient floor covering types – noraplan acoustic 4 mm, norament 926 3.5 mm, noraplan 3 mm, noraplan 2 mm, luxury vinyl tile (LVT) 3 mm, PVC 2 mm, linoleum 2.5 mm, vinyl composition tile (VCT) 3 mm – installed directly on a concrete floor at the centre of an acoustic test rig.

A tapping machine with four standard positions

•

30% Quicker than single disc machines

•

Easy clean after use reducing risk of spreading potentially harmful pathogens

•

Designed to reduce musculoskeletal issues for cleaning operatives

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Available for use 24/7 AND cable free

•

Replace mopping in many areas keeping floors clean and dry at all times

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SPECIAL REPORT: INNOVATIONS IN RUBBER FLOORING SOLUTIONS

In the test, nora floor coverings achieved the best results. Compared with the other products, they could reduce the noise levels to just under 10 dBA, or half of the volume perceived in the ear

generated noise whose volume was measured at a distance of 1 m and a height of 1.53 m.

This height is approximately that of the human ear. The noise levels were measured in A weighted decibels (dBA). In other words, the acoustic signals in the measuring device were filtered to simulate the sensations in the human ear. The result: The noise levels generated on the floor depend essentially on the floor covering type. In the test, nora floor coverings achieved the best results (see graph). Compared with the other products, they could reduce the noise

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levels to just under 10 dBA, or half of the volume perceived in the ear. The reasons for this lies in the material properties of the permanently resilient rubber, which greatly suppresses the noise generated on the floor.

The use of rubber floor coverings is therefore a suitable means to suppress noise levels in clinics, day care centres, educational facilities and other buildings frequented by large number of people, to reduce stress, and to boost wellbeing and performance on a permanent basis.

SPECIAL REPORT: INNOVATIONS IN RUBBER FLOORING SOLUTIONS

Flooring and the Battle Against Austerity Tom Cropper, Editor Floors will have a major impact on how healthcare organisations meet their goals, but how do they make the transition in an environment of limited resources?

T

HE NHS is in crisis. We’ve all seen the stories. Years of austerity leave the health service short staffed and underfunded. As it looks to the future, more and more people are asking the question: how can it continue to function? The Government believes the solution lies in efficiency savings – £22bn of them to be precise. Critics may complain, but the undeniable conclusion is that the NHS will have to do much more with much less.

An Expensive Business The NHS is expensive. The total cost of running just the NHS estate was £8.8bn in 2016, an increase of 6.5% on 20161. Total health spending in the UK was £124bn in 2017/182. However, budgets have undershot requirements over the course of the last few years. In 2013 the NHS warned it faced a funding black hole of £30bn by 20203.

The impacts became all too visible over the winter of 2017/18 with A&E departments turning away all but the most essential operations, and stories of rising waiting times. Waiting times hit new records4 and nurses were quoted as saying conditions in hospitals were the worst they had ever seen5.

Whatever happens, the NHS is set for decades of austerity in which budgets will be tight.

At the same time, it is coming under pressure to improve dramatically waiting times, hygiene and patient satisfaction. Squaring this circle will force managers to adopt novel solutions throughout the hospital to reduce overheads and minimise unnecessary costs. In response to the projected £30bn shortfall, the Government injected an additional £8bn. However, there have been concerns about when this new money will be fed into the system and it still leaves the thorny issue of £22bn which the Government believes can be found from efficiency and productivity improvements6.

So where can these be found? Health Secretary Jeremy Hunt has already identified a program of digitisation to reduce administration costs.

Other operations such as cleaning offer potential opportunities. The NHS report states that hospital cleaning cost £1bn in 2016/2017, a rise of 1.2%.

The NHS also spends approximately £1bn in compensation pay-outs7.

On top of this, ongoing maintenance and repairs create a constant drain on NHS resources.

The health service will eagerly embrace those solutions which help them address one or more of these areas.

At the same time, managers are working to make hospital environments more comfortable and pleasant. There is a growing belief that a positive aesthetic environment gives patients a more favourable impression of a hospital and can also help with their recovery. Acoustics are an important issue – more so in hospitals than most other environments. Unwanted noise can increase stress and raise blood pressure. The strain of working in a noisy and busy environment can also reduce the wellbeing and satisfaction of staff.

The World Health Organisation recommends the average sound level in a general hospital should not exceed 35 decibels. However, in some A&E departments levels can be more than double that level. Simple measures can go a long way towards reducing the impact.

Sound-absorbent materials such as synthetic rubber can decrease the sound by up to 20 decibels. In most cases this would be enough to bring levels down to WHO safety recommendations8.

nora® nTx SAFE. FAST. UNIVERSAL. The revolutionary quick installation system

www.nora.com

A Sustainable Future The health service is following in the footsteps of other sectors and pushing towards a more sustainable and environmentally friendly future. Managers seek to reduce their carbon footprint and a good way to do this is to use sustainable materials. According to a report from Practice Green Healthcare, more than half of architects and installers reported having used at least one sustainable flooring material such as rubber (56.7%) and linoleum (51.8%)9.

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The World Health Organisation recommends the average sound level in a general hospital should not exceed 35 decibels. However, in some A&E departments levels can be more than double that level However, less sustainable products such as sheet vinyl and composition vinyl remain extremely common. There is much work to be done, but the trend is moving in the right direction with a greater emphasis on the environmental credentials of flooring options.

Against that, hospitals must also consider practical considerations. Installing flooring will take time. They will need a material which is flexible, hard-wearing, safe and sustainable. It will also have to come with an affordable pricetag – both in terms of the up-front cost and ongoing maintenance. Because of this, new products will always be at a slight disadvantage.

Managers understandably want to manage cost and reduce the risk of an installation going wrong. They will tend to lean towards those materials which are familiar and have a proven track record.

At the same time, the sector recognises the need to change and embrace innovative products in order to manage the conflicting demands of healthcare services.

It is a big challenge – far too big for any single solution, which means incremental changes across the estate will be vital. Flooring materials are being developed which specifically meet the needs of hospitals. Designs can vary from location to location, as can materials. As we move into the future, designers will refine their approach to deliver a more durable and sustainable solution.

This, then, is the challenge facing flooring products: to be hygienic and resistant to infection while also being durable and reliable. Sustainability is an increasingly important consideration with more pressure on manufacturers to demonstrate sustainability throughout the product’s lifecycle, from manufacture to use and eventual disposal.

The sector recognises the need to change and embrace innovative products in order to manage the conflicting demands of healthcare services

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The Evolution of Hospital Flooring James Butler, Staff Writer Hospital flooring has not always enjoyed as much attention as it might expect, but fresh thinking and a new generation of technologies is making a difference.

T

EC H N O LO GY IS revo lu t i o ni s ing healthcare, but one area which is often overlooked is flooring. New materials make it easier to clean, maintain reliability and even to look good. It represents a change of mindset which will have a significant impact on the way hospitals are designed in the future.

Traditional approaches suffer from being uniform and somewhat unimaginative, but those days are gone. As managers become more aware of the differences advanced flooring materials can make, they are giving it a growing priority. The purpose of flooring is changing, and managers will now consider a wide range of parameters before making a buying decision.

•A esthetics: Hospitals have rarely enjoyed a reputation for aesthetics. However, the last few years have seen a growing acknowledgement of how important this can be. Art has become more prominent, while the design of basic features now pays more attention to form as well as function. Flooring designers understand their role in this and are tailoring their designs for looks. Materials which avoid staining and increase the perception of cleanliness improve the public’s attitude towards a hospital. Having a more pleasant environment benefits both staff and patients. It leads to higher worker wellbeing and satisfaction rates.

• Safety: High-friction flooring designs can reduce the risk of slipping which, in turn, reduces the risk of claims being made against an organisation.

•W ayfinding: Hospitals are making use of floors to help direct patients through the hospital.

They may use different designs or surfaces to delineate a certain area.

Focus on Rubber Materials are changing. As developers design the flooring solutions of the future, they are turning to a range of different options. One of the most popular is rubber. Advances in construction technique and design make it a good fit for all areas of the hospital.

For example, rubber surfaces are increasingly being used in high traffic areas. These can be hard wearing non-slip and exhibit less wear over time. nora®rubber flooring is more durable and maintains its appearance for longer requiring no sealants or coatings to ensure it retains its original look. Tim Cole, Vice President of Marketing at nora systems, told HFN Magazine: “Premium flooring can be easily cleaned, in some cases with just water, which means large areas of the hospital need not be closed while floors are stripped, recoated and allowed to dry.

Rubber’s dense, nonporous surface repels dirt and stands up to liquid spills without absorbing them. It also provides slip-resistance10.”

Rubber’s construction absorbs pressure in a different way to other materials such as wood. It offers more give which can reduce the stress and strains on joints – a feature which might be useful for older patients. But it is particularly valuable for nurses and hospital staff who spend all day, every day, roaming the corridors. Complaints such as shin splints and heel pain are common among hospital staff.

Work related musculoskeletal disorders are one of the most expensive causes of work disability and account for 40% of spending on work-related health conditions11. A recent report found that longer working hours were leading to a rise in lower back pain among nurses12. nora®flooring also creates savings when it comes to cleaning. It is designed to have lower porosity, which reduces the amount of dirt and water it absorbs and so repels bacteria and stains. Its benefits include.

• It is cleaner: The ability to repel bacteria reduces the risk of infection • It looks cleaner: Almost as importantly, it retains its look, reduces stains and is perceived to be much cleaner than conventional materials.

•R educes cleaning expense: Floors are easier to clean, dry quickly and cause minimal disruption when cleaning takes place. Not only does this reduce cleaning costs, but it also causes less disruption for staff and patients.

noraplan® valua INSPIRED BY NATURE PERFECTED FOR YOUR ENVIRONMENT

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Premium rubber flooring can be easily cleaned, in some cases with just water, which means large areas of the hospital need not be closed while floors are stripped, recoated and allowed to dry

Moving to the Future Flooring may be an issue which has been widely neglected by the healthcare sector, but that is changing. New technologies produce materials tailor-made to the hospital environment. A growing awareness about how certain buildings are used is also likely to lead to a greater variety of floor designs across the hospital. Floor designs can help patients find their way, identify their location and cope with the specific requirements of that area.

It’s a more nuanced approach, offering multiple benefits to improve the wellbeing of staff and patients. This market creates competition, with the makers of various flooring materials vying to be the solution of choice in the future. As a result,

purchasers are presented with a growing array of choices.

For the hospital manager it may not always be a case on one size fits all. Various areas of a building may require something different from flooring materials. New technologies create more opportunities. Choice is certainly wider, but in an environment in which their budgets are limited, managers will need to see a solid return on their investment. To justify the increased expenditure, they will want to achieve savings and improvements across the board. As more hospitals focus on flooring, they are generating the metrics that will help them and others move forward into a more sustainable future.

This market creates competition, with the makers of various flooring materials vying to be the solution of choice in the future

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Hospital Flooring: Key Issues to Consider Tom Cropper, Editor Infection control, safety, design, cost and much more – all these issues weigh on managers’ minds when choosing a flooring option.

T

HE CHALLENGE of installing a floor is greater in a hospital than perhaps anywhere else. Strict hygiene standards, high traffic and a desire to minimise the number of accidents people suffer each year all mean flooring has to meet the highest standards.

It’s an ongoing battle, and despite the best efforts of hospital staff, problems still occur.

Battling Infection A 2017 study in the US found that hospital floors may be an overlooked source of infection.

Researchers investigated 318 floor sites across 159 rooms in five Cleveland hospitals.

They found that rooms included bacteria such as C-difficile, Methicillin-resistant Staphylococcus aureus (MRSA), VRE. Of these, C-difficile was the most common13.

Items in the patients’ rooms, the report found, could touch the floor and then spread infection via the hands and high touch surfaces. Of 100 occupied rooms they found that 41% had bacteria on more than one high-touch surface.

Another study by ICHE14 also measured the speed of infection spread from isolation room floors to patients’ hands and high-touch surfaces. It found that MS2 was detected on 40% of patients’ hands on Day 1 and 63% on day 2.

On day 3, after the floors had been inoculated, it was still present on 43% of patients’ hands.

Part of the cause, argued the report, was that hospital floors were not normally considered a source of potential infection.

“Notably, hospital floors are often heavily contaminated but are not considered an important source for pathogen dissemination because they are rarely touched,” states the report. “However, floors are frequently contacted by objects that are subsequently touched by hands (eg, shoes, socks, slippers). In addition, it is not uncommon for high-touch objects such as call buttons and blood pressure cuffs to be in contact with the floor (authors’ unpublished observations). Therefore, we hypothesised that

floors might be an underappreciated reservoir for pathogen transmission.”

Issues with Cleaning Hospitals, of course, employ intensive cleaning regimes, but these can be expensive and will not always be sufficient. The use of private cleaning firms makes it difficult to guarantee standards. Take, for example, a report from 2015 when a private firm repeatedly failed to meet standards at Cornish hospitals15. The company had failed to meet standards more than 80 times in a single month with two incidents classed as critical.

The lessons from these reports are that floors represent a higher infection risk than previously thought and that it’s difficult to guarantee that cleaning measures will eliminate harmful bacteria. Even if cleaning companies meet and exceed standards, some bacteria can live on within some conventional floors.

Depending on their porosity, germs can seep into the flooring and stains can ruin their appearance. Over time, even floors which have been cleaned adequately may look dirty or unhygienic.

To address this issue, the latest premium rubber flooring products focus on reducing porosity and preventing the penetration of germs of hazardous materials. nora®rubber floorcoverings also have the benefit of being easier to clean with few joins and less opportunities for dirt to get a hold.

nora® system blue THE FIRST QUALITY MANAGEMENT SYSTEM FOR THE FLOOR. nora system blue® combines nora’s low-emission rubber floor coverings with low-emission installation materials.

All the system‘s components have been awarded the „Blue Angel“ eco-label and are also tested within the composite system. This eliminates the likelihood of any hazardous interaction between the single components and assures healthy indoor air.

Slips, Trips and Falls For all attempts to improve health and safety within hospitals, accidents are still a significant problem – both among staff and patients.

According to the NRLS16, the most common causes are slips, trips and falls. Because patients are more likely than the general population to be older and infirm, the risks of suffering a fall are higher than in the community – as are the consequences.

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Notably, hospital floors are often heavily contaminated but are not considered an important source for pathogen dissemination because they are rarely touched

A National Patient Safety Agency report into slips, trips and falls17 analysed 200,000 incidents reported to it. They found that 96% of these incidents resulted in little or no harm to the patient. Even so, they said, it could impact on the confidence and wellbeing of patients. One of the common causes, it said, were floor surfaces, patterns, or the hardness or softness of the floor.

Testing safer flooring options, it suggested, should be an important part of any measures to resolve the problem.

Regulations have tightened in recent years.

In 2013, the Department of Health updated its recommendations for the performance requirements of building elements in healthcare facilities18. It includes more responsibility for building commissioners, architects, designers, specifiers and contractors to make a full risk assessment and identify the most appropriate flooring options for any specific area. Failure to so could expose anyone along the project chain to a liability claim in court.

It also contained a number of new recommendations including that carpet should be avoided in certain clinical areas and that it should only be used once a proper risk assessment has been carried out.

The recommendations encourage a move towards hard flooring surfaces across the hospital. Once again it pushes the case for rubber flooring. Its anti-slip nature and ease of cleaning means there will be fewer wet surfaces to create a risk for patients. Softer designs also mean walking places less of a strain on joints. Rubber flooring is now being specifically designed for use across hospital settings to reduce slipperiness and improve friction.

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“A floor with a pendulum test value as 36+(PTV) is categorized as a low slip risk for pedestrian traffic. This applies to dry areas as much as it does wet areas. Smooth resilient floors meet or exceed the required slip resistance standard, making them a suitable choice for dry, commercial and public settings.” Excerpt taken from nora technical document Specifying Flooring to Create Safer Spaces, A guide to reducing slip risk, (reviewed by the HSE).

Specialist Designs A specialised focus on hospitals ensures that floors are equipped to cater for their very special requirements. These present risks which are unique to a hospital environment.

Those providers who demonstrate a successful track record in delivering tailored solutions to a hospital environment will be more likely to offer the most appropriate flooring and lasting value.

Other issues will come into the equation including cost, lifespan and the different environments within a hospital. With awareness about the health and safety issues related to flooring growing, managers will be shifting their attention to those designs and materials which can both aid in infection control and reduce the risk of accidents while meeting budgetary requirements. nora® systems is driven by the idea of creating extraordinary and individual floor solutions and constantly adds to the range with new and innovative flooring designs and installation solutions. With the nora Design Studio you can see instantly how the flooring will look before you make a final decision.

SPECIAL REPORT: INNOVATIONS IN RUBBER FLOORING SOLUTIONS

Which Flooring Material Should Hospitals Use? Jo Roth, Staff Writer PVC, linoleum or rubber? How to decide on the best material for a hospital floor.

H

OSPITALS ARE focusing attention on their floors. Improved manufacturing techniques give them a wider choice, while environmental concerns inject a need for more sustainability. It’s an important decision.

Flooring goes a long way to determining the look, cleanliness, maintenance costs and safety of a hospital. The choice here will go a long way towards determining how successful they are in achieving their goals.

Choosing a Material Hospitals choose from a wide range of materials.

PVC and linoleum have always been popular.

They are resilient and designed to handle high traffic, are soft and absorbent, relatively affordable, easy to clean and available in a range of different colours. They also have a high resistance to chemicals and can be used in a range of different settings. However, they do have a number of drawbacks and, as manufacturing techniques improve, rubber is attracting more and more attention.

A major concern is the sustainability of its manufacture. Research into resilient flooring and chemical hazards shows that it has high levels of persistent bioaccumulative toxicants (PBTs) in its life cycle19. The report also states that it “has significant user and manufacturing exposure issues associated with chemical additives used in manufacture, including phthalates, heavy metals, and other carcinogens and reproductive and developmental toxicants that are required for its performance characteristics.”

Against that, the report found that synthetic rubber represented an “improvement over PVC, although it still had some hazards as its manufacture also included a high level of PBTs. However, it had a higher potential to reduce levels through the use of materials other than PVC.

Assessing Costs Commissioners want options which fit into their budgetary constraints. Here PVC appears to have a clear advantage as the initial cost is

relatively low when compared with alternatives.

But that only tells part of the story. Maintaining a PVC floor is hard work and its overall lifecycle is significantly lower than rubber, which can offer a life expectancy of up to 50 years . A research paper entitled ‘How to Make Business Decisions’ for facility flooring found that those materials with the cheapest upfront cost turned out to be the most expensive over the course of the lifecycle.

The study suggests that rubber flooring would be a superior option. The study’s author, Suzanne Barnes, said: “Rubber flooring was a prime candidate because we knew it lasts longer, looks better, is much more comfortable to stand and work on, safer to walk on, safer to fall on, and it requires much less effort and upkeep20.”

The dense non-porous construction simplifies cleaning and maintenance. It resists chemicals and disinfectants and most spills can be quickly removed without leaving a stain. This has a supplementary impact on the overall appearance of the flooring. While PVC can age badly, rubber will retain a cleaner appearance for longer. For example, when Dietrich-Bonhoeffer-Klinikum Neubrandenburg started a programme of refurbishment, it found that there was no need to replace the rubber flooring which had been in place for 20 years21.

nora® nTx SAFE. FAST. UNIVERSAL. The revolutionary quick installation system

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Ease of Cleaning Cleaning is easier and quicker. Large areas of the hospital will not need to be roped off at a time to clean surfaces – invaluable in a busy 24/7 environment such as a hospital. Without the need to use harsh cleaning products, waxes or sealants, there are fewer fumes.

Rubber is quieter than other materials. The background noise of a busy healthcare facility can cause stress, unsettle patients and distract healthcare staff from their duties. Rubber flooring has been shown to eliminate up to 70% of these sounds and reduce noise levels by as much as 17-20%22.

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Maintaining a PVC floor is hard work and its overall lifecycle is significantly lower than rubber, which can offer a life expectancy of 30 years

reduces the daily strain on hospital staff of walking down corridors. Research by a specialist footwear company found that the average nurse walks 3.6 miles per day. However, the highest figure recorded by a participant in the study was 11 miles23.

Specialist footwear can go some way towards alleviating the strain, but over the course of a career, softer floors will reduce the risk of conditions relating to wear and tear which, in turn, reduces the number of days lost due to absenteeism. Estimates from Public Health England suggest that the annual cost to the NHS of absenteeism is more than £2bn24.

Softer materials, such as rubber, which can be designed to offer the optimal amount of give, instantly feel more comfortable for staff and will reduce the strain on joints over the long-term.

It can also be helpful for older or more infirm patients who may find a softer floor easier to walk on.

The Right Look and Feel While practical considerations such as safety will take priority, there is a growing recognition among architects and designers of the impact on health and wellbeing of an interior environment.

Floors which look bright, clean and eye-catching will instantly be more pleasing on the eye. nora® systems are producing rubber flooring in a wide variety of colours and designs to help create spaces which are eye-catching and pleasant to be in. Designs can be varied to differentiate between different areas of the hospital as well as offering way finding information for visitors.

Completely new design options thanks to innovative technology: With the new noraplan®

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lona rubber covering, now so many different graphic designs can be integrated into the rubber flooring. This is possible due to a special manufacturing method: The requested design is incorporated into the covering during vulcanisation at a high temperature and under a large pressure - for a permanently attractive look that will last for decades.

Manufacturers will also point to the acoustic advantages of rubber hospital floors. Gone is the constant rattle of hospital trolleys and equipment against hard PVC floors. Noise is reduced and rooms feel quieter as a result.

This lowers stress levels for hospital staff and patients alike, who have to spend their days in a hospital environment.

Hospital flooring is being asked to do a great deal – it must be safe, affordable and pleasant to look at. These demands give managers a difficult decision. They want a solution which meets their requirements, but they also need one which fits into their tightening budgetary constraints. The calculation will not be simple. On the one hand they will look at the lower upfront cost of options such as PVC, but as we’ve seen in this article, a long-term total lifecycle cost calculation tends to favour rubber floors. To that calculation they will add less tangible benefits such as the impact on wellbeing, reduced risk and improved looks and aesthetics.

The decision will depend on the attitude of commissioners – are they focused on short term budgeting considerations or do they look at the long term? Market trends are moving in favour of rubber. Hospitals need options which are effective, quiet, resilient, safe and resistant to infection. All these tend towards the adoption of rubber flooring technologies.

SPECIAL REPORT: INNOVATIONS IN RUBBER FLOORING SOLUTIONS

References: 1

Cost of the NHS Estate: http://digital.nhs.uk/catalogue/PUB30096

2

The Autumn Budget. Joint Statement on Health and Social Care: http://bit.ly/2GBTyIY

3

NHS Faces Funding Blackhole, Parties Warned: https://news.sky.com/story/nhs-faces-30bn-black-hole-parties-warned-10387427

4

Worst Winter Ever: https://ind.pn/2kbiQ7K

Nurse Says Conditions in the NHS this Winter are the Worst She has Ever Seen: https://www.buzzfeed.com/laurasilver/an-ae-nurse-says-conditions-in-the-nhs-this-winter-are-the?utm_term=.hm2bo9rXj#.fpwbLvKY7 5

Ministers Won’t Rule Out Staff Cuts: http://www.independent.co.uk/news/uk/politics/ministers-wont-rule-out-nhs-staff-cuts-as-part-of-33bn-health-service-efficiency-savings-10293971.html 6

7

ÂŁ1bn Negligence Pay-outs by the NHS: https://www.express.co.uk/news/uk/792364/NHS-compensation-payout-patients-delays-diagnosis-treatment

8

Investigation into Noise Levels in Intensive Care Units: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056361/

9

Sustainable Resilient Floors: https://practicegreenhealth.org/sites/default/files/upload-files/resilientflooring_paper_r8.pdf

10

Patients Are a Priority for Hard Flooring: https://www.hfmmagazine.com/articles/3110-patients-are-a-priority-for-hard-flooring-makers

11

Work Related Musculoskeletal Disorders Among Healthcare Workers: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4280781/

12

Increased Lower Back Pain in Nurses: https://www.sciencedirect.com/science/article/pii/S1028455916300894

Hospital Floors May Pose a Larger Health Risk Than thought: https://www.elsevier.com/about/press-releases/research-and-journals/hospital-floors-may-pose-a-larger-health-risk-than-previously-thought 13

14

Hospital Floors Linked to Pathogens: http://haicontroversies.blogspot.co.uk/2016/08/hospital-floors-linked-to-pathogen.html

15

Mitie Hospital Contract: Service Failures in Cornwall: http://www.bbc.co.uk/news/uk-england-devon-31648523

Most Hospital Accidents Due to Slips, Trips and Falls: https://www.nursingtimes.net/most-hospital-safety-incidents-caused-by-slips-trips-and-falls/5049631.article 16

17

Slips, Trips and Falls in Hospitals: http://www.nrls.npsa.nhs.uk/EasySiteWeb/getresource.axd?AssetID=60129

18

Anti-Slip Flooring a Necessity: http://www.buildingtalk.com/anti-slip-flooring-a-necessity-in-hospitals-under-new-legislation/

Resilience flooring and chemical hazards: Resilience flooring and chemical hazards: https://healthybuilding.net/uploads/files/resilient-flooring-chemical-hazards-a-comparative-analysis-of-vinyl-and-other-alternatives-for-health-care.pdf 19

Rubber Flooring: Value and Beauty for the Long Term: https://www.interiorsandsources.com/article-details/articleid/6130/title/rubber-flooring-value-and-beauty-for-the-long-term 20

21

Refurbishment over Replacement: https://www.nora.com/canada/en/news-and-press/2017/10-09_de-dietrich-bonhoeffer-klinikum

22

The Benefits of Rubber Flooring: http://hconews.com/2015/03/16/the-benefits-rubber-flooring/

NHS Staff Walk Over Three Miles Per Day: https://www.nursingtimes.net/roles/nurse-managers/nhs-staff-walk-over-three-miles-a-day-on-average/7001523.article 23

24

Cost of NHS Staff Sickness Absence: http://www.qualitywatch.org.uk/indicator/nhs-staff-sickness-absence

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Notes:

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