NICU Standard 22: Floor Surfaces

Floor surfaces shall be durable to withstand frequent cleaning and heavy foot and equipment traffic.

Floor surfaces shall be easy to clean and maintain to minimize the ability to harbor bacterial pathogens9.

Flooring material shall have a light reflectance value not to exceed 30%10.

Flooring in infant care spaces and hallways and rooms opening onto them shall be designed for impact sound reduction11.

Interpretation: Appropriate specifications of flooring surfaces assure that materials are durable, cleanable, easy to disinfect, attractive, comfortable, minimize unwanted noise, and address safety concerns.

Materials suitable to the standard for floor surface criteria may include resilient sheet flooring (rubber, vinyl or linoleum) with heat- or chemically-welded seams and carpet tile with an impermeable backing. Some flooring materials may have antimicrobial and antistatic properties. Carpet tile has been shown to be an acceptable floor covering in the hospital12 and the NICU13 and has aesthetic, comfort, and noise reduction appeal, but it is not suitable in all areas (e.g., around sinks or in isolation or soiled utility/holding areas). Small floor tiles (e.g., 12-inch squares) have many seams and may have areas of non-adherence to the sub-floor. Monolithic or similar transitions that do not obstruct mobility should be provided where material changes are occurring to minimize noise and jarring of equipment. Opportunistic collection of fluid and particulates should be minimized to reduce potential sources of bacterial and fungal growth. Seams may be minimized by using sheet goods or large tile products. Any resilient sheet flooring should be selected to minimize shrinkage to reduce risk of harboring microorganisms.

Although ease of cleaning and durability of NICU surfaces are of primary importance, consideration should also be given to indirect (reflective) glare, acoustic properties and underfoot comfort, all factors contributing to safety for healthcare staff and patients Minimizing indirect glare will reduce discomfort and fatigue. Acoustic properties and material characteristics will directly affect noise and comfort. Reducing impact noise may be achieved with cushioning material between the surface and backing; the thicker the layer of cushion material the less the impact noise, although the flooring material durability may be compromised. In addition to impact noise reduction, cushioning material may reduce lower extremity pressure for those who stand for long periods of time.

The selection of flooring materials is one component in a comprehensive strategy to reduce risk and increase safety in the NICU environment. Materials should be selected to minimize chemical exposures to healthcare staff and patients. Long-term exposure to chemicals in cleaning and disinfecting products present exposure risks that may lead to health effects. Additional efforts should be made to exclude persistent, bio-accumulative toxic chemicals (PBTs) such as polyvinyl chloride (PVC) from health-care environments. PVC or vinyl is a common chemical found in some flooring materials, including sheet goods, tiles and carpet. The production of PVC generates dioxin, a potent carcinogen and fumes emitted from vinyl degrade indoor air quality. Dioxin release is not associated with materials such as polyolefin, rubber (latex) or linoleum.

Volatile organic compounds (VOCs) such as formaldehyde and chlorinated compounds such as neoprene should also be avoided when selecting adhesives or sealants for floor coverings. Specify low or no-VOC and non-toxic and non-carcinogenic materials. Flooring-containing natural rubber (latex) should be certified non-allergenic by the manufacturer.

Every effort to minimize infant exposure to new materials off-gassing should be made. Off-gassing of new synthetic products happens over time, but initial off-gassing is significantly higher than continuous off-gassing. Infants should not be moved into an area of newly installed flooring that has not been pre-conditioned for off-gassing for a minimum of 2 weeks to permit reasonable off-gassing of adhesives and flooring materials.

Consider selecting materials that are resistant to degradation by ultraviolet light, bleach, hydrogen peroxide, and other exposure elements.

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