Selecting surfaces that fulfil multiple needs

One of the key functions of the healthcare estate is to provide a care environment that helps the clinicians and nurses working in the facility to improve patient outcomes. All design, wherever possible, should be geared towards this aim — providing care and comfort in an environment that is effective, safe, and operationally efficient. Each aspect of a modern built environment contributes towards this, whether directly or indirectly. Indeed, beyond the clinical aspect, it is important for patients and providers alike to be in a comfortable and convenient setting if the best outcomes are to be achieved.

Engineered surfaces such as melamine-faced chipboard (MFC), high-pressure laminate (HPL), and compact laminate, are key to this. Beyond intangibles such as developing trust and comfort through high-quality aesthetics in public spaces, a hospital’s décor must match form with function. This includes acting as a safeguard against the risk of infectious agents and healthcare-associated infections (HAIs). This conclusion is neither new nor novel for specifiers working on healthcare projects, yet there are important nuances and details to be discerned when discussing surface hygiene and specification in the hospital environment.

Going beyond the expected

When it comes to selecting surfaces, the Equality Act 2010 must be kept in mind. It requires that all new and refurbished public buildings offer equal access to all, regardless of disability, age, or gender, ensuring safe entry, exit, and passage, through the building. Alongside this, the Disability Discrimination Act 1995 should also be considered. This legislation requires facilities and services with buildings to be easily accessible to all, regardless of the adverse effect that physical or mental impairments may have on the individuals within.

Given that hospitals are demanding places, built with vulnerable people in mind, and subject to unique stresses and strains, this commitment to providing safe and accessible spaces is further underlined. Surfaces have a key role to play here. Cleanliness has always been vital to the healthcare estate, so these components should be selected to facilitate the best possible hygiene management. This is vital, as any significant bacterial proliferation could impair patient outcomes and healthcare procedures. Consequently, any specified product should be hard-wearing as standard, while simultaneously being easy to clean and maintain without requiring additional protective coatings such as varnish or paint. Surfaces in healthcare facilities must also be able to withstand intensive cleaning procedures such as bio cleaning or disinfection with hydrogen peroxide, alongside being resistant to a large variety of cleaning products.

Aim to exceed commonly held standards

In fact, these are all regular and long-held considerations within the healthcare estate, and in areas such as these where hygiene is vitally important, meeting these requirements should be the bare minimum. Even the selection of passive components within the healthcare environment can have a direct and indirect impact on patient outcomes. Consequently, specification professionals should look to exceed commonly held standards to best safeguard patient health, while also providing staff and visitors with a clean, comfortable, and calming environment.

Taking this into account, the role of microbial protection within surfaces should be further analysed. Here, an important distinction must be made between coverings that are classed as ‘hygienic’, and those designated ‘antibacterial’. Specifically, while the former passively limits bacterial proliferation, the latter actively assists toward this aim. Importantly for specifiers, while all laminate surfaces will generally be considered hygienic, not every type of surface can be classed as antibacterial.

Whether used in a decorative or technical context, antibacterial laminate panels are designed to destroy 99.9% of bacteria within 24 hours. This is made possible due to the integration of enhanced silver ion protection into the material during the resin impregnation stage of manufacture.

Importantly, this benefit is enmeshed within the product, meaning its effect will not deteriorate over time as a result of wear and tear within the hospital environment. When complemented with the rigorous cleaning practices expected in healthcare facilities, antibacterial panels can provide an important marginal gain toward infection control and patient safety that more basic laminate panels cannot.

Against this backdrop, healthcare facility decision-makers should seek out suppliers experienced in antimicrobial hygiene and material protection for surfaces, including MFC, HPL, and compact laminate. Given the high-traffic nature of healthcare environments, it is also vital to discern whether suppliers offer these products as standard, without additional costs or delays.

Additionally, any selected surfaces must be certified as food-safe, skin-safe, and water-repellent, to prevent mould and bacteria growth. The silver ions in the antibacterial panels should be non-soluble, non-migratory, and non-allergenic, to ensure safety and mitigate HAI risks. Suppliers should also rigorously test their antimicrobial technology annually to ensure ongoing effectiveness, and it is advised that specifiers seek evidence of this during the selection process.

No European standard

It must also be noted that despite the widespread use of antibacterial materials in hospital environments and beyond, there is no European standard for the time it takes to kill bacteria. This lack of a central knowledge resource can lead to information gaps in hospital specifications, and the sector must adapt its practices to avoid potential pitfalls here.

The supply chain can play a crucial role here, and project stakeholders should look to leverage their expertise and that of their suppliers in surface selection, and assist where standardisation does not exist. With patient protection paramount, antibacterial technology should be considered an essential part of a whole in healthcare facility design.

Another crucial consideration when specifying antibacterial laminate panels is where specifically they can be used. The zoning of healthcare settings, and ISO standards delineating the intended use of each space, could potentially have the effect of narrowing the focus of specification professionals. This is understandable, and something to be encouraged to safeguard the health of hospital visitors, staff and — most of all — patients. Each disinfection zone in a hospital — from ‘zone 1’ public areas through to ‘zone 4’ procedure spaces and surgical suites — requires surfaces made up of different materials depending on the level of infection risk.

While areas such as hospital lobbies and urgent care waiting rooms may pose less risk, antibacterial panels are still advised as standard. Yet other factors should be considered beyond this. For instance, the high volume of traffic passing through these areas means any specified surface needs to be highly durable.

Healthcare facility specifiers should therefore insist that any selected panels have undergone sufficient impact and fire resistance testing. With this in mind, MFC, HPL, and compact laminate surfaces are a popular choice in these circumstances, and are often used for reception desks, waiting area tables, and shelving.

At the other end of the spectrum, lab countertops and furniture in zone 4 areas must be able to withstand constant disinfection, even by hospital standards. Given their use in patient-critical spaces such as operating rooms, it is of paramount importance that any specified antibacterial surface meets the requisite performance and certification standards, such as ISO Class 5.

Decision-makers should also ensure that the performance levels of any selected surface will not deteriorate over time. It is for this reason that non-porous antibacterial HPL and compact laminate surfaces are well-suited to these circumstances. The destruction of bacteria through such surfaces can further safeguard patient outcomes beyond varying zone-by-zone requirements.

Opening the door

Though infection control requirements may change depending on the function and use of different areas of the healthcare estate, certain surfaces found in all zones are often overlooked. Specifically, while doors are possibly one of the most touched objects in a hospital setting, more attention is paid to their handles than the surface of the door itself.

Understandable as this may be, it still presents a possible oversight. Door surfaces in healthcare facilities tend to use a wood veneer that will suit infection control strategies, but may only meet ‘hygienic’ requirements. Similarly, their frequent use means they are also vulnerable to wear and tear over time.

Given the ubiquity of doors in most buildings, and the need to exceed standards in the hospital environment, it is clear how the use of durable, antibacterial surfaces could greatly reduce the risk of bacterial proliferation. As well as offering higher impact and artificial light resistance than veneers, they do not require varnishing during installation, which can impede access during the process and ensuing drying time.

Risk of staff being obstructed

This may become an increasing concern during retrofitting works, where staff may be obstructed while carrying out their duties. Yet, most of all, by only meeting ‘hygienic’ standards, door veneers do not possess any additional properties that could help mitigate infection risks within the healthcare estate. By contrast, antibacterial surfaces used on doors passively limit bacterial proliferation, allowing these key components to assist in safeguarding patient wellbeing and outcomes.

Alongside antibacterial properties, light reflectance values (LRVs) are another key factor to consider when specifying surfaces for healthcare estates. Approved Document M of the Building Regulations requires that building elements — including doors, handles, and walls, have a minimum LRV contrast of 30 points to improve the ability of visually impaired people to move around. In buildings such as hospitals, where vulnerable people will undoubtedly be present, the importance of this cannot be overstated.

Taking this into account, healthcare estate decision-makers should make sure that any surface they select achieves good daylight values. Doing so is also useful for creating contrasting layouts to assist those with visual impairments navigate their environment. To best source these components, specifiers need to further evaluate potential surface suppliers and the ranges they offer. By discerning whether they can provide a range of decorative combinations in a variety of materials that retain antibacterial properties — including MFC, HPL, and compact laminate — specifiers are better able to create a safe and welcoming environment.

Looking forward

In conclusion, balancing form and function in healthcare furnishings is crucial for efficiency, cleanability, antimicrobial protection, and durability. Engineered surfaces such as MFC, HPL, and compact laminate, have a part to play in safeguarding patient outcomes, providing all-important infection control alongside aesthetic appeal. Yet specifiers must go beyond basic hygiene standards, including ensuring that surfaces are hard-wearing, easy-to-clean, and resistant to intensive cleaning procedures.

Antibacterial surfaces, with integrated silver ion protection, offer significant benefits that go beyond these standard features. Healthcare decision-makers should therefore identify suppliers that are familiar with the technology and other considerations and pressures within the healthcare estate’s everyday operations. Leveraging supplier expertise and adhering to legislation ensures safe, accessible, and effective healthcare environments.

This manufacturer guidance may be instrumental in mitigating against bacterial proliferation across the healthcare estate. As such, healthcare architects or specifiers keen to explore the selection process more formally should seek out RIBA-accredited CPDs on the topic to raise awareness of the role that panel and surface technologies can play in patient outcomes.