Design From The Floor Up

The second in a two-part series exploring how to build a safe, sanitary floor
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If you remodel or build a new hospital, one day during the process you will become obsessed with flooring. Selecting the right floor finishes for your hospital involves a series of very important decisions. How can you be assured that you will arrive at the best balance between performance and cost?

In the Spring 2012 issue, we offered guidance on building a high-quality concrete slab. In this second part of our two-part series, we will walk you through the basics of flooring material selections, tailored to the concerns of an equine veterinary practice.

The decisions you make will vary based on the use of the space. So the best way to tackle the question of flooring is to divide the hospital into functional areas. We will begin with the medical areas. If we have those areas under control, everything else will seem easy by comparison!

The Medical Areas

If you want to do it right, then it is best to install a seamless floor covering in medical areas, which include the exam room, the diagnostic imaging and treatment areas, and the standing surgery room.

A good equine floor system should have the following attributes:

• Slip resistance
• Durability
• Cleanability—sanitation is key
• Ability to detail seams and joints

There are a few flooring systems that have all those attributes, but not many. It is difficult to build a resilient floor that is durable enough for horse traffic. Some of the products that are marketed for horses do not wear well or are too slick. For safety, the floor should compress and then spring back into shape.

Look for client references when selecting a product. Ask your colleagues what they have used in their hospitals. Many well-regarded hospitals have installed a poured rubberized floor product over a pad. This provides the desired cushioned, seamless, slip-resistant, durable floor. While this type of product can be very successful, you should be aware of two significant concerns: First, some of the pads are made of an open-cell material. If the top layer is punctured, water can get into the pad and this can cause an unsanitary condition at best. Second, the floor is difficult to detail around seams and floor drains.

Another option is a seamless polyurethane system that is poured over a rubber base layer. This type of installation has the benefit of a resilient, cushioned surface while providing a better mechanical bond between the top and bottom layers. The bottom layer does not wick moisture, which also helps to prevent potential failures. Finally, it is much easier to detail around drains and easier to feather at floor transition areas. If you use this type of product, it is important to get the right level of slip resistance in the top layer. Have the manufacturer provide you with a mock-up that is large enough to allow you to test the surface.

Any high-performance product is going to be very expensive. The floor systems described above can cost $20 per square foot or more. This is why it is so important to do your homework prior to committing to an expensive floor.

If you do not have the budget for a top-end floor in your medical areas, consider leaving some of the concrete slab exposed and installing a thick rubber surface or rubber mats where the horses will stand. Be aware that recycled rubber surfacing, while fine for some applications, is a porous material and is not always appropriate in medical areas. Rubber mats manufactured for equine uses typically have a sealed surface for better cleanability.

If you use rubber mats anywhere in your hospital, it is critical to seal them to each other and to the substrate below to prevent the growth of salmonella. If you are using just a few mats, you may avoid having to adhere them to the subsurface if you follow a rigorous protocol of removing, sanitizing and drying the mats and the subsurface.

Pre- and Post-Surgery
The goal in induction and recovery rooms is to strike the right balance between a floor that is too firm and a floor that is too squishy. In some cases, a good recovery floor may be firmer than a high-performance medical floor. Most practices install either a thick, sealed rubber mat or a polyurethane seamless floor over a dense rubber matrix.

Surgery Room
Because the horse is not standing on the floor, it does not have to be resilient, but the finished surface still needs to withstand a 2,000-pound load from the horse and the surgery table, and it must be able to maintain the right level of sanitation. The best solution is resinous flooring, which includes epoxy products, acrylic and cementitious urethane. We prefer resinous floor systems that have the following characteristics:

· At least 3/16” thick

· Can be covered up the wall at the base between the floor and wall

· Are available with a urethane wear layer on top for chemical resistance

· Can be applied over concrete slabs that emit greater than three pounds of moisture per 1,000 square feet in a 24-hour period

The floor system that meets these characteristics is a cementitious urethane. Cementitous urethane floor systems are becoming more common, but they do cost at minimum $1 more per square foot than epoxy floors. Expect to pay in the range of $9 to $10 per square foot for this type of system. The cost per square foot will decrease if you are covering a larger area.

Patient Areas
In general, it is a good practice to use as little water as necessary in cleaning the stall environment. If you use a lot of water to clean, then it is essential to design the stalls and aisles with seamless surfaces to prevent the growth of salmonella, which in turn dramatically affects construction costs. Before selecting the floor system, consider the patient.

In isolation, ICU and other high-risk patient wards, we encourage the use of seamless flooring materials. If the practice rarely sees an infectious patient, then it may be reasonable to use materials found in traditional barns. Rubber paver tiles are effective because they can be placed indoors and outdoors, and they drain naturally if placed over compacted, porous sub-grade. They look great, as well! An inexpensive solution for a low-risk patient barn is a simple concrete slab in the barn aisles. Follow the guidelines that we presented in part one to create the most sanitary condition given the limitations of concrete.

To conclude our two-part series on designing a better hospital from the floor up, here are three helpful hints:

· Apply the industry “best practices” for concrete slab design.

· Use products that you know to be successful in other equine hospitals.

· Get flooring samples and mock-ups so you will know whether the surface will work for you.

The goal of a good hospital design is to support the medicine, the patient care and the client relationship. Being armed with the right knowledge will allow you to stop worrying about flooring and start building your business.


Heather E. Lewis, AIA, NCARB, is a principal of Animal Arts, an architectural firm that has designed animal hospitals and animal-care facilities since 1979.