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CONTEXT
== Context ==


=== 1. Overview – Finishes in the healthcare environment ===


1. Overview – Finishes in the healthcare environment
Building finishes account for a large proportion of the overall cost of constructing a healthcare facility. According to Shohet et al. (2002), interior finishing and interior construction accounts for 32% of the initial budget. Maintenance and cleaning of finishes adds substantially to the ‘whole-life costs’ of finishes within a hospital or healthcare facility.


Despite this, finishes are often treated as optional and purely aesthetic components of the building and the spaces within it. When budget constraints are implemented, the finishes are usually the first area to suffer. Institutions will often standardise finishes across a spectrum of rooms/facilities for economy in replacement and/or cleaning regimes.


Building finishes account for a large proportion of the overall cost of constructing a healthcare facility. According to Shohet et al. (2002), interior finishing and interior construction accounts for 32% of the initial budget. Maintenance and cleaning of finishes adds substantially to the ‘whole-life costs’ of finishes within a hospital or healthcare facility.  
Interior finishes, however, play a vital role in the healthcare environment,


Despite this, finishes are often treated as optional and purely aesthetic components of the building and the spaces within it. When budget constraints are implemented, the finishes are usually the first area to suffer. Institutions will often standardise finishes across a spectrum of rooms/facilities for economy in replacement and/or cleaning regimes.  
and contribute substantially to the delivery of healthcare service and the protection of staff and patients.


Interior finishes, however, play a vital role in the healthcare environment,  
Interior finishes play a vital role in a healthcare facility, as proper wall


and contribute substantially to the delivery of healthcare service and the protection of staff and patients.  
treatments can contribute to the


Interior finishes play a vital role in a healthcare facility, as proper wall
creation and maintenance of a positive


treatments can contribute to the
therapeutic environment for patients


creation and maintenance of a positive
(Mayer, 2005)


therapeutic environment for patients  
In a study conducted by PricewaterhouseCoopers LLP (PwC) in association with the University of Sheffield and Queen Margaret University College, 2004, the comments from the majority of people who visited hospitals, including staff and patients, included “ cold, depressing, dehumanising, Kafkaesque, dirty, smelly, frightening, impersonal, confusing, dull shabby, windowless, grim, stressful…”. While it is a fact that most patients interviewed may have been negative as a result of their being ill, it does highlight a problem of the inhumane and


(Mayer , 2005)  
threatening appearance of hospital environments “UNTIL THE GERM THEORY WAS DEVELOPED, (historically) where even more attention should be paid MORE MEN WERE DYING FROM SMALL WOUNDS


In a study conducted by PricewaterhouseCoopers LLP (PwC) in association with the University of Sheffield and Queen Margaret University College, 2004, the comments from the majority of people who visited hospitals, including staff and patients, included “ cold, depressing, dehumanising, Kafkaesque, dirty, smelly, frightening, impersonal, confusing, dull shabby, windowless, grim, stressful…”. While it is a fact that most patients interviewed may have been negative as a result of their being ill, it does highlight a problem of the inhumane and
AND DISEASES THAN FROM MAJOR TRAUMAS to creating a caring atmosphere.


threatening appearance of hospital environments “UNTIL THE GERM THEORY WAS DEVELOPED, (historically) where even more attention should be paid MORE MEN WERE DYING FROM SMALL WOUNDS
ON THE FRONTLINES. BUT AS SOON AS GERM


AND DISEASES THAN FROM MAJOR TRAUMAS to creating a caring atmosphere.  
It is this paradigm shift that is required when THEORY WAS DEVELOPED A WHOLE NEW considering and selecting finishes. The role of finishes in PARADIGM, A BETTER WAY OF UNDERSTANDING


ON THE FRONTLINES. BUT AS SOON AS GERM
WHAT WAS HAPPENING MADE DRAMATIC


It is this paradigm shift that is required when THEORY WAS DEVELOPED A WHOLE NEW considering and selecting finishes. The role of finishes in PARADIGM, A BETTER WAY OF UNDERSTANDING
a healthcare facility has become as important an aspect SIGNIFICANT MEDICAL IMPROVEMENT


WHAT WAS HAPPENING MADE DRAMATIC
of design as room sizes and relationships.


a healthcare facility has become as important an aspect SIGNIFICANT MEDICAL IMPROVEMENT
Building finishes are usually seen as a separate and final application to the building structure (Dean, 1996). There are however, instances where the finish is integral to the structure. These documents therefore include finishes and materials in such cases.


of design as room sizes and relationships.
=== 2. Suite of documents ===


Building finishes are usually seen as a separate and final application to the building structure (Dean, 1996). There are however, instances where the finish is integral to the structure. These documents therefore include finishes and materials in such cases.  
This document forms part of a series of documents addressing internal materials and finishes in health facilities, which in turn forms part of the suite of documents created under the IUSS Project. The aim of the materials and finishes suite of documents is to provide guidance on design and specification for the various building components where current legislation, including the National Building Regulations, does not adequately cover suitability of finishes in the healthcare facility context.


While the guidelines speak mostly of new building work, most of the principles are consistent with refurbishment projects to existing buildings as well.


2.  Suite of documents
* Other IUSS health facility guides in this series include:


Internal Floor Finishes.


This document forms part of a series of documents addressing internal materials and finishes in health facilities, which in turn forms part of the suite of documents created under the IUSS Project. The aim of the materials and finishes suite of documents is to provide guidance on design and specification for the various building components where current legislation, including the National Building Regulations, does not adequately cover suitability of finishes in the healthcare facility context.
* Internal Ceiling Finishes


  While the guidelines speak mostly of new building work, most of the principles are consistent with refurbishment projects to existing buildings as well.  
* Joinery and Storage Systems (to follow)


• Other IUSS health facility guides in this series include:  
* Doors and Ironmongery (to follow)


Internal Floor Finishes.
* Sanitary Ware (to follow)


• Internal Ceiling Finishes
* Signage and Way-finding (to follow)


• Joinery and Storage Systems (to follow)
These guidelines are updated and revised periodically, and can be accessed at www.iussonline.co.za


• Doors and Ironmongery (to follow)
The primary objective of this technical guide is to assist decision-makers with the selection of ‘appropriate’ wall finishes in the health facility context.


• Sanitary Ware (to follow)  
The guide looks at the context (Part A), then examines various selection criteria (Part B), then summarises technical information of various wall finishes (Part C) to assist with assessing the best finish for the facility. Finally, the selection criteria are grouped together to form performance categories (Part D) and a matrix of rooms, which indicates the most relevant performance category. The guide also examines various protection types to walls, including bump-rails and corner protection.


• Signage and Way-finding (to follow)
=== 3. Policy context ===


These guidelines are updated and revised periodically, and can be accessed at www.iussonline.co.za
This document offers guidance on the selection of appropriate wall finishes in health facilities. While the aim is to inform project and design teams about the wide range of considerations to take into account when selecting finishes, it does not diminish the responsibility of the design team to comply with all applicable professional and regulatory obligations and to specify materials and finishes ‘fit for purpose’.


Some of the pertinent regulations are the following:


The primary objective of this technical guide is to assist decision-makers with the selection of ‘appropriate’ wall finishes in the health facility context.  
* National Building Regulations and Building Standards Act, 1977 (Act 103 of 1977) amended 30 May 2008


The guide looks at the context (Part A), then examines various selection criteria (Part B), then summarises technical information of various wall finishes (Part C) to assist with assessing the best finish for the facility. Finally, the selection criteria are grouped together to form performance categories (Part D) and a matrix of rooms, which indicates the most relevant performance category. The guide also examines various protection types to walls, including bump-rails and corner protection.  
* SANS 10400, Code of Practice for the application of the National Building Regulations, first rev. August 1990


3. Policy context
* R158, Government Notice dated February 1980 (updated March 1993) Regulation pertaining to control of private hospitals, (revised 5 November 1996, but not gazetted).


* R187, Regulations governing private health establishments, Western Cape, 22 June 2001


This document offers guidance on the selection of appropriate wall finishes in health facilities. While the aim is to inform project and design teams about the wide range of considerations to take into account when selecting finishes, it does not diminish the responsibility of the design team to comply with all applicable professional and regulatory obligations and to specify materials and finishes ‘fit for purpose’.
The design principles on the above documents must be taken into account alongside the recommendations of this document. Furthermore, the South African National Standard (SANS) 10400 addresses numerous aspects


involving materials and finishes. (Refer specifically to Parts J and T.) Current SANS applicable are as follows:


Some of the pertinent regulations are the following:  
Other provincial policy documents are also applicable:


• National Building Regulations and Building Standards Act, 1977 (Act 103 of 1977) amended 30 May 2008
* KwaZulu-Natal, Department of Health Policy Document for the Design of Structural Installations, Rev.7, January 2013


• SANS 10400, Code of Practice for the application of the National Building Regulations, first rev. August 1990
* Eastern Cape Department of Roads and Public Works and Department of Health Hospital Design Guide, Rev. August 2004


• R158, Government Notice dated February 1980 (updated March 1993) Regulation pertaining to control of private hospitals, (revised 5 November 1996, but not gazetted).
== PART B - SELECTION CRITERIA ==


• R187, Regulations governing private health establishments, Western Cape, 22 June 2001
=== 1. Scope ===


The design principles on the above documents must be taken into account alongside the recommendations of this document. Furthermore, the South African National Standard (SANS) 10400 addresses numerous aspects
Healthcare facilities are complex buildings with spaces varying from general offices to highly specialised treatment areas. Each of these spaces has a specific need in terms of how the wall finishes should perform and how they can affect the perceptions and comfort of the user. Of the three dimensions of wall, floor and ceiling, the walls are most likely to be touched by the occupants, making them an important factor in terms of infection control. These and other criteria are discussed in more detail under selection criteria (Section C).


The healthcare environment is increasingly becoming a ’wheeled‘ environment, with everything from patients to equipment being moved on wheeled chairs, beds or trolleys of some kind. The wall finishes should be able to resist the accidental impact of trolleys and other objects. This is achieved by the inclusion of wall protection at strategic points. This guide examines the range of protection types available, and the advantages and disadvantages of their applications in the healthcare


involving materials and finishes. (Refer specifically to Parts J and T.) Current SANS applicable are as follows:
setting.


Other provincial policy documents are also applicable:
The type and scope of activity in a space is one of the main factors that


• KwaZulu-Natal, Department of Health Policy Document for the Design of Structural Installations, Rev.7, January 2013
govern the selection of wall finishes in a healthcare facility.


• Eastern Cape Department of Roads and Public Works and Department of Health Hospital Design Guide, Rev. August 2004
(Onaran, 2009)


The following three basic categories of wall finishes should be considered:


PART B -  SELECTION CRITERIA
=== 1. Liquid applied coverings ===


This includes paints such as PVA and enamel.


1. Scope
=== 2. Flexible coverings ===


This includes vinyl cladding, linoleum, cork, carpet or wallpaper.


Healthcare facilities are complex buildings with spaces varying from general offices to highly specialised treatment areas. Each of these spaces has a specific need in terms of how the wall finishes should perform and how they can affect the perceptions and comfort of the user. Of the three dimensions of wall, floor and ceiling, the walls are most likely to be touched by the occupants, making them an important factor in terms of infection control. These and other criteria are discussed in more detail under selection criteria (Section C).  
=== 3. Hard, pre-formed finishes ===


The healthcare environment is increasingly becoming a ’wheeled‘ environment, with everything from patients to equipment being moved on wheeled chairs, beds or trolleys of some kind. The wall finishes should be able to resist the accidental impact of trolleys and other objects. This is achieved by the inclusion of wall protection at strategic points. This guide examines the range of protection types available, and the advantages and disadvantages of their applications in the healthcare
This includes timber panels, ceramic and porcelain tiles, and the use of glass/glazed panels.


setting.  
Each wall finish has different applications, resultant benefits and disadvantages. The various characteristics would need to be weighed against the functions of the various rooms within a healthcare facility.


The type and scope of activity in a space is one of the main factors that
=== 2. Environmental aspects in the choice of finishes ===


govern the selection of wall finishes in a healthcare facility.  
A guide of finishes would be incomplete without highlighting the environmental aspects in the choice of finishes. This is an extremely broad factor that covers the following:


(Onaran, 2009)
* Embodied energy of materials


The following three basic categories of wall finishes should be considered:
* Life cycle costing and sustainability


1. Liquid applied coverings
* Toxicity and the effects of indoor environment quality


This includes paints such as PVA and enamel.  
==== 2.1. Embodied energy of materials ====


2. Flexible coverings
The term embodied energy refers to the total energy measure required to manufacture a product. This includes the following:


This includes vinyl cladding, linoleum, cork, carpet or wallpaper.
* Harvesting/mining of the raw material


3. Hard, pre-formed finishes
* Processing the material


This includes timber panels, ceramic and porcelain tiles, and the use of glass/glazed panels.  
* Manufacturing the product


Each wall finish has different applications, resultant benefits and disadvantages. The various characteristics would need to be weighed against the functions of the various rooms within a healthcare facility.  
* Transporting/delivering the product to the manufacturing plant, retail outlets and finally the end-user


2. Environmental aspects in the choice of finishes
* Labour or mechanical energy spent on placing the product in its finished position


Life cycle costs are described as the social, economic and environmental costs of a material or product from cradle to grave – that is, from the


A guide of finishes would be incomplete without highlighting the environmental aspects in the choice of finishes. This is an extremely broad factor that covers the following:
extraction of the raw ore needed to


• Embodied energy of materials
make it, through the manufacturing, to the end use to disposal or


• Life cycle costing and sustainability
recycling (Daniel D. Chiras. The New Ecological Home, 2004).


• Toxicity and the effects of indoor environment quality
Buying locally produced materials is an easy and achievable way to lower the embodied energy of a building. The table below gives an indication of the embodied energy of various typical building materials. Embodied energy of common wall finishes (and substrates)


2.1. Embodied energy of materials  
While health facility design may limit your selection of materials in terms of other performance factors, which are more critical, every opportunity to reduce the embodied energy of materials should be pursued. Manufacturers increasingly aim at reducing embodied energy and the carbon footprint in the manufacture of their products. This is driven by the market demand and designers can contribute by choosing materials that support green initiatives in this regard.


The term embodied energy refers to the total energy measure required to manufacture a product. This includes the following:
==== 2.2. Lifecycle costing and sustainability ====


• Harvesting/mining of the raw material
The durability of materials is a key element in the life cycle cost assessment. A product may have a low embodied energy, but requires more frequent replacement in the building.


• Processing the material
Specifiers should investigate the service life of materials with the respective manufacturers, to establish its lifespan. This element should also be highlighted to funders who often place more emphasis on reducing the capital cost of a facility, without considering the long-term cost.


• Manufacturing the product  
The graph below indicates how capital outlay costs compare to lifespan costs – emphasising the importance of life cycle costs. Sustainability should be considered in all four stages of product life:


• Transporting/delivering the product to the manufacturing plant, retail outlets and finally the end-user
==== 2.3. Toxicity and effects on indoor environment quality ====


• Labour or mechanical energy spent on placing the product in its finished position
Indoor Environment Quality (IEQ) is one of the nine categories of the Green Building Council of South Africa’s Green Star TM Rating Tools. These rating tools are used to assess the environmental performance of a building and/or materials. By improving the IEQ, the wellbeing of the occupant is protected.


Life cycle costs are described as the social, economic and environmental costs of a material or product from cradle to grave – that is, from the  
IEQ is measured in terms of the following:


extraction of the raw ore needed to
* Internal noise levels (this is discussed in more detail under Selection Criteria: Acoustics)


make it, through the manufacturing, to the end use to disposal or
* Mould prevention (this is discussed in more detail under Section Criteria: Humidity)


recycling (Daniel D. Chiras. The New Ecological Home, 2004).
* Volatile organic compounds (VOCs)


Buying locally produced materials is an easy and achievable way to lower the embodied energy of a building. The table below gives an indication of the embodied energy of various typical building materials.  Embodied energy of common wall finishes (and substrates)
Materials such as paints and polyvinyl-chlorides can emit VOCs (gasses) when finishes are new and then reduce over the lifespan of the product. Sealants and adhesives also give off VOCs, thus having a negative effect on indoor air quality.


VOCs can cause irritation and odour annoyance and could lead to behavioural, neurotoxic, hemotoxic and genotoxic effects (Meininghaus et al., 2000;


Hoskins, 2003; Hodgson et al., 2000).


While health facility design may limit your selection of materials in terms of other performance factors, which are more critical, every opportunity to reduce the embodied energy of materials should be pursued. Manufacturers increasingly aim at reducing embodied energy and the carbon footprint in the manufacture of their products. This is driven by the market demand and designers can contribute by choosing materials that support green initiatives in this regard.  
According to Hoskins (2003), VOCs can be carcinogenic, depending on the compound.


2.2.  Lifecycle costing and sustainability
When considering the toxic impact on the environment in which the wall finish will be installed, the finish as a whole (complete with sealants, substrate material and adhesives) must be taken into account.


The durability of materials is a key element in the life cycle cost assessment. A product may have a low embodied energy, but requires more frequent replacement in the building.  
Another important aspect to consider is the use of nontoxic materials in mental health facilities, where


Specifiers should investigate the service life of materials with the respective manufacturers, to establish its lifespan. This element should also be highlighted to funders who often place more emphasis on reducing the capital cost of a facility, without considering the long-term cost.   
patients are prone to chew and ingest any material that can be uplifted off surfaces, from paint to flooring.


The graph below indicates how capital outlay costs compare to lifespan costs – emphasising the importance of life cycle costs.  Sustainability should be considered in all four stages of product life:
Every effort must be made when specifying materials and finishes in these facilities to ensure that materials and their junctions are well secured and cannot be peeled back or picked off by patients. The toxicity of the material and/or content should be carefully considered to ensure it is appropriate for its location. The specifier should clarify the toxic content with manufacturers to ensure that these materials are safe and fit for this purpose.


=== 3. Evidence-based design ===


Determining which criteria to apply when selecting finishes appropriate for health facilities could be very subjective. However, in recent years, there have been substantial advances made by various researchers in providing scientific evidence for the impact of the healthcare environment on healthcare outcomes. Many studies, such as Ulrich et al. (2008), demonstrated connections between the design of facilities and the effect on patients, staff and the public utilising healthcare buildings. This has led to a growing understanding of what the priorities in designing health facilities.


Extensive research by The Center for Health Design (CHD) FIGURE 5


2.3. Toxicity and effects on indoor environment quality
Research Coalition on evidence-based Design led to the


Indoor Environment Quality (IEQ) is one of the nine categories of the Green Building Council of South Africa’s Green Star TM Rating Tools. These rating tools are used to assess the environmental performance of a building and/or materials. By improving the IEQ, the wellbeing of the occupant is protected.  
evidence-based design glossary, Phase 1 Report Healthcare Environmental Terms and Outcome Measures, November 2011.


IEQ is measured in terms of the following:  
Various unrelated research papers were gathered with interesting results. These included the following:


• Internal noise levels (this is discussed in more detail under Selection Criteria: Acoustics)  
* Environmental factors influencing the contamination of inanimate surfaces, including interior finish materials of flooring and furniture, as well as surface cleaning methods (Anderson, Mackle, Stoler and Mallison, 1982; and Lankford, Collins, Youngberg, Rooney, Warren and Noskin, 2006).


• Mould prevention (this is discussed in more detail under Section Criteria: Humidity)  
* Reducing background noise in operating theatres and the impact on surgical errors (Moorthy, Munz, Dosis, Bann &and Darzi, 2003).


• Volatile organic compounds (VOCs)  
* Multiple environmental factors affecting patient fall rates (Calkins, Biddle and Biesan, 2011; and Becker et al., 2003).


Materials such as paints and polyvinyl-chlorides can emit VOCs (gasses) when finishes are new and then reduce over the lifespan of the product. Sealants and adhesives also give off VOCs, thus having a negative effect on indoor air quality.  
* Patient satisfaction with quality of care when sound-reflecting ceiling tiles were replaced with soundabsorbing tiles to reduce noise (Hagerman and Colleagues, 2005).


VOCs can cause irritation and odour annoyance and could lead to behavioural, neurotoxic, hemotoxic and genotoxic effects (Meininghaus et al., 2000;  
* Positive visual distractions including windows, nature photographs, etc. and the effect on patients’ restless behaviour in waiting rooms (Nanda, 2010; and Pati and Nanda, 2011).


Hoskins, 2003; Hodgson et al., 2000).  
* Nurses’ exposure to daylight correlating to job satisfaction (Alimoglu and Donmez, 2005).


According to Hoskins (2003), VOCs can be carcinogenic, depending on the compound.  
* Noise as a source of stress and its negative impact on staff (Morrison, Haas, Shaffner, Garett and Fackler, 2003).


When considering the toxic impact on the environment in which the wall finish will be installed, the finish as a whole (complete with sealants, substrate material and adhesives) must be taken into account.
“Ideal features of surfaces that satisfy sustainability, infection prevention and safe patient outcomes include


Another important aspect to consider is the use of nontoxic materials in mental health facilities, where
cleanability, resistance to moisture and


patients are prone to chew and ingest any material that can be uplifted off surfaces, from paint to flooring.
reducing the risk of fungal


Every effort must be made when specifying materials and finishes in these facilities to ensure that materials and their junctions are well secured and cannot be peeled back or picked off by patients. The toxicity of the material and/or content should be carefully considered to ensure it is appropriate for its location. The specifier should clarify the toxic content with manufacturers to ensure that these materials are safe and fit for this purpose.  
* Textile materials containing microbial agents (Takai et al., 2002).


3. Evidence-based design  
* Aesthetic appeal and its effect on patient and staff satisfaction and patient waiting (Becker and Douglass, 2008).


Determining which criteria to apply when selecting finishes appropriate for health facilities could be very subjective. However, in recent years, there have been substantial advances made by various researchers in providing scientific evidence for the impact of the healthcare environment on healthcare outcomes. Many studies, such as Ulrich et al. (2008), demonstrated connections between the design of facilities and the effect on patients, staff and the public utilising healthcare buildings. This has led to a growing understanding of what the priorities in designing health facilities.
An overview of these studies identified the following selection criteria:


Extensive research by The Center for Health Design (CHD) FIGURE 5
* Infection prevention


Research Coalition on evidence-based Design led to the
* Cleaning and maintenance


evidence-based design glossary, Phase 1 Report Healthcare Environmental Terms and Outcome Measures, November 2011.
* Safety


Various unrelated research papers were gathered with interesting results. These included the following:
* Indoor air quality – humidity


• Environmental factors influencing the contamination of inanimate surfaces, including interior finish materials of flooring and furniture, as well as surface cleaning methods (Anderson, Mackle, Stoler and Mallison, 1982; and Lankford, Collins, Youngberg, Rooney, Warren and Noskin, 2006).  
* Indoor air quality – emissions


• Reducing background noise in operating theatres and the impact on surgical errors (Moorthy, Munz, Dosis, Bann &and Darzi, 2003).  
* Acoustics


• Multiple environmental factors affecting patient fall rates (Calkins, Biddle and Biesan, 2011; and Becker et al., 2003).  
* Aesthetics


• Patient satisfaction with quality of care when sound-reflecting ceiling tiles were replaced with soundabsorbing tiles to reduce noise (Hagerman and Colleagues, 2005).  
Although all these factors are important, the specific functions of each space or room will re-order the priority of fulfilling each aspect.


• Positive visual distractions including windows, nature photographs, etc. and the effect on patients’ restless behaviour in waiting rooms (Nanda, 2010; and Pati and Nanda, 2011).  
To assist with establishing these priorities and assessing the effects of each criterion, these are examined in more detail in the next section.


• Nurses’ exposure to daylight correlating to job satisfaction (Alimoglu and Donmez, 2005).  
=== 4. Selection criteria ===


• Noise as a source of stress and its negative impact on staff (Morrison, Haas, Shaffner, Garett and Fackler, 2003).  
==== 4.1. Infection prevention ====


“Ideal features of surfaces that satisfy sustainability, infection prevention and safe patient outcomes include
The South African Patients’ Rights Charter (1997) states: “Everyone has the right to a healthy and safe environment that will ensure their physical and mental health or wellbeing including … protection from all forms of environmental danger, such as pollution, ecological degradation or infection.”


cleanability, resistance to moisture and  
According to a survey conducted by Rohde (2002), materials and finishes have in the past been selected according to the following characteristics in declining order of importance: aesthetics, durability, ease of maintenance, client preference, initial cost, cost of maintenance, infection control, ease of installation and life cycle cost.


reducing the risk of fungal
Selecting the correct finish is a complex process with many aspects to consider, and the many and varied room types in a health facility extend the options. However, in healthcare facilities, the importance of the effect of a particular finish on the prevention of infection control must be prioritised. While it is understood that not every area of a hospital or health facility will carry infection prevention as the highest priority, this aspect remains the most pressing issue in the selection of finishes in health facilities.


• Textile materials containing microbial agents (Takai et al., 2002).  
The rising incidence of healthcare-associated infections (HAIs) in hospital and medical facilities supports the view that the selection of materials must first address infection prevention. This impacts on the choice of materials in two aspects. The first is whether the surfaces are likely to become reservoirs for infectious agents.


• Aesthetic appeal and its effect on patient and staff satisfaction and patient waiting (Becker and Douglass, 2008).  
This is a function of the surface conditions and structure of the finish. The second is the ability to clean the finish, which is discussed in the next section.


An overview of these studies identified the following selection criteria:
The Center for Disease Control in the United States quoted statistics in 2010 of one out of every 20 hospitalised patients contracting HAIs, particularly in relation to sepsis and pneumonia.


• Infection prevention
Although there is no known direct evidence linking HAIs in patients to particular finishes, there have been numerous studies conducted on microbial counts on floor finishes – particularly in soft textiles such as carpets. Beyer and Belsito (2000) proved that carpets acted as a


• Cleaning and maintenance
reservoir for fungi and bacteria.


• Safety
Lankford et al. (2006) examined different wall finishes after inoculation with Vancomycin-resistant Enterococci (VRE) and compared the results after seven days. The types of wall finishes tested included latex-based paint, enamel paint, vinyl, micro-perforated vinyl (with paper backing) and textured wallpaper. The report showed that all finishes still harboured some VRE pathogens that could be transferred through hand contact. The wallpaper and micro-perforated vinyl (used for printing large-scale wallpaper graphics) showed no reduction at all, indicating that the pathogens were harboured by these finishes. After cleaning and disinfection, results showed that latex paints did not clean as well as enamel paints.


• Indoor air quality –  humidity
In order to keep wall finishes from transmitting harmful bacteria, they should be easy to clean and able to withstand


• Indoor air quality – emissions
repetitive wear and frequent germicidal decontamination, and have the ability to repel moisture


• Acoustics
(Lankford et al., 2006).


• Aesthetics
The selection of finishes is still strongly linked to adequate cleaning and disinfection routines, and the location


Although all these factors are important, the specific functions of each space or room will re-order the priority of fulfilling each aspect.  
of the finish in terms of its performance. Notwithstanding, it is recommended that perforated finishes be avoided where patients are at greater risk of infection. Below is a table adapted from New South Wales Health: Infection Control Policy (PD 2007-035), which sets out patient risk categories:


To assist with establishing these priorities and assessing the effects of each criterion, these are examined in more detail in the next section.  
When selecting finishes for a room/area that has an extreme or high infection control risk, special care has to be taken to select an appropriate finish. Nosocomial infections can be acquired in hospitals, nursing homes, rehabilitation centres and extended care facilities. Especially susceptible patients are immuno-compromised patients, the elderly and young children. These infections can be caused by unclean or non-sterile environmental surfaces.


4. Selection criteria
Wall finishes that resist the spread of infection have qualities that can be summarised as follows:


* Smooth


4.1. Infection prevention
* Impervious


The South African Patients’ Rights Charter (1997) states: “Everyone has the right to a healthy and safe environment that will ensure their physical and mental health or wellbeing including … protection from all forms of environmental danger, such as pollution, ecological degradation or infection.”  
* Joint-less/seamless


According to a survey conducted by Rohde (2002), materials and finishes have in the past been selected according to the following characteristics in declining order of importance: aesthetics, durability, ease of maintenance, client preference, initial cost, cost of maintenance, infection control, ease of installation and life cycle cost.
On the opposite side of this spectrum, where infection prevention is the lowest priority, wall finishes have the following properties:


Selecting the correct finish is a complex process with many aspects to consider, and the many and varied room types in a health facility extend the options. However, in healthcare facilities, the importance of the effect of a particular finish on the prevention of infection control must be prioritised. While it is understood that not every area of a hospital or health facility will carry infection prevention as the highest priority, this aspect remains the most pressing issue in the selection of finishes in health facilities.  
prevented from multiplying. For cleaning to be effective, the finish must be able to withstand regular and fairly vigorous cleaning.


The rising incidence of healthcare-associated infections (HAIs) in hospital and medical facilities supports the view that the selection of materials must first address infection prevention. This impacts on the choice of materials in two aspects. The first is whether the surfaces are likely to become reservoirs for infectious agents.  
Sufficient access to all areas of the finish or adversely the absence of any inaccessible gaps, voids and joints is of critical importance to prevent breeding areas for bacteria, etc.


This is a function of the surface conditions and structure of the finish. The second is the ability to clean the finish, which is discussed in the next section.  
A further aspect to consider is the level of disruption required to clean walls regularly. While textile finishes can reduce cold and institutional environments, they would be totally unsuitable in areas with a high infection control risk and a high incidence of soiling. It is also important for the paint or wall finish manufacturer to convey the cleaning and maintenance requirements to the end-user or institution for product guarantees to remain.. An effective cleaning regime is the primary means of defense in terms of controlling infection.


The Center for Disease Control in the United States quoted statistics in 2010 of one out of every 20 hospitalised patients contracting HAIs, particularly in relation to sepsis and pneumonia.  
Wall finishes that are easily cleaned and have low dirt retention can be summarised as follows:


Although there is no known direct evidence linking HAIs in patients to particular finishes, there have been numerous studies conducted on microbial counts on floor finishes – particularly in soft textiles such as carpets. Beyer and Belsito (2000) proved that carpets acted as a
* Low maintenance


reservoir for fungi and bacteria.  
* Washable


Lankford et al. (2006) examined different wall finishes after inoculation with Vancomycin-resistant Enterococci (VRE) and compared the results after seven days. The types of wall finishes tested included latex-based paint, enamel paint, vinyl, micro-perforated vinyl (with paper backing) and textured wallpaper. The report showed that all finishes still harboured some VRE pathogens that could be transferred through hand contact. The wallpaper and micro-perforated vinyl (used for printing large-scale wallpaper graphics) showed no reduction at all, indicating that the pathogens were harboured by these finishes. After cleaning and disinfection, results showed that latex paints did not clean as well as enamel paints.  
==== 4.3. Fire safety ====


In order to keep wall finishes from transmitting harmful bacteria, they should be easy to clean and able to withstand
The South African National Standard (SANS) 10400 lists specific requirements for hospitals and medical facilities with regard to the classification of internal finishes, irrespective of whether the area is sprinklerprotected or not. These materials are to achieve a Class 2 rating when tested in accordance with SANS 10177-3. The exceptions are the emergency routes where Class 1 is required.


repetitive wear and frequent germicidal decontamination, and have the ability to repel moisture
Note that these requirements are not room-specific, and are therefore considered a global requirement in the overall building, rather than for an individual space. The specifier would need to consult the fire regulations applicable to the building type and confirm that the products meet these requirements. The definitions in SANS 10400: Part A read as follows:


(Lankford et al., 2006).  
E2 Hospital: Occupancy where people are cared for or treated because of physical or mental disabilities and where they are generally bedridden.


The selection of finishes is still strongly linked to adequate cleaning and disinfection routines, and the location
E3 Other institutional (residential): Occupancy where groups of people who either are not fully fit, or who are restricted in their movements or their ability to make decisions, reside and are cared for.


E4 Healthcare: Occupancy which is a common place of long-term or transient living for a number of unrelated persons consisting of a single unit on its own site who, due to varying degrees of incapacity, are provided with personal care services or are undergoing medical treatment.


of the finish in terms of its performance. Notwithstanding, it is recommended that perforated finishes be avoided where patients are at greater risk of infection. Below is a table adapted from New South Wales Health: Infection Control Policy (PD 2007-035), which sets out patient risk categories:
The requirements for finishes are set out in Part T of SANS 10400, and include the following: bathing or food preparation. These rooms generate more moisture than others, and as a result require moisture-resistant finishes. If the wall finishes are hygroscopic, these finishes can be prone to mildew and


When selecting finishes for a room/area that has an extreme or high infection control risk, special care has to be taken to select an appropriate finish. Nosocomial infections can be acquired in hospitals, nursing homes, rehabilitation centres and extended care facilities. Especially susceptible patients are immuno-compromised patients, the elderly and young children. These infections can be caused by unclean or non-sterile environmental surfaces.  
mould growth. Surfaces must remain dry and clean in order to prevent the growth of fungus (Hodgson et al., 2000).


Wall finishes that resist the spread of infection have qualities that can be summarised as follows:
Non-porous materials that do not absorb water are essential in these areas. These materials should also withstand regular cleaning, and should be able to withstand regular exposure to the moisture. Indoor air quality may be compromised by microbial contaminants such as mould, bacteria, allergens, chemicals, etc. in


• Smooth
the air, which can affect the health of people. Where this is a requirement in wall finishes, this property is listed as:


• Impervious
High humidity


• Joint-less/seamless
High humidity is considered as 25–100% relative humidity over an air temperature range of 10–30°C. A suitable finish should be able to withstand sustained contact with water vapour/water in these conditions.


On the opposite side of this spectrum, where infection prevention is the lowest priority, wall finishes have the following properties:
(Normal conditions would be considered as 25–65% relative humidity over air temperature range of 20–25 °C).


(National Health Services Health Technical Manual HTM56: Partitions)


prevented from multiplying. For cleaning to be effective, the finish must be able to withstand regular and fairly vigorous cleaning.  
Emissions from materials


Sufficient access to all areas of the finish or adversely the absence of any inaccessible gaps, voids and joints is of critical importance to prevent breeding areas for bacteria, etc.  
As discussed under environmental aspects, the kind of wall finish installed can affect the environmental quality of the interior if VOCs are given off – commonly referred to as off-gassing.


A further aspect to consider is the level of disruption required to clean walls regularly. While textile finishes can reduce cold and institutional environments, they would be totally unsuitable in areas with a high infection control risk and a high incidence of soiling. It is also important for the paint or wall finish manufacturer to convey the cleaning and maintenance requirements to the end-user or institution for product guarantees to remain.. An effective cleaning regime is the primary means of defense in terms of controlling infection.
These VOC emissions can be given off by:


Wall finishes that are easily cleaned and have low dirt retention can be summarised as follows:
* the product itself;


• Low maintenance
* the adhesives used to fix the product (for example, in the case of vinyl cladding or tiles);


• Washable
Proper moisture control is essential in order to reduce health risks and sick building syndrome in an enclosed space (Mortenson et al., 2005).


4.3. Fire safety  
* the sealants/grouts used to finish; and


The South African National Standard (SANS) 10400 lists specific requirements for hospitals and medical facilities with regard to the classification of internal finishes, irrespective of whether the area is sprinklerprotected or not. These materials are to achieve a Class 2 rating when tested in accordance with SANS 10177-3. The exceptions are the emergency routes where Class 1 is required.  
* the cleaning solutions required for regular maintenance.


Note that these requirements are not room-specific, and are therefore considered a global requirement in the overall building, rather than for an individual space. The specifier would need to consult the fire regulations applicable to the building type and confirm that the products meet these requirements. The definitions in SANS 10400: Part A read as follows:  
The smell of the interior of a new car – enjoyed by many – is an example of plasticisers that have evaporated (emissions that affect the indoor air quality). Various methods for measuring VOCs have been developed since the increase in awareness of these emissions and their influence on indoor air quality. The Green Building Council of South Africa awards points in the IEQ13 category where interior finishes minimise the contribution and levels of VOCs in buildings – with reference to paints, adhesives/sealants and carpets/flooring, where these products meet the indoor environmental quality (IEQ) levels as outlined.


E2 Hospital: Occupancy where people are cared for or treated because of physical or mental disabilities and where they are generally bedridden.  
The IEQ14 section measured the formaldehyde minimization, which is common with composite wood products. In addition, the MAT-7 section recognises the reduction of PVC products in the building materials used.


E3 Other institutional (residential): Occupancy where groups of people who either are not fully fit, or who are restricted in their movements or their ability to make decisions, reside and are cared for.  
It should be noted that primary VOCs decline quickly in the short term (less than one year), while secondary emissions can continue for the lifespan of the product, and should also be kept in mind when assessing this aspect of materials. Timing of the testing will yield very diverse results.


E4 Healthcare: Occupancy which is a common place of long-term or transient living for a number of unrelated persons consisting of a single unit on its own site who, due to varying degrees of incapacity, are provided with personal care services or are undergoing medical treatment.
Patients with respiratory weaknesses such as asthma are most likely to be


The requirements for finishes are set out in Part T of SANS 10400, and include  the following: bathing or food preparation.  These rooms generate more moisture than others, and as a result require moisture-resistant finishes. If the wall finishes are hygroscopic, these finishes can be prone to mildew and
affected by VOC emissions. High-risk patients would benefit from materials that do not contribute to their condition. The ultimate goal of reducing emissions in the manufacture of building products should be to create a better and healthier environment for the patients and users of the facility.


mould growth. Surfaces must remain dry and clean in order to prevent the growth of fungus (Hodgson et al., 2000).
However, the ‘order of magnitude’ should also be applied when using low VOC emissions as a criterion to select finishes. The use of vinyl sheeting, for example, may result in higher VOC emissions than, for example, ceramic tiles, but the infection control benefits of the seamless finish of the vinyl will outweigh the risks of VOC emissions. (More fatalities in patients have been linked to infection control issues than to VOC-emissions issues.)


Non-porous materials that do not absorb water are essential in these areas. These materials should also withstand regular cleaning, and should be able to withstand regular exposure to the moisture. Indoor air quality may be compromised by microbial contaminants such as mould, bacteria, allergens, chemicals, etc. in  
The achievement of low VOC emissions should be a global criterion for a healthcare building rather than for one or more specific rooms, hence a separate criterion has not been listed for this item. More details on the VOC emissions of the individual wall finish types are provided in Section C.


the air, which can affect the health of people. Where this is a requirement in wall finishes, this property is listed as:
==== 4.5. Acoustics ====


High humidity
Noise in health facilities is mainly generated by the following:


High humidity is considered as 25–100% relative humidity over an air temperature range of 10–30°C. A suitable finish should be able to withstand sustained contact with water vapour/water in these conditions.  
* Impact sounds, for example, pedestrian and wheeled equipment, • bedrails moved up and down, doors closing and opening, footfalls, etc.


(Normal conditions would be considered as 25–65% relative humidity over air temperature range of 20–25 °C).  
* Airborne sounds, for example, talking, medical equipment bleeps and alarms, nurse calls, PA system, etc.


(National Health Services Health Technical Manual HTM56: Partitions)
Acoustical engineers at John Hopkins University found that the average (continuous level equivalent, LAeq) daytime hospital noise levels have risen from 57dBA in 1960 to 72dBA in 2006, with night-time sounds increasing from 42 dBA to 60 dBA over the same period. (HermanMiller Healthcare, 2006). An average motorcycle noise level measures 85 dB. The World Health Organization recommended an LAeq value of 30 dBA for ward areas.


Emissions from materials  
“People who work in noisy environments for long shifts day in and day out, also have similar


As discussed under environmental aspects, the kind of wall finish installed can affect the environmental quality of the interior if VOCs are given off – commonly referred to as off-gassing.  
stress-induced experiences. They


These VOC emissions can be given off by:
report everything from exhaustion to burnout, depression and irritability.”


• the product itself;  
S. Mazer –


• the adhesives used to fix the product (for example, in the case of vinyl cladding or tiles);  
Studies have shown that high levels of noise have negative physical and psychological effects on patients, disrupting sleep, increasing stress and raising blood pressure levels (Cmiel et al., 2004). The University of Michigan released a news brief in November 2005, showing that chronic noise increased the risk of heart-attacks in patients by 50% for men and 75% for women. The negative effect of chronic noise extends to staff as well. While the presence of electronic devices and healthcare apparatus, designed to give audible signals and alarms to the


Proper moisture control is essential in order to reduce health risks and sick building syndrome in an enclosed space (Mortenson et al., 2005).  
nursing staff of the patient’s vital signs, architects and health facility planners need to make an effort to minimise this effect of noise and alarm fatigue.


• the sealants/grouts used to finish; and  
Long straight passages are perfect echo corridors, often amplifying noise levels. Disturbances in the sound path help limit the sound transmission by, for example, creating steps in the ceiling level or changing direction in the passageways.


• the cleaning solutions required for regular maintenance.  
According to Cmiel, et al. (2004), noise levels can reach those similar to jackhammer levels at nurses’ stations during shift changes Consideration should be given to applying acoustic materials to these areas to maximise sound absorption where possible.


The smell of the interior of a new car – enjoyed by many – is an example of plasticisers that have evaporated  (emissions that affect the indoor air quality). Various methods for measuring VOCs have been developed since the increase in awareness of these emissions and their influence on indoor air quality. The Green Building Council of South Africa awards points in the IEQ13 category where interior finishes minimise the contribution and levels of VOCs in buildings – with reference to paints, adhesives/sealants and carpets/flooring, where these products meet the indoor environmental quality (IEQ) levels as outlined.  
Recesses to accommodate noisy equipment can also be treated acoustically to reduce reverberation. Distance is also a good strategy (where feasible) as sound intensity decreases with distance, provided that the room dimensions and surfaces are designed so that there is very little reverberation.


The IEQ14 section measured the formaldehyde minimization, which is common with composite wood products. In addition, the MAT-7 section recognises the reduction of PVC products in the building materials used.
Wall finishes that absorb sound, or at least do not contribute to noise levels,


It should be noted that primary VOCs decline quickly in the short term (less than one year), while secondary emissions can continue for the lifespan of the product, and should also be kept in mind when assessing this aspect of materials. Timing of the testing will yield very diverse results.
used in conjunction with sound-absorbent ceiling finishes should be used in key areas such as nurse restrooms or waiting areas where infection control requirements would not be as critical. In areas where sound reduction is rated as a high requirement (for example, ICU and general wards), this factor would be listed as “High acoustic”


==== 4.6. Aesthetics ====


Patients with respiratory weaknesses such as asthma are most likely to be  
Research results from CABE, 2004 and 2005, King’s Fund, 2004, and Leather, Beale and Lee, 2000, all highlight the need for an integrated, holistic and sympathetic hospital aesthetic. Tofle et al. (2004) also emphasised the role of colour in healthcare environments. Key results show that the architectural setting, including finishes, has an effect on the patient’s experience, as well as the recruitment and retention of staff – a happy staff is more motivated to care for patients, who in turn recover more quickly. Paediatric wards particularly give an opportunity to set a playful scene and help young patients feel at ease. In public areas, more emphasis may be required for an attractive and welcoming interior.


affected by VOC emissions. High-risk patients would benefit from materials that do not contribute to their condition. The ultimate goal of reducing emissions in the manufacture of building products should be to create a better and healthier environment for the patients and users of the facility.  
Coloured and vinyl wallpaper can be used to good effect in passageways and public areas to set anxious patients at ease and create a cheerful atmosphere.


However, the ‘order of magnitude’ should also be applied when using low VOC emissions as a criterion to select finishes. The use of vinyl sheeting, for example, may result in higher VOC emissions than, for example, ceramic tiles, but the infection control benefits of the seamless finish of the vinyl will outweigh the risks of VOC emissions. (More fatalities in patients have been linked to infection control issues than to VOC-emissions issues.)  
Colours and patterns can be used in wall finishes in health facilities for the following practical and aesthetical purposes:


The achievement of low VOC emissions should be a global criterion for a healthcare building rather than for one or more specific rooms, hence a separate criterion has not been listed for this item. More details on the VOC emissions of the individual wall finish types are provided in Section C.
* To improve the ‘institutional/cold’ interior look of the facility, room or area


4.5.  Acoustics
* To be used for wayfinding, for example, colour-coding each department


Noise in health facilities is mainly generated by the following:
* To create ’spaces’ by giving individuality to a specific area within a large open area


• Impact sounds, for example, pedestrian and wheeled equipment, • bedrails moved up and down, doors closing and opening, footfalls, etc.
However, the following is to be considered:


• Airborne sounds, for example, talking, medical equipment bleeps and           alarms, nurse calls, PA system, etc.  
* Excessive combination of colours and patterns is inappropriate in certain areas/rooms such as operating theatres.


Acoustical engineers at John Hopkins University found that the average (continuous level equivalent, LAeq) daytime hospital noise levels have risen from 57dBA in 1960 to 72dBA in 2006, with night-time sounds increasing from 42 dBA to 60 dBA over the same period. (HermanMiller Healthcare, 2006). An average motorcycle noise level measures 85 dB.  The World Health Organization recommended an LAeq value of 30 dBA for ward areas.   
* Some patterns and colours could impact negatively on certain patient groups, for example, the elderly or mentally ill.


“People who work in noisy environments for long shifts day in and day out, also have similar
* The wall finish must be adaptable should the space usage result in the need to change the aesthetics.


stress-induced experiences. They
Where aesthetics is a primary requirement, this factor will be listed as:


report everything from exhaustion to burnout, depression and irritability.”  
* High aesthetics


S. Mazer –  
== PART C - TECHNICAL INFORMATION – WALL FINISH TYPES ==


Studies have shown that high levels of noise have negative physical and psychological effects on patients, disrupting sleep, increasing stress and raising blood pressure levels (Cmiel et al., 2004).  The University of Michigan released a news brief in November 2005, showing that chronic noise increased the risk of heart-attacks in patients by 50% for men and 75% for women. The negative effect of chronic noise extends to staff as well. While the presence of electronic devices and healthcare apparatus, designed to give audible signals and alarms to the
=== 1. Liquid coverings ===


nursing staff of the patient’s vital signs, architects and health facility planners need to make an effort to minimise this effect of noise and alarm fatigue.  
The quality of the wall finish (especially with liquid finishes such as paint), are only as good as the quality of the substrate. A poor quality plaster will not only affect the aesthetics, but also the integrity of the smooth impervious finish. Plaster cracks will be carried through almost all paints, and any crack can become a reservoir for bacteria. Bonding liquids could be used to some extent, but due to poor plaster sands and a lack of plastering skills, it is recommended that double plaster or skimming to finish a plastered wall be specified at the outset. (If the first plaster skin is approved, the second coat could be omitted.)


Long straight passages are perfect echo corridors, often amplifying noise levels. Disturbances in the sound path help limit the sound transmission by, for example, creating steps in the ceiling level or changing direction in the passageways.  
==== 1.1. Paint (emulsion or oil-based) ====


According to Cmiel, et al. (2004), noise levels can reach those similar to jackhammer levels at nurses’ stations during shift changes Consideration should be given to applying acoustic materials to these areas to maximise sound absorption where possible.   
* General description and properties


Recesses to accommodate noisy equipment can also be treated acoustically to reduce reverberation.  Distance is also a good strategy (where feasible) as sound intensity decreases with distance, provided that the room dimensions and surfaces are designed so that there is very little reverberation.  
Paint is easily applied by a roller to a plastered wall surface. Following a primer and undercoat, three coats of paint are usually applied. Two-coat plaster is especially recommended where enamel paints are used, as any defects will be highlighted with these highgloss type paints.


Wall finishes that absorb sound, or at least do not contribute to noise levels,  
“Wall finishes do change, due to changes in management or taste,


used in conjunction with sound-absorbent ceiling finishes should be used in key areas such as nurse restrooms or waiting areas where infection control requirements would not be as critical. In areas where sound reduction is rated as a high requirement (for example, ICU and general wards), this factor would be listed as “High acoustic”
and it is usually the first surface to be ’replaced’ or changed.”


4.6. Aesthetics
(Vittori, 2002)


Research results from CABE, 2004 and 2005, King’s Fund, 2004, and Leather, Beale and Lee, 2000, all highlight the need for an integrated, holistic and sympathetic hospital aesthetic. Tofle et al. (2004) also emphasised the role of colour in healthcare environments. Key results show that the architectural setting, including finishes, has an effect on the patient’s experience, as well as the recruitment and retention of staff – a happy staff is more motivated to care for patients, who in turn recover more quickly. Paediatric wards particularly give an opportunity to set a playful scene and help young patients feel at ease. In public areas, more emphasis may be required for an attractive and welcoming interior.  
Paint types include emulsion paints which are water-based and produce a matt or silk effect – such as PVA. Oil-based paints like enamel dry to a hard, glossy finish that is impervious to water.


Coloured and vinyl wallpaper can be used to good effect in passageways and public areas to set anxious patients at ease and create a cheerful atmosphere.  
Paint is fairly inexpensive when compared to other wall finishes. FIGURE 14


Colours and patterns can be used in wall finishes in health facilities for the following practical and aesthetical purposes:
Infection prevention


• To improve the ‘institutional/cold’ interior look of the facility, room or area
The seamless finish produced by painted plaster makes this finish ideal for areas where infection prevention is paramount. There are no joints or crevices to encourage growth of microbes. Any mechanical damage can, however, lead to small cracks, and it is important to protect vulnerable areas. This is discussed in more detail under ‘Protection’. Studies have shown that PVA can be degraded by filamentous fungi, such as algae, yeasts, lichens and bacteria (Cappilelli and Sorlini, 2008). Paints with mould inhibitors and nano-technology enhancements are available on the market. Oil-based paints are more suited to areas that require high infection prevention criteria as the surface is impervious to water, oil and other fluids.


• To be used for wayfinding, for example, colour-coding each department
Cleaning and maintenance


• To create ’spaces’ by giving individuality to a specific area within a large open area
The enamel and velvet sheen paints are highly washable, durable and stain-resistant. PVA can also be washed, but is not as stain-resistant or impervious and therefore not suitable in treatment areas. Paint is a low maintenance finish that requires re-application every few years (more often if mechanical damage occurs). Special attention should be given to the placement of switches and sockets in walls, as these areas are regularly touched, and can become infection-control risk areas if not kept clean. The smoother the surface, the easier it is to clean.


However, the following is to be considered:
Fire safety


• Excessive combination of colours and patterns is inappropriate in certain areas/rooms such as operating theatres.  
Paint is considered a non-combustible finish as the thickness of the paint is usually less than 0.5 mm. Refer to the manufacturer’s specifications and consult with SANS Part T to check the compliance and fire-resistance.


• Some patterns and colours could impact negatively on certain patient groups, for example, the elderly or mentally ill.
Indoor air quality: Humidity


• The wall finish must be adaptable should the space usage result in the need to change the aesthetics.  
Paints are generally not adversely affected by a reasonable amount of moisture being generated by the presence of taps or wet fittings in a room. Oil-based enamel paints are more resistant to moisture when compared to water-based PVA-type paints, and are therefore more suitable in wet or humid environments.


Where aesthetics is a primary requirement, this factor will be listed as:  
Indoor air quality: Emissions


• High aesthetics
The strong odour of a newly painted room is an indication of the high VOC emissions. Low-odour paints are marketed by manufacturers, and products with reduced or zero VOCs are being produced. Due to the increasing range of products and suppliers, the level of emissions should be checked with the manufacturer (refer to product-specific literature).


Acoustics


PART C -  TECHNICAL INFORMATION – WALL FINISH TYPES
The hard surface of painted walls reflects sound and does not contribute to the impact of noise reduction or absorption. Where acoustics is a priority in a room or facility, other sound-absorbing products and finishes should be combined with the painted walls to achieve improved acoustics.


Aesthetics


1. Liquid coverings  
Paint is available in an extensive range of colours, and this is one of the great advantages of using paint. It provides a flexible means of adapting a space to suit the function of the room – from calming colours in a staff restroom, to cheerful and inviting colours in a doctor’s waiting room.


The effect of colour on healing has been well documented by Tofle et al. (2004).


The quality of the wall finish (especially with liquid finishes such as paint), are only as good as the quality of the substrate. A poor quality plaster will not only affect the aesthetics, but also the integrity of the smooth impervious finish. Plaster cracks will be carried through almost all paints, and any crack can become a reservoir for bacteria. Bonding liquids could be used to some extent, but due to poor plaster sands and a lack of plastering skills, it is recommended that double plaster or skimming to finish a plastered wall be specified at the outset. (If the first plaster skin is approved, the second coat could be omitted.)
Colour can also be used for the coding of areas – to demarcate different departments or floors of a multistorey building. It can be effective in establishing zones for public and staff use. Paint can also be used to introduce colour for features or emphasis.


1.1. Paint (emulsion or oil-based)
Private sector health facilities often make use of colourbranding for their facilities, and the use of specific combinations of colours becomes identifiable with the brand.


In public health facilities, the support of the Department of Health in the use of colour in this regard is paramount, as historically, decisions about colour have been based on ease of maintenance and whether new paints can match existing colours.


• General description and properties
The colour codes and type of paints should always be included in the as-built documents to assist managers to obtain the correct paint.


Paint is easily applied by a roller to a plastered wall surface. Following a primer and undercoat, three coats of paint are usually applied. Two-coat plaster is especially recommended where enamel paints are used, as any defects will be highlighted with these highgloss type paints.   
==== 1.2. Epoxy coatings ====


“Wall finishes do change, due to changes in management or taste,
General description and properties


and it is usually the first surface to be ’replaced’ or changed.”
There are two main types of epoxy coatings – water-borne and solvent-borne coatings. Both types have improved properties compared to water- or oil-based paints, including the following:


(Vittori, 2002)
* Chemical and abrasion resistance


Paint types include emulsion paints which are water-based and produce a matt or silk effect – such as PVA. Oil-based paints like enamel dry to a hard, glossy finish that is impervious to water.  
* Outstanding adhesion to a variety of substrates


Paint is fairly inexpensive when compared to other wall finishes.  FIGURE 14
* Excellent toughness, hardness and flexibility


Infection prevention
* Superior dimensional stability


The seamless finish produced by painted plaster makes this finish ideal for areas where infection prevention is paramount. There are no joints or crevices to encourage growth of microbes. Any mechanical damage can, however, lead to small cracks, and it is important to protect vulnerable areas. This is discussed in more detail under ‘Protection’. Studies have shown that PVA can be degraded by filamentous fungi, such as algae, yeasts, lichens and bacteria (Cappilelli and Sorlini, 2008). Paints with mould inhibitors and nano-technology enhancements are available on the market. Oil-based paints are more suited to areas that require high infection prevention criteria as the surface is impervious to water, oil and other fluids.  
* Heat resistance


Cleaning and maintenance
Water-dispersed epoxy coatings are resin-based wall coatings of between 0.3 and 0.5 mm thick. A primer or pore-filler coat is first applied to smooth plaster, followed by two coats of epoxy wall coating applied with a roller. This creates an impermeable seal on the wall surface with a gloss finish.


The enamel and velvet sheen paints are highly washable, durable and stain-resistant. PVA can also be washed, but is not as stain-resistant or impervious and therefore not suitable in treatment areas. Paint is a low maintenance finish that requires re-application every few years (more often if mechanical damage occurs). Special attention should be given to the placement of switches and sockets in walls, as these areas are regularly touched, and can become infection-control risk areas if not kept clean. The smoother the surface, the easier it is to clean.  
The use of water in lieu of solvent in the coating means less hazardous material for the environment, and reduced odours/fumes.


Fire safety
Solvent-borne epoxy paints are more economical, but should not be exposed to extensive sunlight as this leads to chalking and degradation. The solvent-based epoxy coating is also toxic when wet, unlike the water-borne version, but once dry, the solvent-borne epoxy coating is also non-toxic. Special precautions need to be taken when applying this product. Primers are also required, and solvent-based epoxy coatings can be applied with a roller, brush or airless spray.


Paint is considered a non-combustible finish as the thickness of the paint is usually less than 0.5 mm. Refer to the manufacturer’s specifications and consult with SANS Part T to check the compliance and fire-resistance.
Infection prevention


Indoor air quality: Humidity
The water-borne epoxy resin coatings have been tested under ISO 14644, which classifies different materials according to their cleanliness in terms of the particle and airborne molecular contaminants that are emitted or released by the finished product. This is critical in industrial environments where optical or electronic goods are manufactured, or where food is processed. Water-dispersed epoxy resin wall coatings are one such product that satisfies the criteria and is approved for use in ‘cleanroom’ settings.


Paints are generally not adversely affected by a reasonable amount of moisture being generated by the presence of taps or wet fittings in a room. Oil-based enamel paints are more resistant to moisture when compared to water-based PVA-type paints, and are therefore more suitable in wet or humid environments.
Cleaning and maintenance


Indoor air quality: Emissions  
The impermeable finish is smooth and non-porous, making it easy to clean, highly washable, durable and stain resistant. Colour variation in different batches of solvent-based epoxy coatings is expected.


The strong odour of a newly painted room is an indication of the high VOC emissions. Low-odour paints are marketed by manufacturers, and products with reduced or zero VOCs are being produced.  Due to the increasing range of products and suppliers, the level of emissions should be checked with the manufacturer (refer to product-specific literature).  
Fire safety


Acoustics
Since the epoxy finish is less than 0.5 mm, it is considered a non-combustible finish (once dry). Refer to the manufacturer’s specifications, and consult with SANS Part T to check compliance and fire-resistance.


The hard surface of painted walls reflects sound and does not contribute to the impact of noise reduction or absorption. Where acoustics is a priority in a room or facility, other sound-absorbing products and finishes should be combined with the painted walls to achieve improved acoustics.
Indoor air quality: Humidity


Aesthetics  
Epoxy coatings have good water-resistance and are suitable for use in moist/humid areas as the finish is hydrophobic and prevents the ingress of moisture.


Paint is available in an extensive range of colours, and this is one of the great advantages of using paint. It provides a flexible means of adapting a space to suit the function of the room – from calming colours in a staff restroom, to cheerful and inviting colours in a doctor’s waiting room.
Indoor air quality: Emissions


The effect of colour on healing has been well documented by Tofle et al. (2004).  
Solvent-borne epoxy coatings produce a strong odour in a newly painted room, unlike water-dispersed epoxy coatings. The development of water-dispersed epoxy coatings has been hastened by the move away from VOC emissions in paints to meet air quality standards.


Colour can also be used for the coding of areas – to demarcate different departments or floors of a multistorey building. It can be effective in establishing zones for public and staff use. Paint can also be used to introduce colour for features or emphasis.  
Acoustics


Private sector health facilities often make use of colourbranding for their facilities, and the use of specific combinations of colours becomes identifiable with the brand.  
The hard surface of epoxy-painted walls reflects sound and does not contribute to the impact of noise reduction or absorption. Where acoustics is a priority in a room or facility, other sound-absorbing products and finishes should be combined with the painted walls to achieve improved acoustics.


In public health facilities, the support of the Department of Health in the use of colour in this regard is paramount, as historically, decisions about colour have been based on ease of maintenance and whether new paints can match existing colours.  
Aesthetics


The colour codes and type of paints should always be included in the as-built documents to assist managers to obtain the correct paint.  
Epoxy coatings are available in a muted range of pastel colours. Although the colour range and variety is more limited than regular paints, the comparative expense of epoxy coatings usually means it is used for its superior performance properties, and less likely for its aesthetics.


1.2. Epoxy coatings  
=== 2. Flexible sheeting ===


General description and properties
Vinyl wall cladding, as in the case of vinyl floor sheeting, is manufactured from a combination of vinyl resin and various additives, such as the following:


There are two main types of epoxy coatings – water-borne and solvent-borne coatings. Both types have improved properties compared to water- or oil-based paints, including the following:
* Plasticisers – used to make the sheet more flexible.


• Chemical and abrasion resistance
* Stabilisers – to minimise degradation and discoloration.


• Outstanding adhesion to a variety of substrates
* Pigments – for colours and patterns


• Excellent toughness, hardness and flexibility
* Fillers – such as lime or other locally available material


• Superior dimensional stability  
Vinyl cladding is generally 1.25 mm thick, but sheeting that is 2 mm in thickness can also be used. Depending on the manufacturer, it is supplied in 1.2 m- or 2 m-wide rolls. Vinyl cladding is sometimes used as a dado cladding in passageways or high-traffic areas due to its durable, resilient and impervious finish.


• Heat resistance  
Vinyl cladding can be supplied with a specialised polyurethane-resistant (PUR) surface treatment. This coating improves resistance to staining and cleaning chemicals and supports indentation recovery.


Water-dispersed epoxy coatings are resin-based wall coatings of between 0.3 and 0.5 mm thick. A primer or pore-filler coat is first applied to smooth plaster, followed by two coats of epoxy wall coating applied with a roller. This creates an impermeable seal on the wall surface with a gloss finish.  
Infection prevention FIGURE 18


The use of water in lieu of solvent in the coating means less hazardous material for the environment, and reduced odours/fumes.  
Vinyl sheeting, as a material, has been found to inhibit the growth of


Solvent-borne epoxy paints are more economical, but should not be exposed to extensive sunlight as this leads to chalking and degradation. The solvent-based epoxy coating is also toxic when wet, unlike the water-borne version, but once dry, the solvent-borne epoxy coating is also non-toxic. Special precautions need to be taken when applying this product. Primers are also required, and solvent-based epoxy coatings can be applied with a roller, brush or airless spray.  
bacteria, and particularly Methicillin-resistant Staphylococcus aureus (MRSAs). The welded joints prevent dust or dirt from congregating in areas that are difficult to clean, and the integral skirting supports this seamless appeal. This has made vinyl sheeting very suitable for use in healthcare facilities. However, the adhesives behind the cladding are important for the success of this wall finish from an infection-prevention aspect, as any lifting away from the wall or failure in the application of the adhesive will create voids in which bacteria or insects can breed. If the wall is mechanically damaged in any way, even the finest of cracks will provide the access needed to these voids. Ends should be well sealed and any area at risk of being damaged should be protected. Refer to the section on bump-rails and protection.


Infection prevention
Cleaning and maintenance


The water-borne epoxy resin coatings have been tested under ISO 14644, which classifies different materials according to their cleanliness in terms of the particle and airborne molecular contaminants that are emitted or released by the finished product. This is critical in industrial environments where optical or electronic goods are manufactured, or where food is processed. Water-dispersed epoxy resin wall coatings are one such product that satisfies the criteria and is approved for use in ‘cleanroom’ settings.  
The cladding is easily washed, which contributes to its performance as a hygienic wall finish. Vinyl cladding is not easily damaged, and when treated with a polymer dressing/surface treatment, is low-maintenance. When maintained properly, the sheets have a long lifespan, and are therefore fairly cost-effective in comparison to other wall finishes. Cladding with PUR treatment requires only spray-and-dry buffing for general cleaning, although water-based dressings are beneficial. Special cleaning solutions are used for heavy staining, but abrasive cleaning methods should not be used. If portions of the wall cladding are damaged, replacement of a section is difficult as the stripping off of adhesives may require re-plastering prior to applying the new cladding.


Cleaning and maintenance
This is also very disruptive in high-use areas. Colour matching is also difficult when replacing panels as colour batches will vary.


The impermeable finish is smooth and non-porous, making it easy to clean, highly washable, durable and stain resistant. Colour variation in different batches of solvent-based epoxy coatings is expected.  
This is, however, a low-maintenance, flexible covering that is not likely to crack with small movements in the wall.


Fire safety
Cleaning should always be carried out in accordance with the manufacturer’s specifications to comply with material warranties. The specifier should ensure that these instructions are included in handover packs issued to the building owner/user when occupation takes place.


Since the epoxy finish is less than 0.5 mm, it is considered a non-combustible finish (once dry). Refer to the manufacturer’s specifications, and consult with SANS Part T to check compliance and fire-resistance.
Fire safety


Indoor air quality: Humidity
In terms of SANS 10400, operating theatres, ICUs, high-care or critical care units, and maternity delivery units are required to have walls with a fire-resistance of 120 minutes. The effect of the finish, in conjunction with the wall structure, should be checked with the manufacturer for compliance in this regard.


Epoxy coatings have good water-resistance and are suitable for use in moist/humid areas as the finish is hydrophobic and prevents the ingress of moisture.
Indoor air quality – Humidity


Indoor air quality: Emissions  
Vinyl sheeting is well suited to areas of high humidity, and wet areas such as sluice rooms.


Solvent-borne epoxy coatings produce a strong odour in a newly painted room, unlike water-dispersed epoxy coatings. The development of water-dispersed epoxy coatings has been hastened by the move away from VOC emissions in paints to meet air quality standards.
Indoor air quality – Emissions


Acoustics
Some manufacturers have addressed VOC emissions in their products and indicate a pass in VOC emissions tests as well as Building Research Establishment (BRE) A+ ratings. Materials are 100% recyclable or contain a percentage of recycled materials. Each supplier will differ, and the specifier should check these aspects when considering a product. VOC emissions of adhesives and sealants, where applicable, are also to be considered.


The hard surface of epoxy-painted walls reflects sound and does not contribute to the impact of noise reduction or absorption. Where acoustics is a priority in a room or facility, other sound-absorbing products and finishes should be combined with the painted walls to achieve improved acoustics.
Aesthetics


Aesthetics  
Vinyl wall cladding is available in subtle pastel colours that can contribute to creating a calming/soothing effect. The application of cladding requires skill to apply and if the substrate plaster is not completely smooth below the surface, the vinyl cladding will amplify imperfections and could look unsightly.


Epoxy coatings are available in a muted range of pastel colours. Although the colour range and variety is more limited than regular paints, the comparative expense of epoxy coatings usually means it is used for its superior performance properties, and less likely for its aesthetics.  
Acoustics


2. Flexible sheeting  
Vinyl sheeting is softer than tiled surfaces, with better sound absorption qualities than hard finishes.


==== 2.2. Wallpaper murals ====


Vinyl wall cladding, as in the case of vinyl floor sheeting, is manufactured from a combination of vinyl resin and various additives, such as the following:
General description and properties


• Plasticisers – used to make the sheet more flexible.  
Digitally printed wallpapers are becoming more popular in public areas of health facilities. These murals can be custom-sized and printed to any image and can make a strong contribution to introduce outdoor and nature scenes where external windows and natural light is not possible. The murals are supplied in panels that


• Stabilisers – to minimise degradation and discoloration.  
generally overlap and are glued to a substrate that should be smooth, sound and dry. A lining paper can be applied prior to the finish paper. Wallpapers generally have a textured matt finish, which can be cleaned. Selfadhesive papers which are PVC-free are also manufactured. The wallpaper generally has a latex-saturated paper backing.


• Pigments – for colours and patterns
Infection prevention


• Fillers – such as lime or other locally available material  
While some wallpapers can be cleaned, micro-perforated vinyl, which is commonly used for large-scale digital prints, were found to perform poorly when inoculated with pathogens. These wallpaper murals should not be used in areas where patients are immuno-compromised, especially if the prints can be touched easily. The joints between the panels – although sealed with the glue used to affix the mural, mean that the surface is not seamless. By applying a clear varnish sealing coat over the product, the infection prevention is improved.


Vinyl cladding is generally 1.25 mm thick, but sheeting that is 2 mm in thickness can also be used. Depending on the manufacturer, it is supplied in 1.2 m- or 2 m-wide rolls. Vinyl cladding is sometimes used as a dado cladding in passageways or high-traffic areas due to its durable, resilient and impervious finish.  
Cleaning and maintenance


Vinyl cladding can be supplied with a specialised polyurethane-resistant (PUR) surface treatment. This coating improves resistance to staining and cleaning chemicals and supports indentation recovery.  
Light cleaning with a soft, non-abrasive cloth – which can be damp – will allow for regular cleaning, but the wallpapers are susceptible to stains. Any mechanical damage to the mural will be difficult to repair. The location of these murals should be carefully considered, as the images will lose their effect if bump-rails run clear across the image. If well cared for, though, the murals require little maintenance.


Infection prevention FIGURE 18
Fire safety


Vinyl sheeting, as a material, has been found to inhibit the growth of
Self-adhesive wallpapers have been tested in accordance with EN13501-1:2007 and were classified as B-s1, d0 (fire behaviour (B), smoke production (Class 1), flaming droplets(0)). In terms of SANS 10400, operating theatres, ICUs, high-care or critical care units and maternity delivery units are required to have walls with a fire-resistance of 120 minutes. The effect of the finish, in conjunction with the wall structure, should be checked with the manufacturer for compliance in this regard.


bacteria, and particularly Methicillin-resistant Staphylococcus aureus (MRSAs). The welded joints prevent dust or dirt from congregating in areas that are difficult to clean, and the integral skirting supports this seamless appeal. This has made vinyl sheeting very suitable for use in healthcare facilities. However, the adhesives behind the cladding are important for the success of this wall finish from an infection-prevention aspect, as any lifting away from the wall or failure in the application of the adhesive will create voids in which bacteria or insects can breed. If the wall is mechanically damaged in any way, even the finest of cracks will provide the access needed to these voids. Ends should be well sealed and any area at risk of being damaged should be protected. Refer to the section on bump-rails and protection.   
Indoor air quality: Humidity


Cleaning and maintenance
The paper constituents of this product and the micro-perforations make it unsuitable for use in high-humidity areas.


The cladding is easily washed, which contributes to its performance as a hygienic wall finish. Vinyl cladding is not easily damaged, and when treated with a polymer dressing/surface treatment, is low-maintenance. When maintained properly, the sheets have a long lifespan, and are therefore fairly cost-effective in comparison to other wall finishes. Cladding with PUR treatment requires only spray-and-dry buffing for general cleaning, although water-based dressings are beneficial. Special cleaning solutions are used for heavy staining, but abrasive cleaning methods should not be used. If portions of the wall cladding are damaged, replacement of a section is difficult as the stripping off of adhesives may require re-plastering prior to applying the new cladding.  
Indoor air quality: Emissions


This is also very disruptive in high-use areas. Colour matching is also difficult when replacing panels as colour batches will vary.  
The adhesives used to install the wallpaper are often high in VOC emissions, although PVC-free self-adhesive papers are produced. In comparison to paints, however, the emissions are lower.


This is, however, a low-maintenance, flexible covering that is not likely to crack with small movements in the wall.
Acoustics


Cleaning should always be carried out in accordance with the manufacturer’s specifications to comply with material warranties. The specifier should ensure that these instructions are included in handover packs issued to the building owner/user when occupation takes place.  
Wallpaper is softer than tiled surfaces, with better sound-absorption qualities than hard finishes. Thicker and heavily textured papers will aid sound absorption.


Fire safety
Aesthetics


In terms of SANS 10400, operating theatres, ICUs, high-care or critical care units, and maternity delivery units are required to have walls with a fire-resistance of 120 minutes. The effect of the finish, in conjunction with the wall structure, should be checked with the manufacturer for compliance in this regard.  
The aspect of aesthetics is where wallpaper scores well. The use of high-resolution photographic images in murals can contribute almost as much as a real view of a natural environment. This is useful where external windows are not feasible. This can also be used to good effect in staff restroom areas, cafeterias or foyers.


Indoor air quality – Humidity
=== 3. Hard preformed coverings ===


Vinyl sheeting is well suited to areas of high humidity, and wet areas such as sluice rooms.  
==== 3.1. Porcelain or ceramic tiles ====


Indoor air quality – Emissions  
General description and properties


Some manufacturers have addressed VOC emissions in their products and indicate a pass in VOC emissions tests as well as Building Research Establishment (BRE) A+ ratings. Materials are 100% recyclable or contain a percentage of recycled materials. Each supplier will differ, and the specifier should check these aspects when considering a product. VOC emissions of adhesives and sealants, where applicable, are also to be considered.  
Porcelain and ceramic tiles generally provide a durable, aesthetically acceptable wall finish that is moistureresistant. A wide spectrum of tiles is available in varying sizes, material composition, quality and cost, resulting in varying performance. Porcelain and/or ceramic tiles are most commonly used in health facilities in wet areas, such as bathrooms, kitchens, and utility and cleaning areas due to the impervious quality and performance under wet conditions. The use of unglazed tiles is not recommended in health facilities as these absorb moisture and other fluids, which may be present in kitchens, mortuaries, etc.


Aesthetics  
The specifier should research the actual tile carefully, ascertain if the product is imported, what long-term stocks would be available, and ensure the tiles have been sufficiently cured. Where possible, the specifier should use full-bodied porcelain tiles rather than glazed porcelain or ceramic tiles. This is evident in the following comparison between the general properties of the two tile types:


Vinyl wall cladding is available in subtle pastel colours that can contribute to creating a calming/soothing effect. The application of cladding requires skill to apply and if the substrate plaster is not completely smooth below the surface, the vinyl cladding will amplify imperfections and could look unsightly.
Full-bodied porcelain tile:


Acoustics
* Colour is throughout, as the term ’full-bodied‘ implies.


Vinyl sheeting is softer than tiled surfaces, with better sound absorption qualities than hard finishes.  
* Squareness of tiles is consistent with minor deviations.


2.2. Wallpaper murals
* Tile sizes are consistent with minor deviations.


General description and properties
* Smaller joints can be used, due to tile size consistency.


Digitally printed wallpapers are becoming more popular in public areas of health facilities. These murals can be custom-sized and printed to any image and can make a strong contribution to introduce outdoor and nature scenes where external windows and natural light is not possible. The murals are supplied in panels that
* Flatness of tile face is consistent.


generally overlap and are glued to a substrate that should be smooth, sound and dry. A lining paper can be applied prior to the finish paper. Wallpapers generally have a textured matt finish, which can be cleaned.  Selfadhesive papers which are PVC-free are also manufactured. The wallpaper generally has a latex-saturated paper backing.  
Glazed ceramic tile:


Infection prevention
* Colour is a glaze on top of the tile that can wear or chip off.


While some wallpapers can be cleaned, micro-perforated vinyl, which is commonly used for large-scale digital prints, were found to perform poorly when inoculated with pathogens. These wallpaper murals should not be used in areas where patients are immuno-compromised, especially if the prints can be touched easily. The joints between the panels – although sealed with the glue used to affix the mural, mean that the surface is not seamless. By applying a clear varnish sealing coat over the product, the infection prevention is improved.  
* Tile sizes can vary.


Cleaning and maintenance
* Squareness of tiles can vary.


Light cleaning with a soft, non-abrasive cloth – which can be damp – will allow for regular cleaning, but the wallpapers are susceptible to stains. Any mechanical damage to the mural will be difficult to repair. The location of these murals should be carefully considered, as the images will lose their effect if bump-rails run clear across the image. If well cared for, though, the murals require little maintenance.  
* Wider joints are required, due to size and squareness inconsistencies.


Fire safety
* Tiles are often not flat and edged surfaces tend to dip, resulting in rough surfaces.


Self-adhesive wallpapers have been tested in accordance with EN13501-1:2007 and were classified as B-s1, d0 (fire behaviour (B), smoke production (Class 1), flaming droplets(0)). In terms of SANS 10400, operating theatres, ICUs, high-care or critical care units and maternity delivery units are required to have walls with a fire-resistance of 120 minutes. The effect of the finish, in conjunction with the wall structure, should be checked with the manufacturer for compliance in this regard.
Infection prevention


Indoor air quality: Humidity
Although an individual tile unit complies with selection criteria such as being impervious and easy to clean, a finished tiled wall, including grout and movement joints, provides a less favourable result in terms of the following:


The paper constituents of this product and the micro-perforations make it unsuitable for use in high-humidity areas.  
* Grout in the joints is porous and can retain moisture, which encourages the growth of mould.


Indoor air quality: Emissions  
* Grout joints pose a potential infection-control risk in small cracks and openings that form between the tile edge and the body of the grout.


The adhesives used to install the wallpaper are often high in VOC emissions, although PVC-free self-adhesive papers are produced. In comparison to paints, however, the emissions are lower.  
* Tiles may crack and chip when trolleys bump against them, creating small cracks where moisture can be retained and microbes can grow.


Acoustics
* Replacement of these damaged tiles or re-grouting is disruptive to the daily operations of the facility, and matching existing tiles can be difficult.


Wallpaper is softer than tiled surfaces, with better sound-absorption qualities than hard finishes. Thicker and heavily textured papers will aid sound absorption.  
Anti-fungal grout will contribute to the control of mildew, but cannot replace good maintenance regimes.


Aesthetics  
Cleaning and maintenance


The aspect of aesthetics is where wallpaper scores well. The use of high-resolution photographic images in murals can contribute almost as much as a real view of a natural environment. This is useful where external windows are not feasible. This can also be used to good effect in staff restroom areas, cafeterias or foyers.  
Porcelain wall tiles generally need to be cleaned with water and a cleaning agent. For oily spatter in hospital kitchens or body fluids or chemicals in laboratories or mortuaries, appropriate cleaning is required. The ease of cleaning, as well as the durability of the tiles under rigorous cleaning regimes, makes a tiled wall suitable in areas where splash-back is common – such as above sinks and hand basins.


3. Hard preformed coverings  
Fire safety


Porcelain is non-combustible in terms of SANS 10400: Part T. In terms of SANS 10400, operating theatres, ICUs, high-care or critical care units and maternity delivery units are required to have walls with a fire resistance of 120 minutes. The effect of the finish, in conjunction with the wall structure, should be checked with the manufacturer for compliance in this regard.


3.1. Porcelain or ceramic tiles
Indoor air quality: Humidity


General description and properties
The polished or glazed surfaces of the tiles make them highly suitable and unaffected by high humidity in the room. However, as mentioned above, the joints are susceptible to moisture-retention and encourage mould and microbe growth in the minute cracks and gaps. Proper scrubbing and regular maintenance will inhibit fungal contamination. The use of epoxy grout is recommended (and not cementitious grout). Epoxy grouts are resinbased, and repel moisture, which inhibits the growth of mould.


Porcelain and ceramic tiles generally provide a durable, aesthetically acceptable wall finish that is moistureresistant. A wide spectrum of tiles is available in varying sizes, material composition, quality and cost, resulting in varying performance. Porcelain and/or ceramic tiles are most commonly used in health facilities in wet areas, such as bathrooms, kitchens, and utility and cleaning areas due to the impervious quality and performance under wet conditions. The use of unglazed tiles is not recommended in health facilities as these absorb moisture and other fluids, which may be present in kitchens, mortuaries, etc.
Indoor air quality: Emissions


The specifier should research the actual tile carefully, ascertain if the product is imported, what long-term stocks would be available, and ensure the tiles have been sufficiently cured. Where possible, the specifier should use full-bodied porcelain tiles rather than glazed porcelain or ceramic tiles. This is evident in the following comparison between the general properties of the two tile types:
Porcelain tiles and cementitious grout (not recommended in health facilities) do not generate VOC emissions, but some adhesives, other grouts, sealants and cleaning agents generate VOC, which affect the indoor air quality. The production of tiles has a high-energy input, with high sustainability production costs and production emissions.


Full-bodied porcelain tile:
Acoustics


• Colour is throughout, as the term ’full-bodied‘ implies.  
Tiled walls are hard surfaces that do not absorb any sound and will contribute substantially to noise in the healthcare setting. This is due to the reflective surfaces on walls, causing echoes. Where the function of the room does not warrant special attention to acoustics, and other criteria have priority, then tiled walls are suitable.


• Squareness of tiles is consistent with minor deviations.
Aesthetics


• Tile sizes are consistent with minor deviations.  
Tiles are available in a wide selection of colours, shapes and sizes. This allows for visually appealing, non-institutional aesthetics in health facilities. Since the surfaces do not scratch or scuff easily, the aesthetic appeal is durable. A variety of stainless steel or PVC tile-in trims are available to finish the edges of tiles on walls or reveals. These also provide some protection to the exposed edge.


• Smaller joints can be used, due to tile size consistency.  
==== 3.2. Timber panelling ====


• Flatness of tile face is consistent.  
General description and properties


Glazed ceramic tile:
Timber panelling creates a warm, welcoming environment and can be used in certain areas of healthcare facilities.


• Colour is a glaze on top of the tile that can wear or chip off.  
The most common locally available timber is meranti and pine, which is available in various standards and quality. The versatility of the timber products provides almost unlimited options in terms of cladding walls or creating features from wood, ranging from standard tongue-and-groove planks to slatted battens and perforated acoustic panels. The timber is usually varnished or painted for internal use. Engineered timber products are also available with melamine and veneer finishes.


• Tile sizes can vary.  
Infection prevention


• Squareness of tiles can vary.  
Timber is a source of nutrients to bacteria, and good maintenance and cleaning will be needed to ensure that mould and other bacteria are prevented from establishing. Timber would not be suitable for areas where a seamless finish is required due to the jointing. Acrylic resin-based anti-bacterial varnish may extend the lifespan of the timber.


• Wider joints are required, due to size and squareness inconsistencies.  
Cleaning and maintenance


• Tiles are often not flat and edged surfaces tend to dip, resulting in rough surfaces.  
The timber panelling is usually finished with varnish or sealant that is water-resistant and therefore washable, but access to narrow grooves may limit the effectiveness of cleaning. Occasional re-varnishing would be required, which could be disruptive to the activities in such areas. Engineered medium-density fibreboard (MDF) wall panels do not require repainting if clad, but should not come into contact with water.


Infection prevention
Fire safety


Although an individual tile unit complies with selection criteria such as being impervious and easy to clean, a finished tiled wall, including grout and movement joints, provides a less favourable result in terms of the following:
Timber is combustible, and in terms of SANS 10400: Part T, internal finishes can be combustible, but must comply with Class 2 (Part T: Table 9), except in emergency routes, where Class 1 is required. Specific requirements are listed for operating theatres, ICUs, high-care or critical care units and maternity delivery units in that these areas are required to have walls with a fire resistance of 120 minutes. The extent and effect of the timber finish, in conjunction with the wall structure, should be checked for compliance in this regard.


• Grout in the joints is porous and can retain moisture, which encourages the growth of mould.  
Indoor air quality: Humidity


• Grout joints pose a potential infection-control risk in small cracks and openings that form between the tile edge and the body of the grout.  
Well-varnished timber will be protected from the effects of moisture, but generally timber should not be used in rooms where humid and moist conditions persist. MDF wall panels are not suitable for humid or wet areas.


• Tiles may crack and chip when trolleys bump against them, creating small cracks where moisture can be retained and microbes can grow.  
Indoor air quality: Emissions


• Replacement of these damaged tiles or re-grouting is disruptive to the daily operations of the facility, and matching existing tiles can be difficult.  
Timber is a natural product that does not emit VOCs, but the finishing specification, such as varnish, is often a source of VOCs. Engineered timber products, such as MDF board, contains a higher resin-to-wood ratio than any other urea-formaldehyde pressed wood product, and is recognised as being the highest formaldehydeemitting pressed wood product. (US Environmental Protection Agency). These VOCs are fairly quickly dissipated. Refer to product-specific literature.


 
Aesthetics


Anti-fungal grout will contribute to the control of mildew, but cannot replace good maintenance regimes.  
The warmth of wood grains, with their natural beauty and range of timber hues, is a sought-after aesthetic that is being replicated in many other finishes, such as ceramic tiles, vinyl and wallpaper. Original wood finishes are unique without production pattern repetition. This is the appeal of timber.


Cleaning and maintenance
Acoustics


Porcelain wall tiles generally need to be cleaned with water and a cleaning agent. For oily spatter in hospital kitchens or body fluids or chemicals in laboratories or mortuaries, appropriate cleaning is required. The ease of cleaning, as well as the durability of the tiles under rigorous cleaning regimes, makes a tiled wall suitable in areas where splash-back is common – such as above sinks and hand basins.  
Slatted or perforated timber panels are well suited to rooms that require acoustic performance, such as conference rooms, prayer rooms or quiet spaces. Perforated surfaces aid in reducing the retransmission of sound and can assist where many other surfaces are hard and reflective.


Fire safety
Glazed partitions


Porcelain is non-combustible in terms of SANS 10400: Part T. In terms of SANS 10400, operating theatres, ICUs, high-care or critical care units and maternity delivery units are required to have walls with a fire resistance of 120 minutes. The effect of the finish, in conjunction with the wall structure, should be checked with the manufacturer for compliance in this regard.
General description and properties


Indoor air quality: Humidity
There are areas in the healthcare environment that can benefit from the use of glazed partitions to improve the visual supervision of the occupants – for example, in isolation or paediatric wards. All glass in healthcare facilities must have safety glazing, but some additional protection should be included at critical heights where bump-rails would normally be fixed. This can be done using the aluminium frames and mullions at the correct heights.


The polished or glazed surfaces of the tiles make them highly suitable and unaffected by high humidity in the room. However, as mentioned above, the joints are susceptible to moisture-retention and encourage mould and microbe growth in the minute cracks and gaps. Proper scrubbing and regular maintenance will inhibit fungal contamination. The use of epoxy grout is recommended (and not cementitious grout). Epoxy grouts are resinbased, and repel moisture, which inhibits the growth of mould.  
Provision must be made for blinds or curtains to allow for privacy or room darkening when needed. Glass also brings the opportunity to allow natural light into deep spaces where external windows cannot be accommodated. Alimoglu and Donmex (2005) reported that nurses’ daily exposure to daylight correlated positively with job satisfaction. Berry and Parish (2008) reported that nursing staff who worked in a new unit that featured (among other aspects) more natural light, were more satisfied and less stressed. Stress negatively reflects on staff job satisfaction, which in turn correlates with staff turnover.


Indoor air quality: Emissions  
Exposure to daylight reduces depression among patients, decreases length of stay, improves sleep and circadian rhythms, lessens agitation among dementia patients, and eases pain (Joseph 1999).


Porcelain tiles and cementitious grout (not recommended in health facilities) do not generate VOC emissions, but some adhesives, other grouts, sealants and cleaning agents generate VOC, which affect the indoor air quality. The production of tiles has a high-energy input, with high sustainability production costs and production emissions.  
Infection prevention


Acoustics
Glass is impervious and unaffected by moisture or water, and is easy to clean, making this a useful wall finish in high-infection control areas. The key is in how the joints are treated. Welds on frames should be continuous – leaving no gaps or small apertures for moisture or bacteria to gain access. Gaskets in the aluminium frames must seal the junctions with glazed panels to support proper cleaning. Blinds should be encapsulated in double glazing to maintain the hygienic finish.


Tiled walls are hard surfaces that do not absorb any sound and will contribute substantially to noise in the healthcare setting. This is due to the reflective surfaces on walls, causing echoes. Where the function of the room does not warrant special attention to acoustics, and other criteria have priority, then tiled walls are suitable.  
Micro-perforated vinyl stickers can retain moisture and harbour pathogens, and special attention to cleaning procedures for these areas should be highlighted.


Aesthetics
Cleaning and maintenance


Tiles are available in a wide selection of colours, shapes and sizes. This allows for visually appealing, non-institutional aesthetics in health facilities. Since the surfaces do not scratch or scuff easily, the aesthetic appeal is durable. A variety of stainless steel or PVC tile-in trims are available to finish the edges of tiles on walls or reveals. These also provide some protection to the exposed edge.  
Glass walls require occasional washing, but the glass is waterproof and unaffected by most cleaning agents and acids. Glass can also be supplied with proprietary films that ’self-clean‘ by using sunlight and rain to wash off organic dirt. These are suitable for external glazing only.


3.2. Timber panelling
Fire safety


General description and properties
Both glass and aluminium (cast or extruded) are categorised as non-combustible materials in terms of SANS 10177-5. Internal finishes can be combustible, but must comply with Class 2 (Part T: Table 9), except in emergency routes, where Class 1 is required. Specific requirements are listed for operating theatres, ICUs, high-care or critical care units and maternity delivery units in that these areas are required to have walls with a fire resistance of 120 minutes.


Timber panelling creates a warm, welcoming environment and can be used in certain areas of healthcare facilities.
Indoor air quality: Humidity


The most common locally available timber is meranti and pine, which is available in various standards and quality. The versatility of the timber products provides almost unlimited options in terms of cladding walls or creating features from wood, ranging from standard tongue-and-groove planks to slatted battens and perforated acoustic panels. The timber is usually varnished or painted for internal use.  Engineered timber products are also available with melamine and veneer finishes.  
Glazed walls are well suited to humid environments as they are unaffected by moisture.


Infection prevention
Indoor air quality: Emissions


Timber is a source of nutrients to bacteria, and good maintenance and cleaning will be needed to ensure that mould and other bacteria are prevented from establishing. Timber would not be suitable for areas where a seamless finish is required due to the jointing. Acrylic resin-based anti-bacterial varnish may extend the lifespan of the timber.  
While the production of glass may emit VOCs, glass is inert and impermeable and does not emit VOCs. Coatings to the framework may, however, emit low VOCs. Refer to productspecific literature.


Cleaning and maintenance
Aesthetics


The timber panelling is usually finished with varnish or sealant that is water-resistant and therefore washable, but access to narrow grooves may limit the effectiveness of cleaning. Occasional re-varnishing would be required, which could be disruptive to the activities in such areas. Engineered medium-density fibreboard (MDF) wall panels do not require repainting if clad, but should not come into contact with water.  
In a well-maintained facility, glass walls can give a clean, open feel to the healthcare environment. The aesthetics can be improved by what lies beyond the glazing – especially if there is a view to be admired. An open configuration provides the caregiver or visitor with a more ‘global’ view of the unit, and allows immediate assessment of the status. This transparent


Fire safety
''FIGURE 30 aesthetic can improve order and cleanliness standards in the facility.''


Timber is combustible, and in terms of SANS 10400: Part T, internal finishes can be combustible, but must comply with Class 2 (Part T: Table 9), except in emergency routes, where Class 1 is required. Specific requirements are listed for operating theatres, ICUs, high-care or critical care units and maternity delivery units in that these areas are required to have walls with a fire resistance of 120 minutes. The extent and effect of the timber finish, in conjunction with the wall structure, should be checked for compliance in this regard.  
Acoustics


Indoor air quality: Humidity
Glass is a hard, reflective surface that will not absorb sound, but possibly add to noise scatter.


Well-varnished timber will be protected from the effects of moisture, but generally timber should not be used in rooms where humid and moist conditions persist. MDF wall panels are not suitable for humid or wet areas.
=== 4. Bump-rails ===


Indoor air quality: Emissions  
Beds, food trolleys, medicine trolleys, drip stands, mop buckets and wheelchairs are just some of the types of wheeled equipment common in


Timber is a natural product that does not emit VOCs, but the finishing specification, such as varnish, is often a source of VOCs. Engineered timber products, such as MDF board, contains a higher resin-to-wood ratio than any other urea-formaldehyde pressed wood product, and is recognised as being the highest formaldehydeemitting pressed wood product. (US Environmental Protection Agency). These VOCs are fairly quickly dissipated.  Refer to product-specific literature.  
the hospital or healthcare environment. This often leads to accidents and FIGURE 29 mechanical damage to walls, corners and exposed edges. Bump-rails should be specified and fitted in key areas to minimise repairs and prolong the wall finishes. In addition, bump-rails are useful behind chair-backs in waiting areas, where scuff marks are common.


Aesthetics
Most damage to walls will be prevented by running a bump-rail at around 900 mm above the floor (to the centreline), with a depth of 200 –300 mm. The areas behind beds or cots can be deeper at around 600 mm. Some trolleys also have projections at low level, and the equipment to be used in the particular area should be considered when setting heights and spacing of bump-rails.


The warmth of wood grains, with their natural beauty and range of timber hues, is a sought-after aesthetic that is being replicated in many other finishes, such as ceramic tiles, vinyl and wallpaper. Original wood finishes are unique without production pattern repetition. This is the appeal of timber.  
Some bump-rails simply consist of sheeting of only a few millimetres thick, cladding the wall at a particular height, but the offset type of rail that projects


Acoustics
''FIGURE 31 away from the wall is more effective in protecting the surface, as the force of the impact is difficult to predict or contain. These projecting rails have the added benefit of providing a handhold for patients who are walking in the passage.''


Slatted or perforated timber panels are well suited to rooms that require acoustic performance, such as conference rooms, prayer rooms or quiet spaces. Perforated surfaces aid in reducing the retransmission of sound and can assist where many other surfaces are hard and reflective.  
The different types of commonly used bump-rails are summarised below.


  Glazed partitions
==== 4.1. Laminated or solid timber bump-rails ====


General description and properties  
General description and properties


There are areas in the healthcare environment that can benefit from the use of glazed partitions to improve the visual supervision of the occupants – for example, in isolation or paediatric wards. All glass in healthcare facilities must have safety glazing, but some additional protection should be included at critical heights where bump-rails would normally be fixed. This can be done using the aluminium frames and mullions at the correct heights.  
Timber bump-rails are relatively inexpensive and easy to manufacture and fit. These can be routed, and shaped into solid timber sections, or smooth laminated timber sections. The benefit of using timber is that sections that may become damaged are easy to replace. The use of timber creates a warm, welcoming environment. The most common locally available timber is meranti and pine, which is available in various standards and quality. The timber is usually varnished for internal use.


Provision must be made for blinds or curtains to allow for privacy or room darkening when needed. Glass also brings the opportunity to allow natural light into deep spaces where external windows cannot be accommodated. Alimoglu and Donmex (2005) reported that nurses’ daily exposure to daylight correlated positively with job satisfaction.  Berry and Parish (2008) reported that nursing staff who worked in a new unit that featured (among other aspects) more natural light, were more satisfied and less stressed. Stress negatively reflects on staff job satisfaction, which in turn correlates with staff turnover.   
Infection prevention


Exposure to daylight reduces depression among patients, decreases length of stay, improves sleep and circadian rhythms, lessens agitation among dementia patients, and eases pain (Joseph 1999).  
Timber is a source of nutrients to bacteria, and good maintenance and cleaning will be needed to ensure that mould and other bacteria are prevented from establishing. Timber would not be suitable for areas where a seamless finish is required due to jointing, small ledges and recessed areas. Acrylic resin-based anti-bacterial varnish may extend the lifespan of the timber.


Infection prevention
Cleaning and maintenance


Glass is impervious and unaffected by moisture or water, and is easy to clean, making this a useful wall finish in high-infection control areas. The key is in how the joints are treated. Welds on frames should be continuous – leaving no gaps or small apertures for moisture or bacteria to gain access. Gaskets in the aluminium frames must seal the junctions with glazed panels to support proper cleaning. Blinds should be encapsulated in double glazing to maintain the hygienic finish.  
The timber panelling is usually finished with varnish or sealant, which is water-resistant, and therefore washable, but access to narrow grooves may limit the effectiveness of cleaning. Occasional re-varnishing would be required, which could be disruptive to the activities in such areas.


Micro-perforated vinyl stickers can retain moisture and harbour pathogens, and special attention to cleaning procedures for these areas should be highlighted.
Aesthetics


Cleaning and maintenance
The warmth of wood grains with their natural beauty and range of timber hues is a sought-after aesthetic, which is being replicated in many other finishes, such as ceramic tiles, vinyl and wallpaper. Original wood finishes are unique without production pattern repetition. This is the appeal of timber.


Glass walls require occasional washing, but the glass is waterproof and unaffected by most cleaning agents and acids. Glass can also be supplied with proprietary films that ’self-clean‘ by using sunlight and rain to wash off organic dirt. These are suitable for external glazing only.
==== 4.2. Extruded PVC bump-rails ====


Fire safety
General description and properties


Both glass and aluminium (cast or extruded) are categorised as non-combustible materials in terms of SANS 10177-5. Internal finishes can be combustible, but must comply with Class 2 (Part T: Table 9), except in emergency routes, where Class 1 is required. Specific requirements are listed for operating theatres, ICUs, high-care or critical care units and maternity delivery units in that these areas are required to have walls with a fire resistance of 120 minutes.  
Pre-formed rigid PVC bump-rails are fitted over aluminium retainers with rubber inserts, which help absorb any impact. The PVC covering is


Indoor air quality: Humidity
scratch-resistant with a textured surface. These rails can either be flush-mounted against the wall with an overall thickness of about 20–35 mm, or mounted on aluminium brackets at regular centres, usually less than one metre apart, and standing 50–100 mm proud of the wall surface. Continuous timber backing rails can also be fitted where anti-ligature options are needed in mental health facilities.


Glazed walls are well suited to humid environments as they are unaffected by moisture.  
The bump-rail size can vary between 50–200 mm in height. Injection- moulded plastic joiners and end-caps are available in matching colours.


Indoor air quality: Emissions  
Hollow, rigid extruded PVC bump-rails are also available, with PVC brackets, but these should only be used with solid timber inserts as the unsupported PVC has been known to become brittle over time. Flexible PVC hand-rail covers are also manufactured to fit over steel brackets, with a width of 50 mm.


While the production of glass may emit VOCs, glass is inert and impermeable and does not emit VOCs. Coatings to the framework may, however, emit low VOCs. Refer to productspecific literature.  
Infection prevention


Aesthetics
Vinyl/PVC provides no nutrient source for bacteria in which to thrive, and regular cleaning will ensure a hygienic product. Special attention should be paid to cleaning hand-rails as these have more angles and recesses and are more likely to be touched.


In a well-maintained facility, glass walls can give a clean, open feel to the healthcare environment. The aesthetics can be improved by what lies beyond the glazing – especially if there is a view to be admired. An open configuration provides the caregiver or visitor with a more ‘global’ view of the unit, and allows immediate assessment of the status. This transparent
Cleaning and maintenance


FIGURE 30 aesthetic can improve order and cleanliness standards in the facility.  
The manufacturer’s instructions must be followed for cleaning procedures and products to prolong the lifespan of the bump-rails. If a section becomes damaged, the relevant section can be replaced, although colour may vary slightly.


Acoustics
Aesthetics


Glass is a hard, reflective surface that will not absorb sound, but possibly add to noise scatter.  
The PVC bump-rails are available in a wide range of colours to complement the interior colour scheme. Bump-rails also provide an opportunity to introduce bolder colours, and can be used as markers to follow or define different departments.


4. Bump-rails  
==== 4.3. Tubular stainless steel bump-rails ====


Beds, food trolleys, medicine trolleys, drip stands, mop buckets and wheelchairs are just some of the types of wheeled equipment common in
General description and properties


the hospital or healthcare environment. This often leads to accidents and FIGURE 29 mechanical damage to walls, corners and exposed edges. Bump-rails should be specified and fitted in key areas to minimise repairs and prolong the wall finishes.  In addition, bump-rails are useful behind chair-backs in waiting areas, where scuff marks are common.  
Stainless steel bump-rails are sturdy, hard-wearing, easy to clean and an elegant solution for wall protection. Tubular bump-rails for internal areas should be manufactured from Grade 304 stainless steel, and are usually 32 mm in diameter. A wall thickness of 2 mm is recommended to withstand impact. External rails in coastal regions should be made from Grade 316 stainless steel. Material test certificates should be requested from the supplier to indicate the manufacturer, grade, chemical and mechanical specifications. All joints should be specified as fully seamwelded, including where stanchions are fixed to the rail and fixing plates. The screws/bolts and nuts used for fixing the flanges must be the same grade as the tubular rail. Flanges should be a minimum of 6 mm thick. All welded joints should be cleaned of residue prior to pickling and passivation. The TUNGSTEN INERT GAS (TIG) process of welding should be specified as this produces a better-quality weld on a wider range of thicknesses of stainless steel sheeting.


Most damage to walls will be prevented by running a bump-rail at around 900 mm above the floor (to the centreline), with a depth of 200 –300 mm.  The areas behind beds or cots can be deeper at around 600 mm. Some trolleys also have projections at low level, and the equipment to be used in the particular area should be considered when setting heights and spacing of bump-rails.  
Best corrosion-resistance will be achieved by pickling all fabricated items using commercially available products. The item is then thoroughly rinsed with water to remove all traces of acid and is then passivated with nitric acid passivating solution, and rinsed again.


Some bump-rails simply consist of sheeting of only a few millimetres thick, cladding the wall at a particular height, but the offset type of rail that projects
Infection prevention


FIGURE 31 away from the wall is more effective in protecting the surface, as the force of the impact is difficult to predict or contain.  These projecting rails have the added benefit of providing a handhold for patients who are walking in the passage.  
Stainless steel provides no nutrient source for bacteria in which to survive, but dirt build-up on the surface can become a source of bacteria. Although copper has better anti-microbial properties than stainless steel (Noyce, Michels & Keevil, 2006), stainless steel is a more durable and costeffective solution and performs better than most other materials in terms of preventing the transmission of pathogens.


The different types of commonly used bump-rails are summarised below.
Cleaning and maintenance


4.1. Laminated or solid timber bump-rails
Stainless steel is a very low-maintenance product that has longevity superior to most other products available. However, like any surface, the build-up of dirt and dust will affect the performance and lifespan of the product and regular cleaning is required. Stainless steel should be cleaned with a soft cloth, regular household dishwashing liquid and warm water. In coastal areas, stainless steel finishes should be cleaned every four weeks, and every 4–6 months in inland areas. Without regular cleaning, the protective chromium-oxide film will be contaminated by dirt build-up on the surface, thus trapping these corrosive agents.


General description and properties
Aesthetics


Timber bump-rails are relatively inexpensive and easy to manufacture and fit. These can be routed, and shaped into solid timber sections, or smooth laminated timber sections. The benefit of using timber is that sections that may become damaged are easy to replace. The use of timber creates a warm, welcoming environment. The most common locally available timber is meranti and pine, which is available in various standards and quality. The timber is usually varnished for internal use.   
Stainless steel creates an impression of cleanliness, with its smooth, shiny surface. The seamless rails also add to the hygienic appeal. This bump-rail solution has been used widely in hospital environments.


Infection prevention
==== 4.4. Cladding to medium density fibreboard substrate ====


Timber is a source of nutrients to bacteria, and good maintenance and cleaning will be needed to ensure that mould and other bacteria are prevented from establishing. Timber would not be suitable for areas where a seamless finish is required due to jointing, small ledges and recessed areas. Acrylic resin-based anti-bacterial varnish may extend the lifespan of the timber.  
There are various cladding options when using MDF board as a substrate for bump-rails. The surface finish products can be moulded around the MDF substrate, and the shape and size is only limited by the ability of the cladding to follow the radii of corners and edges.


Cleaning and maintenance
Suitable adhesives would need to be considered and should be checked with the respective manufacturers of the cladding product selected. The rear of the bump-rail should be fitted with melamine or similar covering to prevent moisture ingress and balance the board.


The timber panelling is usually finished with varnish or sealant, which is water-resistant, and therefore washable, but access to narrow grooves may limit the effectiveness of cleaning. Occasional re-varnishing would be required, which could be disruptive to the activities in such areas.  
These bump-rails can be fitted flush against the wall, or fixed with a purpose-made bracket or timber spacer behind them.


Aesthetics
Engineered timber products, such as MDF board, contain a higher resin-towood ratio than any other urea-formaldehyde pressed wood product, and is recognised as being the highest formaldehyde- emitting pressed wood product (US Environmental Protection Agency). These VOCs are fairly quickly dissipated.


The warmth of wood grains with their natural beauty and range of timber hues is a sought-after aesthetic, which is being replicated in many other finishes, such as ceramic tiles, vinyl and wallpaper. Original wood finishes are unique without production pattern repetition. This is the appeal of timber.  
The cladding options commonly used for bump-rails include the following:


4.2. Extruded PVC bump-rails
Vinyl sheeting


General description and properties
The advantage of using vinyl on a bump-rail is that the joints can be welded for a seamless finish. This is beneficial in terms of infection control. Mechanical damage can cause fine cracks that would be difficult to repair without replacing a section. The vinyl finish can also match the floor sheeting if required.


Pre-formed rigid PVC bump-rails are fitted over aluminium retainers with rubber inserts, which help absorb any impact. The PVC covering is
Refer to sections on vinyl flooring or wall cladding for general descriptions and performance of vinyl.


scratch-resistant with a textured surface. These rails can either be flush-mounted against the wall with an overall thickness of about 20–35 mm, or mounted on aluminium brackets at regular centres, usually less than one metre apart, and standing 50–100 mm proud of the wall surface. Continuous timber backing rails can also be fitted where anti-ligature options are needed in mental health facilities.
Solid surfacing


The bump-rail size can vary between 50–200 mm in height.  Injection- moulded plastic joiners and end-caps are available in matching colours.  
These smooth resin-based finishes are heated and moulded to the substrate, allowing for seamless curves and corners. Small cracks due to mechanical damage on solid-surfacing can be easily repaired by sanding and resealing. These cracks could present an infection-control risk, as these fine apertures can be difficult to see, and moisture can penetrate to the substrate below and become a reservoir for bacteria.


Hollow, rigid extruded PVC bump-rails are also available, with PVC brackets, but these should only be used with solid timber inserts as the unsupported PVC has been known to become brittle over time. Flexible PVC hand-rail covers are also manufactured to fit over steel brackets, with a width of 50 mm.  
The solid-surfacing is available in a wide range of colours from vibrant flat colours to stone-speckled patterns and translucent pigmented options. Since this product can be used on joinery and counters, the bump-rails can be made from matching or complementary colours.


Infection prevention
Carpeting


Vinyl/PVC provides no nutrient source for bacteria in which to thrive, and regular cleaning will ensure a hygienic product. Special attention should be paid to cleaning hand-rails as these have more angles and recesses and are more likely to be touched.  
Carpet cladding on bump-rails will contribute to sound absorption, but is not recommended in clinical areas as bacteria can be retained in the fibres, and these textile finishes are difficult to keep clean. Refer to sections on carpeting for general descriptions and performance of carpets.


Cleaning and maintenance
Stainless steel cladding


The manufacturer’s instructions must be followed for cleaning procedures and products to prolong the lifespan of the bump-rails. If a section becomes damaged, the relevant section can be replaced, although colour may vary slightly.  
Stainless steel sheeting can be bent or curved to follow simple profiles, and can be glued with appropriate adhesive, as well as mechanically fixed with screws. Edges should be sealed with silicone. The stainless steel cladding should not be less than 1.5–1.6 mm thick on bump-rails to be able to withstand impact. Standard finishes include brushed satin (matt) or a bright annealed (shiny) polished finish. A brushed satin finish will be less likely to show fingerprints, while a shiny finish will easily reveal fingerprints. Both finishes should be cleaned with a soft cloth, warm water and regular household dishwashing liquid at least once every four weeks.


Aesthetics
Refer to the section above on stainless steel tubular bump-rails for general descriptions and performance of stainless steel.


The PVC bump-rails are available in a wide range of colours to complement the interior colour scheme. Bump-rails also provide an opportunity to introduce bolder colours, and can be used as markers to follow or define different departments.  
=== 5. Corner protection ===


4.3. Tubular stainless steel bump-rails
Protection is needed on external corners and exposed edges of walls in healthcare facilities, as these areas are generally subject to more impact than walls in straight runs. The detail must be considered in conjunction with the bump-rail, as the two items will meet at the corner. The bump-rail can be continuous in the horizontal line, with the corner protection only covering the


General description and properties
''FIGURE 41 wall below. Alternately, the corner protection can be continuous in the vertical line, and the bump-rail can stop short of the corner on each side. A projecting bump-rail will still afford some protection to the corner, over and above the corner protector plate.''


Stainless steel bump-rails are sturdy, hard-wearing, easy to clean and an elegant solution for wall protection. Tubular bump-rails for internal areas should be manufactured from Grade 304 stainless steel, and are usually 32 mm in diameter. A wall thickness of 2 mm is recommended to withstand impact. External rails in coastal regions should be made from Grade 316 stainless steel. Material test certificates should be requested from the supplier to indicate the manufacturer, grade, chemical and mechanical specifications. All joints should be specified as fully seamwelded, including where stanchions are fixed to the rail and fixing plates. The screws/bolts and nuts used for fixing the flanges must be the same grade as the tubular rail. Flanges should be a minimum of 6 mm thick. All welded joints should be cleaned of residue prior to pickling and passivation. The TUNGSTEN INERT GAS (TIG) process of welding should be specified as this produces a better-quality weld on a wider range of thicknesses of stainless steel sheeting.  
Corner protectors should cover at least 1 m from the floor, but where taller food trolleys or laundry trolleys are used, the full height of the wall may need to be protected.


Best corrosion-resistance will be achieved by pickling all fabricated items using commercially available products. The item is then thoroughly rinsed with water to remove all traces of acid and is then passivated with nitric acid passivating solution, and rinsed again.  
==== 5.1. Stainless steel corner protectors ====


Infection prevention
Stainless steel corner protectors are fitted to exposed corners using stainless steel screws and adhesive, and are usually 50 x 50 mm in size, depending on the detail of the bump-rail at the corner. The corner edges should be rounded as they can be very sharp.


Stainless steel provides no nutrient source for bacteria in which to survive, but dirt build-up on the surface can become a source of bacteria. Although copper has better anti-microbial properties than stainless steel (Noyce, Michels & Keevil, 2006), stainless steel is a more durable and costeffective solution and performs better than most other materials in terms of preventing the transmission of pathogens.  
A thickness of 1.5–1.6 mm is recommended to give best impact protection. Refer to the section above on tubular steel bump-rails for general properties, performance, cleaning and other recommendations for the specification of stainless steel. Grade 304 is recommended for internal areas. Screws used for fixings must be the same grade as the angle.


Cleaning and maintenance
Columns are also high-impact areas in open spaces, and stainless steel sheeting provides a neat solution where rigid aluminium, timber or MDF substrates cannot be fitted to such tight curves.


Stainless steel is a very low-maintenance product that has longevity superior to most other products available. However, like any surface, the build-up of dirt and dust will affect the performance and lifespan of the product and regular cleaning is required. Stainless steel should be cleaned with a soft cloth, regular household dishwashing liquid and warm water. In coastal areas, stainless steel finishes should be cleaned every four weeks, and every 4–6 months in inland areas.  Without regular cleaning, the protective chromium-oxide film will be contaminated by dirt build-up on the surface, thus trapping these corrosive agents.  
==== 5.2. Vinyl corner protectors ====


Aesthetics
Proprietary systems of vinyl corner protection are available on the market in rigid extruded high-impact resistant PVC. Some systems can be supplied with aluminium retainers where higher impact is expected.


Stainless steel creates an impression of cleanliness, with its smooth, shiny surface. The seamless rails also add to the hygienic appeal. This bump-rail solution has been used widely in hospital environments.  
These PVC corner protectors have a fine textured scratch-resistant finish, and are available in 50 x 50 mm or 70 x 70 mm sizing and are 1.2 mm thick. Standard heights are 1.2 m high.


4.4. Cladding to medium density fibreboard substrate
They are fixed using approved adhesives, but screws can also be used. A range of colours is available to match the PVC bump-rails.


There are various cladding options when using MDF board as a substrate for bump-rails. The surface finish products can be moulded around the MDF substrate, and the shape and size is only limited by the ability of the cladding to follow the radii of corners and edges.  
== PART D - PERFORMANCE ==


Suitable adhesives would need to be considered and should be checked with the respective manufacturers of the cladding product selected. The rear of the bump-rail should be fitted with melamine or similar covering to prevent moisture ingress and balance the board.  
=== 1. Performance categories ===


These bump-rails can be fitted flush against the wall, or fixed with a purpose-made bracket or timber spacer behind them.  
The properties described in the selection criteria in Section C above have been listed in the table below, and then grouped into five performance categories that would satisfy the requirements in various areas in a healthcare facility.


Engineered timber products, such as MDF board, contain a higher resin-towood ratio than any other urea-formaldehyde pressed wood product, and is recognised as being the highest formaldehyde- emitting pressed wood product (US Environmental Protection Agency). These VOCs are fairly quickly dissipated.  
== Table 2 ==


The cladding options commonly used for bump-rails include the following:
WALL PROPERTIES PERFORMANCE CATEGORY


Vinyl sheeting
=== 1 2 3 4 ===


The advantage of using vinyl on a bump-rail is that the joints can be welded for a seamless finish. This is beneficial in terms of infection control. Mechanical damage can cause fine cracks that would be difficult to repair without replacing a section. The vinyl finish can also match the floor sheeting if required.
Smooth   O O


Refer to sections on vinyl flooring or wall cladding for general descriptions and performance of vinyl.
Impervious   O O


Solid surfacing
Jointless/seamless  O O O


These smooth resin-based finishes are heated and moulded to the substrate, allowing for seamless curves and corners. Small cracks due to mechanical damage on solid-surfacing can be easily repaired by sanding and resealing. These cracks could present an infection-control risk, as these fine apertures can be difficult to see, and moisture can penetrate to the substrate below and become a reservoir for bacteria.
Textured O  O O


The solid-surfacing is available in a wide range of colours from vibrant flat colours to stone-speckled patterns and translucent pigmented options. Since this product can be used on joinery and counters, the bump-rails can be made from matching or complementary colours.
Perforated O  O O


Carpeting   
Jointed O O O O


Carpet cladding on bump-rails will contribute to sound absorption, but is not recommended in clinical areas as bacteria can be retained in the fibres, and these textile finishes are difficult to keep clean. Refer to sections on carpeting for general descriptions and performance of carpets.
Low maintenance    


Stainless steel cladding
Washable/easily cleaned    O


Stainless steel sheeting can be bent or curved to follow simple profiles, and can be glued with appropriate adhesive, as well as mechanically fixed with screws. Edges should be sealed with silicone. The stainless steel cladding should not be less than 1.5–1.6 mm thick on bump-rails to be able to withstand impact. Standard finishes include brushed satin (matt) or a bright annealed (shiny) polished finish. A brushed satin finish will be less likely to show fingerprints, while a shiny finish will easily reveal fingerprints. Both finishes should be cleaned with a soft cloth, warm water and regular household dishwashing liquid at least once every four weeks.
Suited to high humidity areas O 


Refer to the section above on stainless steel tubular bump-rails for general descriptions and performance of stainless steel.
O 


5. Corner protection  
 


Protection is needed on external corners and exposed edges of walls in healthcare facilities, as these areas are generally subject to more impact than walls in straight runs. The detail must be considered in conjunction with the bump-rail, as the two items will meet at the corner. The bump-rail can be continuous in the horizontal line, with the corner protection only covering the
Acoustic priority O   


FIGURE 41 wall below. Alternately, the corner protection can be continuous in the vertical line, and the bump-rail can stop short of the corner on each side. A projecting bump-rail will still afford some protection to the corner, over and above the corner protector plate.
Aesthetic priority O   
 
Corner protectors should cover at least 1 m from the floor, but where taller food trolleys or laundry trolleys are used, the full height of the wall may need to be protected.
 
5.1. Stainless steel corner protectors
 
Stainless steel corner protectors are fitted to exposed corners using stainless steel screws and adhesive, and are usually 50 x 50 mm in size, depending on the detail of the bump-rail at the corner. The corner edges should be rounded as they can be very sharp.
 
A thickness of 1.5–1.6 mm is recommended to give best impact protection. Refer to the section above on tubular steel bump-rails for general properties, performance, cleaning and other recommendations for the specification of stainless steel. Grade 304 is recommended for internal areas.  Screws used for fixings must be the same grade as the angle.
 
Columns are also high-impact areas in open spaces, and stainless steel sheeting provides a neat solution where rigid aluminium, timber or MDF substrates cannot be fitted to such tight curves.
 
 
5.2. Vinyl corner protectors
 
Proprietary systems of vinyl corner protection are available on the market in rigid extruded high-impact resistant PVC. Some systems can be supplied with aluminium retainers where higher impact is expected.
 
These PVC corner protectors have a fine textured scratch-resistant finish, and are available in 50 x 50 mm or 70 x 70 mm sizing and are 1.2 mm thick. Standard heights are 1.2 m high.
 
They are fixed using approved adhesives, but screws can also be used.   A range of colours is available to match the PVC bump-rails.
 
 
 
PART D -  PERFORMANCE  
 
 
1. Performance categories
 
 
The properties described in the selection criteria in Section C above have been listed in the table below, and then grouped into five performance categories that would satisfy the requirements in various areas in a healthcare facility.  
 
TABLE 2
 
WALL  PROPERTIES PERFORMANCE CATEGORY
 
1 2 3 4
 
Smooth   O O
 
Impervious   O O
 
Jointless/seamless   O O O
 
Textured    O  O O
 
Perforated O  O O
 
Jointed O O O O
 
Low maintenance    
 
Washable/easily cleaned     O
 
Suited to high humidity areas O 
 
O 
 
 
 
Acoustic priority O   
 
Aesthetic priority O   




Legend/Key:  
Legend/Key:
 
– indicates this property is required for the class
 
– indicates this property is not required for the class
 
O – indicates this property is an optional requirement for the class Examples of wall finishes for Class 1 (typical area – operating theatre):
 
• Enamel paint, epoxy coating, vinyl cladding or glazed partitions in special applications, etc.
 
Examples of wall finishes for Class 2 (typical area – dirty utility or ablution):
 
• Enamel paint, epoxy coating, porcelain or ceramic tiles, etc.
 
Examples of wall finishes for Class 3 (typical room – passage, restroom or waiting room):
 
• PVA paint, glazed partitions, wall-paper, timber panels or enamel paint, etc.
 
Examples of wall finishes for Class 4 (typical area – plant room):
 
• PVA paint, enamel paint, epoxy coating, etc.
 
Refer to Table 2 – Matrix of recommended wall performance categories to establish what performance category the wall of the room in question will require.
 
2. Performance categories recommended per room
 
 
Department Room Name Wall Performance


1 2 3 4 5
– indicates this property is required for the class


Acute Inpatient Wards (Adults) Circulation Space     
– indicates this property is not required for the class


Cleaners’ Room     
O – indicates this property is an optional requirement for the class Examples of wall finishes for Class 1 (typical area – operating theatre):


Consulting Room     
* Enamel paint, epoxy coating, vinyl cladding or glazed partitions in special applications, etc.


Day Lounge (patients)     
Examples of wall finishes for Class 2 (typical area – dirty utility or ablution):


Dirty Utility Room (Sluice)     
* Enamel paint, epoxy coating, porcelain or ceramic tiles, etc.


Duty Room     
Examples of wall finishes for Class 3 (typical room – passage, restroom or waiting room):


Equipment Store     
* PVA paint, glazed partitions, wall-paper, timber panels or enamel paint, etc.


General Ward (single or multi-bed)     
Examples of wall finishes for Class 4 (typical area – plant room):


Isolation Ward     
* PVA paint, enamel paint, epoxy coating, etc.


Kit Room     
Refer to Table 2 – Matrix of recommended wall performance categories to establish what performance category the wall of the room in question will require.


Linen Room     
=== 2. Performance categories recommended per room ===


Office     
Department Room Name Wall Performance


Patient Ablutions     
=== 1 2 3 4 5 ===


Patient-assisted Ablution    
Acute Inpatient Wards (Adults) Circulation Space     


Staff Ablutions     
Cleaners’ Room     


Staff Change Room     
Consulting Room     


Staff Restroom     
Day Lounge (patients)     


Surgical Sundries Store     
Dirty Utility Room (Sluice)     


Treatment Room     
Duty Room     


Waiting Area (public)     
Equipment Store    


Ward Kitchen    
General Ward (single or multi-bed)     


Ward Nurses’ Station      
Isolation Ward     


   
Kit Room     


Administration Department Circulation     
Linen Room    


Cleaners’ Room    
Office     


Offices/interview rooms     
Patient Ablutions    


Reception      
Patient-assisted Ablution    


Boardroom     
Staff Ablutions    


Stores    
Staff Change Room     


Kitchenette    
Staff Restroom     


Records Room    
Surgical Sundries Store    


Print room    
Treatment Room     


Staff WCs    
Waiting Area (public)     


Waiting Area (public)     
Ward Kitchen    


   
Ward Nurses’ Station     


Casualty and Trauma Circulation     
   


Cleaners’ Room    
Administration Department Circulation     


Consulting Room     
Cleaners’ Room     


Dirty Utility Room (Sluice)    
Offices/interview rooms     


Duty Room     
Reception     


Equipment Store    
Boardroom     


Hazmat Shower     
Stores    


Minor Theatre /Suture Room    
Kitchenette     


Observation Area     
Records Room    


Office   
Print room     


Patient Ablutions     
Staff WCs     


Patient-assisted Ablution    
Waiting Area (public)     


POPS Suite     
   


Public WCs    
Casualty and Trauma Circulation     


Reception/Nurses’ Station      
Cleaners’ Room    


Rehydration Area     
Consulting Room     


Resuscitation Area    
Dirty Utility Room (Sluice)     


Scrub Area     
Duty Room     


Department Room Name Wall Performance
Equipment Store     


1 2 3 4 5
Hazmat Shower     


Staff Ablutions and Ablutions    
Minor Theatre /Suture Room     


Staff Restroom     
Observation Area     


Surgical Sundries Store    
Office     


Waiting Area (public)     
Patient Ablutions    


  
Patient-assisted Ablution    


Central Sterilising  and Supply Department  (CSSD) Dirty Utility    
POPS Suite     


Chemical Store    
Public WCs    


Circulation     
Reception/Nurses’ Station     


Cleaners’ Room    
Rehydration Area     


Dirty Linen     
Resuscitation Area     


Office     
Scrub Area     


Packing     
Department Room Name Wall Performance


Plant Room     
=== 1 2 3 4 5 ===


Staff Change Room     
Staff Ablutions and Ablutions    


Staff Restroom     
Staff Restroom     


Staff WCs     
Surgical Sundries Store     


Sterile Storage     
Waiting Area (public)     


Sterilisation (autoclaves)     
   


Trolley Wash    
Central Sterilising and Supply Department (CSSD) Dirty Utility     


Washing and Disinfecting Area     
Chemical Store    


   
Circulation     


Community Health Centre Circulation     
Cleaners’ Room    


Cleaners’ Room    
Dirty Linen     


Consulting Room     
Office     


Delivery Room     
Packing     


Dental Surgery     
Plant Room    


Dirty Utility Room (Sluice)    
Staff Change Room    


Dispensary     
Staff Restroom     


Duty Room     
Staff WCs    


Equipment Store    
Sterile Storage     


Guard House or Security Kiosk     
Sterilisation (autoclaves)     


Isolation/Separate Nursing Ward     
Trolley Wash     


Linen Store    
Washing and Disinfecting Area     


Observation Area     
   


Office     
Community Health Centre Circulation     


Offloading/Holding area for Pharmacy    
Cleaners’ Room    


PABX /Server Rooms     
Consulting Room     


Patient Ablutions    
Delivery Room     


Patient-assisted Ablution    
Dental Surgery     


Pharmacy    
Dirty Utility Room (Sluice)     


Plant Room    
Dispensary     


POPS Suite     
Duty Room     


Public WCs and Change Rooms     
Equipment Store     


Reception/Nurses’ Station      
Guard House or Security Kiosk     


Records Room    
Isolation/Separate Nursing Ward     


Recovery Area    
Linen Store     


Rehydration Area     
Observation Area     


Resuscitation Area     
Office     


Staff Ablutions    
Offloading/Holding area for Pharmacy    


Staff Change Room     
PABX /Server Rooms     


Staff Restroom     
Patient Ablutions    


Surgical Sundries Store     
Patient-assisted Ablution     


Treatment Room     
Pharmacy     


Trolley Bay (entrances)     
Plant Room     


Department Room Name Wall Performance
POPS Suite     


1 2 3 4 5
Public WCs and Change Rooms     


Ultrasound Room     
Reception/Nurses’ Station     


Ward   
Records Room     


Waiting Area (public)     
Recovery Area     


X-Ray Room     
Rehydration Area     


   
Resuscitation Area     


Day Clinic (Department) Circulation Space     
Staff Ablutions    


Cleaners’ Room    
Staff Change Room    


Consulting Room     
Staff Restroom     


Dirty Utility Room (Sluice)     
Surgical Sundries Store     


Duty Room     
Treatment Room     


Equipment Store    
Trolley Bay (entrances)    


General Ward (single or multi-bed)     
Department Room Name Wall Performance


Kit Room     
=== 1 2 3 4 5 ===


Linen Room    
Ultrasound Room    


Office     
Ward     


Operating  Theatre     
Waiting Area (public)     


Patient Ablutions    
X-Ray Room     


Patient Waiting      
   


Recovery Area     
Day Clinic (Department) Circulation Space     


Scrub Area    
Cleaners’ Room     


Setting Area     
Consulting Room     


Staff Ablutions and Change Room     
Dirty Utility Room (Sluice)     


Staff Restroom     
Duty Room     


Surgical Sundries Store     
Equipment Store     


Treatment Room     
General Ward (single or multi-bed)     


Waiting Area (public)     
Kit Room     


Ward Kitchen     
Linen Room     


Ward Nurses’ Station      
Office     


   
Operating Theatre     


Dental Unit (Department) Circulation Space     
Patient Ablutions    


Cleaners’ Room    
Patient Waiting     


Consulting Room     
Recovery Area     


Dental Surgery     
Scrub Area     


Dirty Utility Room (Sluice)    
Setting Area     


Equipment Store     
Staff Ablutions and Change Room     


Panoral Room    
Staff Restroom     


Patient Ablutions     
Surgical Sundries Store     


Reception /Office     
Treatment Room     


Records Room    
Waiting Area (public)     


Staff Ablutions     
Ward Kitchen     


Staff Restroom     
Ward Nurses’ Station     


Surgical Sundries Store    
  


Waiting Area (Public)     
Dental Unit (Department) Circulation Space     


  
Cleaners’ Room    


High Care or Cardiac Care Unit (HC/CCU) Circulation     
Consulting Room     


Cleaners’ Room    
Dental Surgery     


Dirty Utility     
Dirty Utility Room (Sluice)     


Duty Room     
Equipment Store    


Equipment Store     
Panoral Room     


Isolation Ward    
Patient Ablutions     


Linen Room    
Reception /Office     


Nurses’ Station   
Records Room     


Open Ward Area    
Staff Ablutions     


Patient Ablutions    
Staff Restroom     


Staff Change Room     
Surgical Sundries Store    


Department Room Name Wall Performance
Waiting Area (Public)     


1 2 3 4 5
    


Staff Restroom     
High Care or Cardiac Care Unit (HC/CCU) Circulation     


Staff WCs     
Cleaners’ Room     


Surgical Sundries Store     
Dirty Utility     


Ward Kitchen    
Duty Room     


  
Equipment Store    


Intensive Care Unit (ICU) Circulation     
Isolation Ward     


Cleaners’ Room     
Linen Room     


Dirty Utility    
Nurses’ Station     


Duty Room     
Open Ward Area     


Equipment Store     
Patient Ablutions     


Isolation Ward     
Staff Change Room     


Linen Room     
Department Room Name Wall Performance


Nurses’ Station     
=== 1 2 3 4 5 ===


Open Ward Area     
Staff Restroom     


Patient Ablutions     
Staff WCs     


Staff Change Room     
Surgical Sundries Store    


Staff Restroom     
Ward Kitchen    


Staff WCs    
  


Surgical Sundries Store    
Intensive Care Unit (ICU) Circulation     


Ward Kitchen     
Cleaners’ Room     


  
Dirty Utility    


Kitchen – (Main Hospital) Bulk Dry Goods Store    
Duty Room     


Chemical Store    
Equipment Store     


Cleaners’ Room    
Isolation Ward     


Cold Room/Freezer specialised
Linen Room     


Cooking Area     
Nurses’ Station     


Cutlery/Crockery Store    
Open Ward Area     


Dishwashing and Potwashing Area     
Patient Ablutions     


Food Preparation Area    
Staff Change Room     


Office     
Staff Restroom     


Plating /Serving Area     
Staff WCs     


Receiving Area     
Surgical Sundries Store     


Staff Ablutions     
Ward Kitchen     


Staff Restroom     
   


Trolley Wash Area     
Kitchen – (Main Hospital) Bulk Dry Goods Store     


   
Chemical Store    


Laboratory
Cleaners’ Room     


(Pathology/Cytology/  
Cold Room/Freezer specialised


Haematology/Chemistry)  
Cooking Area     


(Biosafety Level 2)
Cutlery/Crockery Store     


 
Dishwashing and Potwashing Area     


  Blood and Blood Products Store     
Food Preparation Area     


Cell and Tissue Laboratory    
Office     


Cytopathology Sample Storage     
Plating /Serving Area     


Clinical Material Store     
Receiving Area     


Disposal Area (dangerous materials)     
Staff Ablutions     


Drug and Vaccines Store     
Staff Restroom     


Flammable Goods Store (external)    
Trolley Wash Area    


Gas Cylinder and Pressure Vessel Store    
  


Hazardous Substances Store     
Laboratory


Histopathology Laboratory     
(Pathology/Cytology/


Microbiology Laboratory     
Haematology/Chemistry)


Offices     
(Biosafety Level 2)


POCT consulting room     
Blood and Blood Products Store    


Reagents /Chemical Stores    
Cell and Tissue Laboratory    


Records Rooms    
Cytopathology Sample Storage    


Sample Collection Laboratory     
Clinical Material Store     


Department Room Name Wall Performance
Disposal Area (dangerous materials)     


1 2 3 4 5
Drug and Vaccines Store     


Specimen Reception and  Sorting rooms    
Flammable Goods Store (external)    


Stores (protective clothing/equipment)   
Gas Cylinder and Pressure Vessel Store     


Staff Ablutions    
Hazardous Substances Store    


Staff Change Room including lockers     
Histopathology Laboratory    


Staff Restroom     
Microbiology Laboratory    


   
Offices     


Laundry – (Main Hospital) Assembly, Packing and Dispatch    
POCT consulting room     


Chemical Store     
Reagents /Chemical Stores     


Circulation     
Records Rooms     


Cleaners’ Room     
Sample Collection Laboratory     


Office     
Department Room Name Wall Performance


Pressing      
=== 1 2 3 4 5 ===


Sorting     
Specimen Reception and Sorting rooms     


Staff Ablutions    
Stores (protective clothing/equipment)     


Staff Restroom     
Staff Ablutions    


Stores    
Staff Change Room including lockers     


Washing Room    
Staff Restroom     


    
    


Maternity /Delivery Department Baby Bathing Area    
Laundry – (Main Hospital) Assembly, Packing and Dispatch     


Circulation    
Chemical Store     


Delivery Suite     
Circulation    


Dirty Utility Room     
Cleaners’ Room     


Duty Room     
Office     


Equipment Store     
Pressing     


First Stage Room    
Sorting     


Kit Room     
Staff Ablutions    


Linen Store    
Staff Restroom     


Milk Kitchen    
Stores    


Nurses’ Station     
Washing Room    


Nursery     
   


Patient Ablutions    
Maternity /Delivery Department Baby Bathing Area     


Staff Change Room     
Circulation     


Staff Restroom     
Delivery Suite     


Staff WCs     
Dirty Utility Room     


Surgical Sundries Store    
Duty Room     


Viewing Area     
Equipment Store    


Waiting Area     
First Stage Room     


Ward Kitchen    
Kit Room     


Wards     
Linen Store    


  
Milk Kitchen    


Mental Health Facility Body Room     
Nurses’ Station     


Children's Play Area     
Nursery     


Clean Utility     
Patient Ablutions     


Cleaners’ Room/Station    
Staff Change Room    


Consulting Room     
Staff Restroom     


Counselling Room     
Staff WCs    


Dirty Linen     
Surgical Sundries Store     


Dirty Utility (Sluice)    
Viewing Area     


ECT Procedure Room     
Waiting Area     


En Suite Bath/Shower Room     
Ward Kitchen     


Equipment Store    
Wards     


Group Therapy Room     
   


Department Room Name Wall Performance
Mental Health Facility Body Room     


1 2 3 4 5
Children's Play Area     


Gymnasium (OT and Physio)     
Clean Utility    


IT Room     
Cleaners’ Room/Station    


Kit Room     
Consulting Room     


Linen Store    
Counselling Room     


Medicine Store     
Dirty Linen     


Multi-Purpose Hall     
Dirty Utility (Sluice)    


Nurses’ Station     
ECT Procedure Room     


Office     
En Suite Bath/Shower Room    


Patient-assisted Bathroom/Shower     
Equipment Store     


Patient Dining Room     
Group Therapy Room     


Patient Laundry     
Department Room Name Wall Performance


Patient Lounge     
=== 1 2 3 4 5 ===


Pharmacy     
Gymnasium (OT and Physio)     


Quiet Room     
IT Room     


Records Room    
Kit Room     


Seclusion Room    
Linen Store     


Security Control Room     
Medicine Store    


Security Search Room     
Multi-Purpose Hall     


Staff Change Room and WCs    
Nurses’ Station     


Surgical Sundries Store    
Office     


Treatment Room    
Patient-assisted Bathroom/Shower     


Wards     
Patient Dining Room     


Ward Kitchen     
Patient Laundry     


Waste Disposal Room     
Patient Lounge     


   
Pharmacy     


Mortuary Blue Room     
Quiet Room     


Circulation Space    
Records Room    


Cleaners’ Room    
Seclusion Room     


Dirty Utility    
Security Control Room     


Instruments Room    
Security Search Room     


Linen Room     
Staff Change Room and WCs     


Medical Observation Room    
Surgical Sundries Store     


Office     
Treatment Room     


Pathologist Change Room     
Wards     


Post-Mortem Room    
Ward Kitchen     


Staff Change Room    
Waste Disposal Room     


Staff WCs    
  


Viewing Room     
Mortuary Blue Room     


Visitors’ Waiting Room     
Circulation Space    


  
Cleaners’ Room    


Neonatal Intensive Care Unit (NNICU) Circulation    
Dirty Utility     


Cleaners’ Room     
Instruments Room     


Dirty Utility     
Linen Room     


Duty Room     
Medical Observation Room     


Equipment Store    
Office     


Incubator Ward Area     
Pathologist Change Room     


Isolation Ward     
Post-Mortem Room     


Linen Room     
Staff Change Room     


Milk Kitchen     
Staff WCs     


Mothers’ Rest Area     
Viewing Room     


Nurses’ Station     
Visitors’ Waiting Room     


Staff Change Room     
   


Staff Restroom     
Neonatal Intensive Care Unit (NNICU) Circulation     


Staff WCs     
Cleaners’ Room     


Surgical Sundries Store     
Dirty Utility     


Department Room Name Wall Performance
Duty Room     


1 2 3 4 5
Equipment Store     


   
Incubator Ward Area     


Operating Theatre (Department) Circulation     
Isolation Ward     


Cleaners’ Room     
Linen Room     


Dirty Utility     
Milk Kitchen     


Duty Room     
Mothers’ Rest Area     


Equipment Store    
Nurses’ Station     


Nurses’ Station     
Staff Change Room     


Operating Theatre     
Staff Restroom     


Post-Operative Recovery Area    
Staff WCs     


Pre-Operative Holding Area    
Surgical Sundries Store     


Scrub-up Area/Room     
Department Room Name Wall Performance


Setting Room     
=== 1 2 3 4 5 ===


Staff Change Room     
   


Staff Restroom     
Operating Theatre (Department) Circulation     


Staff WCs     
Cleaners’ Room     


Surgical Sundries Store     
Dirty Utility     


   
Duty Room     


Outpatients Department  Reception /Nurses’ Station     
Equipment Store    


Admissions Room     
Nurses’ Station     


Baby Changing Area     
Operating Theatre     


Children’s Play /Waiting Area     
Post-Operative Recovery Area     


Circulation     
Pre-Operative Holding Area     


Consulting Room     
Scrub-up Area/Room     


Dirty Utility Room    
Setting Room     


Duty Room     
Staff Change Room     


Equipment Store    
Staff Restroom     


Kitchenette     
Staff WCs     


Linen Store     
Surgical Sundries Store     


Offices     
   


POPS Room     
Outpatients Department Reception /Nurses’ Station     


Public Ablutions    
Admissions Room     


Records Room    
Baby Changing Area    


Staff Ablutions    
Children’s Play /Waiting Area     


Staff Change Room     
Circulation     


Staff Restroom     
Consulting Room     


Surgical Sundries Store     
Dirty Utility Room     


Treatment Room     
Duty Room     


Waiting Areas (public)     
Equipment Store    


Wheelchair storage area    
Kitchenette    


  
Linen Store    


Paediatric Ward Child-assist Ablution    
Offices     


Circulation Space     
POPS Room     


Cleaners’ Room     
Public Ablutions     


Consulting Room   
Records Room    


Dirty Utility (Isolation)    
Staff Ablutions     


Dirty Utility Room (Sluice)    
Staff Change Room    


Duty Room     
Staff Restroom     


Equipment Store     
Surgical Sundries Store     


General Ward (single or multi-bed)     
Treatment Room     


Isolation Ward     
Waiting Areas (public)     


Kit Room   
Wheelchair storage area     


Linen Room    
  


Milk /Ward Kitchen     
Paediatric Ward Child-assist Ablution     


Nurses’ Station      
Circulation Space     


Office     
Cleaners’ Room    


Department Room Name Wall Performance
Consulting Room     


1 2 3 4 5
Dirty Utility (Isolation)     


Parent Ablutions     
Dirty Utility Room (Sluice)     


Play Area (patients)     
Duty Room     


Staff Change Room     
Equipment Store    


Staff Restroom     
General Ward (single or multi-bed)     


Staff WCs    
Isolation Ward     


Surgical Sundries Store    
Kit Room     


Treatment Room    
Linen Room    


  
Milk /Ward Kitchen    


Pharmacy/Dispensary Cleaners’ Room    
Nurses’ Station     


Bulk Stores    
Office     


Circulation Space     
Department Room Name Wall Performance


Counselling Cubicle     
=== 1 2 3 4 5 ===


Dispensary    
Parent Ablutions     


Liquid Filling Room     
Play Area (patients)     


Office     
Staff Change Room     


Offloading Bay    
Staff Restroom     


Patient Waiting Room     
Staff WCs    


Schedule Drugs Strong Room    
Surgical Sundries Store     


Staff Change Room     
Treatment Room     


Staff WCs    
  


Tablet Packing Room    
Pharmacy/Dispensary Cleaners’ Room    


Vacolitre Stores     
Bulk Stores     


   
Circulation Space     


Physiotherapy  Department  Audiology Testing     
Counselling Cubicle     


Circulation     
Dispensary     


Consulting Room     
Liquid Filling Room     


Equipment Store    
Office     


Gymnasium   
Offloading Bay     


Kitchenette    
Patient Waiting Room     


Occupational Therapy Room     
Schedule Drugs Strong Room     


Patient Ablutions    
Staff Change Room     


Reception     
Staff WCs    


Speech Therapy     
Tablet Packing Room     


Staff Restroom   
Vacolitre Stores     


Staff WCs    
  


Treatment Room     
Physiotherapy Department Audiology Testing     


Waiting Area     
Circulation     


   
Consulting Room     


Primary Health Clinic Circulation     
Equipment Store    


Cleaners’ Room    
Gymnasium     


Consulting Room     
Kitchenette    


Delivery Room     
Occupational Therapy Room     


Dirty Utility Room (Sluice)     
Patient Ablutions     


Dispensary and Pharmacy     
Reception     


Duty Room     
Speech Therapy     


Equipment Store    
Staff Restroom     


Guard House or Security Kiosk     
Staff WCs    


Linen Store    
Treatment Room     


Observation /Rehydration Area     
Waiting Area     


Office     
   


Public Ablutions    
Primary Health Clinic Circulation     


Plant Room    
Cleaners’ Room     


POPS Suite     
Consulting Room     


Reception/Nurses’ Station      
Delivery Room     


Records Room    
Dirty Utility Room (Sluice)    


Department Room Name Wall Performance
Dispensary and Pharmacy     


1 2 3 4 5
Duty Room     


Staff Ablutions and Change Room     
Equipment Store     


Staff Restroom     
Guard House or Security Kiosk     


Surgical Sundries Store     
Linen Store     


Treatment Room     
Observation /Rehydration Area     


Trolley Bay (entrances)    
Office     


Waiting Area (public)     
Public Ablutions    


  
Plant Room    


Radiology (Diagnostic) Bucky Room (general X-ray Room)     
POPS Suite     


Change Cubicles     
Reception/Nurses’ Station     


Circulation   
Records Room     


Cleaners’ Room     
Department Room Name Wall Performance


CT /MRI Scan Room     
=== 1 2 3 4 5 ===


Dirty Utility /Sluice     
Staff Ablutions and Change Room     


Fluoroscopy Room     
Staff Restroom     


Fluoroscopy Control Room    
Surgical Sundries Store     


Inpatient Waiting Area     
Treatment Room     


Kitchenette    
Trolley Bay (entrances)    


Linen Room    
Waiting Area (public)     


Mammogram Room     
   


Office     
Radiology (Diagnostic) Bucky Room (general X-ray Room)     


Patient Ablutions    
Change Cubicles     


Public Waiting Area     
Circulation     


Porters and Wheelchair/Trolley Parking    
Cleaners’ Room    


Reception     
CT /MRI Scan Room     


Records Room    
Dirty Utility /Sluice    


Server Room     
Fluoroscopy Room     


Staff Restroom     
Fluoroscopy Control Room     


Staff WCs    
Inpatient Waiting Area     


Stores (Equipment/General)    
Kitchenette    


Ultrasound Room     
Linen Room     


Telemedicine Room     
Mammogram Room     


Viewing Room/CR Room/Reporting Area     
Office     


  
Patient Ablutions    


Nurses’ Residences Ablutions    
Public Waiting Area     


Bedrooms   
Porters and Wheelchair/Trolley Parking     


Circulation     
Reception     


Kitchenette    
Records Room    


Lounge     
Server Room     


Offices     
Staff Restroom     


Public Ablutions     
Staff WCs     


Reception    
Stores (Equipment/General)     


Stores    
Ultrasound Room     


Waiting Areas (public)     
Telemedicine Room     


   
Viewing Room/CR Room/Reporting Area     


    


DEFINITIONS
Nurses’ Residences Ablutions     


Bedrooms     


1. Terminology
Circulation     


Kitchenette     


Aggregation Collected together from different sources and considered a whole.
Lounge     


Ambulant/ambulatory  (of a patient) Being able to walk or move around; not being confined to a bed.
Offices     


Bacteriostatic  A word used to describe the property of a material that claims to inhibit the multiplication of bacteria.
Public Ablutions     


Bariatric Describing the condition of obesity.
Reception     


Bonded Chemically attached or fused in layers.
Stores     


       Emulsion In the context of paint – referring to water-based paint that is not shiny when     dry.
Waiting Areas (public)     


Guarantee A document setting out a promise of quality made by a manufacturer or the provider of a service, a formal promise that a product will be repaired free of charge if it breaks or fails within a particular period or that substandard work will be redone.
    


Homogenous Consisting of things of similar type throughout.
== Definitions ==


Heterogeneous Consisting of various layers or types throughout.  
=== 1. Terminology ===


Hygroscopic Readily absorbing moisture from the atmosphere.  
Aggregation Collected together from different sources and considered a whole.


Hydrophobic Water-repellent.  
Ambulant/ambulatory (of a patient) Being able to walk or move around; not being confined to a bed.


Impervious Not allowing passage through (usually of water/moisture).  
Bacteriostatic A word used to describe the property of a material that claims to inhibit the multiplication of bacteria.


Interstices Small holes or perforations.  
Bariatric Describing the condition of obesity.


Jointed  Junctions which may be open or covered, but not completely sealed and smooth.  
Bonded Chemically attached or fused in layers.


Jointless  Without joints or having joints that are sealed by materials and methods that make the whole surface imperious and prevent the collection of dirt and bacteria in the joint.  
Emulsion In the context of paint – referring to water-based paint that is not shiny when dry.


Olfactory Relating to the smell or the sense of smell.  
Guarantee A document setting out a promise of quality made by a manufacturer or the provider of a service, a formal promise that a product will be repaired free of charge if it breaks or fails within a particular period or that substandard work will be redone.


Perfusion Inject liquid into tissue or organ by circulating through blood vessels in the body.  
Homogenous Consisting of things of similar type throughout.


Polyamide Aa synthetic polymer made by the linkage of an amino group of one molecule and a carboxylic acid group of another, including many synthetic fibres such as nylon.  
Heterogeneous Consisting of various layers or types throughout.


Resilient finish The quality of a material to spring back quickly into shape after being bent, stretched or squashed.  
Hygroscopic Readily absorbing moisture from the atmosphere.


Seamless A surface without open joints or junctions, or where such joints are completely sealed and smoothed to create a continuous and whole membrane.  
Hydrophobic Water-repellent.


Smooth surface A flat surface without projections, indentations or perforations such as a brush-painted plastered surface.  
Impervious Not allowing passage through (usually of water/moisture).


Textured A surface finish that is not smooth, but has a fissured/embossed or ridged finish.  
Interstices Small holes or perforations.


Vitrified To change a material into glass, under high heat and other conditions.  
Jointed Junctions which may be open or covered, but not completely sealed and smooth.


Washable A term implying that a finish can be repeatedly and regularly cleaned using water and water-diluted cleaners without detrimental effect to the finish.  
Jointless Without joints or having joints that are sealed by materials and methods that make the whole surface imperious and prevent the collection of dirt and bacteria in the joint.


Warranty A written promise to repair or replace a product that has a manufacturing fault. This commonly comes with conditions and is limited to a time-frame given at the time of purchase. 
Olfactory Relating to the smell or the sense of smell.


2. Abbreviations
Perfusion Inject liquid into tissue or organ by circulating through blood vessels in the body.


Polyamide Aa synthetic polymer made by the linkage of an amino group of one molecule and a carboxylic acid group of another, including many synthetic fibres such as nylon.


BRE Building Research Establishment
Resilient finish The quality of a material to spring back quickly into shape after being bent, stretched or squashed.


CHD Center for Health Design
Seamless A surface without open joints or junctions, or where such joints are completely sealed and smoothed to create a continuous and whole membrane.


ENT Ear, Nose and Throat
Smooth surface A flat surface without projections, indentations or perforations such as a brush-painted plastered surface.


HAI  Healthcare-associated infections  
Textured A surface finish that is not smooth, but has a fissured/embossed or ridged finish.


HDF High-density fibreboard
Vitrified To change a material into glass, under high heat and other conditions.


IAQ Indoor Environmental Quality IEQ Indoor Environmental Quality
Washable A term implying that a finish can be repeatedly and regularly cleaned using water and water-diluted cleaners without detrimental effect to the finish.


IUSS  Infrastructure Unit Systems Support
Warranty A written promise to repair or replace a product that has a manufacturing fault. This commonly comes with conditions and is limited to a time-frame given at the time of purchase.


MDF Medium-density fibreboard
=== 2. Abbreviations ===


MRSA   Methicillin-resistant Staphylococcus Aureus, which is a common skin bacterium that is  resistant to a range of antibiotics otherwise referred to as  multi-drug resistant bacteria
BRE Building Research Establishment


NDoH  National Department of Health  
CHD Center for Health Design


OoM  Order of Magnitude
ENT Ear, Nose and Throat


PMIS  Project Management Information System
HAI Healthcare-associated infections


PMSU  Project Management Support Unit
HDF High-density fibreboard


PUR Polyurethane-resistant
IAQ Indoor Environmental Quality IEQ Indoor Environmental Quality


PVC Polyvinyl-chloride
IUSS Infrastructure Unit Systems Support


RC  Recommendation Committee
MDF Medium-density fibreboard


SANS South African National Standard
MRSA Methicillin-resistant Staphylococcus Aureus, which is a common skin bacterium that is resistant to a range of antibiotics otherwise referred to as multi-drug resistant bacteria


TIG Tungsten inert gas
NDoH National Department of Health


VOC      Volatile organic compound
OoM Order of Magnitude


VRE Vancomycin-resistant Enterococci (drug-resistant bacteria that can lead to HAIs)  
PMIS Project Management Information System


PMSU Project Management Support Unit


REFERENCES  
PUR Polyurethane-resistant


PVC Polyvinyl-chloride


1. Bibliography
RC Recommendation Committee


SANS South African National Standard


Alcorn, A. and Wood, P., 1998. New Zealand building materials embodied energy coefficients database. (Volume II-Coefficients). Wellington, New Zealand: Centre for Building Performance Research.
TIG Tungsten inert gas


Cement & Concrete Institute (CCI), 2009. Sand-cement screeds and concrete toppings for floors. [pdf] Midrand, South Africa: CCI. Available at:
VOC Volatile organic compound


<nowiki>http://www.afrisam.co.za/media/13770/Sand_cement_floor_screeds_and_concrete_toppings_for_floors.pdf</nowiki>[Ac cessed 9 April 2014].
VRE Vancomycin-resistant Enterococci (drug-resistant bacteria that can lead to HAIs)


Center for Health Assets Australasia, 2009. Floor coverings in healthcare buildings. (Technical series TS-7 version 1.1). New South Wales:NSW Health.
== References ==


Dean, Y., 1996. Finishes. 4th ed. Harlow, UK: Addison Wesley Longman Ltd.  
=== 1. Bibliography ===


Department of Health (DH), 2010. Core elements: Health Building Note 00-03: Clinical and clinical support spaces. UK: DH.  
Alcorn, A. and Wood, P., 1998. New Zealand building materials embodied energy coefficients database. (Volume II-Coefficients). Wellington, New Zealand: Centre for Building Performance Research.


Department of Health (DoH), 1980. Regulations governing private hospitals and unattached operating theatres. (Government notice No. R.158 of the Health Act, 1971. (C.63). Cape Town South Africa: Government Gazette.  
Cement & Concrete Institute (CCI), 2009. Sand-cement screeds and concrete toppings for floors. [pdf] Midrand, South Africa: CCI. Available at:


Department of Health Finance and Investment Directorate Estates and Facilities Division, 2006. Health
<nowiki>http://www.afrisam.co.za/media/13770/Sand_cement_floor_screeds_and_concrete_toppings_for_floors.pdf</nowiki>[Ac cessed 9 April 2014].


Technical Memorandum 61: Building component series flooring. [pdf] London: The Stationery Office. Available at: <nowiki>http://www.wales.nhs.uk/sites3/Documents/254/HTM%2061%202006.pdf</nowiki> [Accessed 9 April 2014].  
Center for Health Assets Australasia, 2009. Floor coverings in healthcare buildings. (Technical series TS-7 version 1.1). New South Wales:NSW Health.


Department of Health Gateway Review, Estates & Facilities Division, 2011. Performance requirements for building elements used in healthcare facilities. (Version:0.6:England). [pdf] Leeds: HMSO. Available at: <nowiki>http://www.derbyshirelmc.org.uk/Guidance/8941-England-8941_0.6_England.pdf</nowiki> [Accessed 9 April 2014].  
Dean, Y., 1996. Finishes. 4th ed. Harlow, UK: Addison Wesley Longman Ltd.


Department of Health, n.d. R&D project B(04)02: Developing an integrated system for the optimal selection of hospital finishes. Aberdeen, Scotland: Department of Health.  
Department of Health (DH), 2010. Core elements: Health Building Note 00-03: Clinical and clinical support spaces. UK: DH.


HermanMiller Healthcare, 2006. Sound practices: Noise control in the healthcare environment. (Research summary/2006). Zeeland, Michigan: Herman Miller.  
Department of Health (DoH), 1980. Regulations governing private hospitals and unattached operating theatres. (Government notice No. R.158 of the Health Act, 1971. (C.63). Cape Town South Africa: Government Gazette.


Joseph, A., 2006. The impact of light on outcomes in healthcare settings. Concord, CA: The Center for Health Design. Available at: <nowiki>http://www.healthdesign.org/sites/default/files/CHD_Issue_Paper2.pdf</nowiki> [Accessed 9 April 2014].
Department of Health Finance and Investment Directorate Estates and Facilities Division, 2006. Health


Joseph, A., Malone, E., Pati, D. and Quan, X., 2011. Healthcare environmental terms and outcome measures: An evidence-based design glossary. Concord, CA:The Center for Health Design.  
Technical Memorandum 61: Building component series flooring. [pdf] London: The Stationery Office. Available at: <nowiki>http://www.wales.nhs.uk/sites3/Documents/254/HTM%2061%202006.pdf</nowiki> [Accessed 9 April 2014].


Jung, W.K., Koo, H.C., Kim, K.W., Shin, S., Kim, S.H. and Park, Y.H., 2008. Antibacterial activity and mechanism of action of the silver ion in staphylococcus aureus and escherichia coli. Applied and Environmental Microbiology, 74(7), pp.2171-2178.  
Department of Health Gateway Review, Estates & Facilities Division, 2011. Performance requirements for building elements used in healthcare facilities. (Version:0.6:England). [pdf] Leeds: HMSO. Available at: <nowiki>http://www.derbyshirelmc.org.uk/Guidance/8941-England-8941_0.6_England.pdf</nowiki> [Accessed 9 April 2014].


Lavy, S., 2010. Facility managers’ preferred interior wall finishes in acute-care hospital buildings. In: CIB, 18th CIB World Building Congress: Facilities management and maintenance. Salford, United Kingdom, 10-13 May 2010. Salford, United Kingdom: CIB.  
Department of Health, n.d. R&D project B(04)02: Developing an integrated system for the optimal selection of hospital finishes. Aberdeen, Scotland: Department of Health.


Makison, C. and Swan, J., 2005. The effect of humidity on the survival of MRSA on hard surfaces. (R&D report B(03)02). [pdf] London: Estates and Facilities Division of the Department of Health. Available at: <nowiki>http://www.wales.nhs.uk/sites3/Documents/254/B(03)02%20MRSA.pdf</nowiki> [Accessed 9 April 2014].  
HermanMiller Healthcare, 2006. Sound practices: Noise control in the healthcare environment. (Research summary/2006). Zeeland, Michigan: Herman Miller.


Nanda, U., Malone, E. and Joseph, A., 2012. Achieving EBD goals through flooring selection & design. [pdf] Concord, CA:The Center for Health Design. Available at:  
Joseph, A., 2006. The impact of light on outcomes in healthcare settings. Concord, CA: The Center for Health Design. Available at: <nowiki>http://www.healthdesign.org/sites/default/files/CHD_Issue_Paper2.pdf</nowiki> [Accessed 9 April 2014].


<nowiki>http://www.healthdesign.org/sites/default/files/chd_achieving_ebd_goals_through_flooring__design_final_0.pd</nowiki> f [Accessed 9 April 2014].  
Joseph, A., Malone, E., Pati, D. and Quan, X., 2011. Healthcare environmental terms and outcome measures: An evidence-based design glossary. Concord, CA:The Center for Health Design.


NHS Estates, 2005. Health Technical Memorandum (HTM) 56: Building component series: Partitions. UK: TSO.  
Jung, W.K., Koo, H.C., Kim, K.W., Shin, S., Kim, S.H. and Park, Y.H., 2008. Antibacterial activity and mechanism of action of the silver ion in staphylococcus aureus and escherichia coli. Applied and Environmental Microbiology, 74(7), pp.2171-2178.


NHS Estates, 2005. Health Technical Memorandum (HTM) 60: Ceilings. 2nd ed. UK: TSO.  
Lavy, S., 2010. Facility managers’ preferred interior wall finishes in acute-care hospital buildings. In: CIB, 18th CIB World Building Congress: Facilities management and maintenance. Salford, United Kingdom, 10-13 May 2010. Salford, United Kingdom: CIB.


NHS, National Services Scotland, 2006. Scottish Health Technical Memorandum (SHTM) 61: Building component series: Flooring. Scotland:Health Facilities Scotland.  
Makison, C. and Swan, J., 2005. The effect of humidity on the survival of MRSA on hard surfaces. (R&D report B(03)02). [pdf] London: Estates and Facilities Division of the Department of Health. Available at: <nowiki>http://www.wales.nhs.uk/sites3/Documents/254/B(03)02%20MRSA.pdf</nowiki> [Accessed 9 April 2014].


NHS, National Services Scotland, 2007. Scottish Health Facilities Note 30: Infection control in the built environment: Design and planning. (Version 3). Scotland:Health Facilities Scotland.  
Nanda, U., Malone, E. and Joseph, A., 2012. Achieving EBD goals through flooring selection & design. [pdf] Concord, CA:The Center for Health Design. Available at:


NHS, National Services Scotland, 2009. Scottish Health Technical Memorandum (SHTM) 61: Building component series: Flooring. Scotland:Health Facilities Scotland.  
<nowiki>http://www.healthdesign.org/sites/default/files/chd_achieving_ebd_goals_through_flooring__design_final_0.pd</nowiki> f [Accessed 9 April 2014].


PricewaterhouseCoopers LLP (PwC) in association with the University of Sheffield and Queen Margaret University College, 2004. The role of hospital design in the recruitment, retention and performance of NHS nurses in England. (Full report). [pdf] Edinburgh: Commission for Architecture and the Built Environment (CABE). Available at: <nowiki>http://webarchive.nationalarchives.gov.uk/20110118095356/http:/www.cabe.org.uk/files/therole-of-hospital-design.pdf</nowiki> [Accessed 9 April 2014].  
NHS Estates, 2005. Health Technical Memorandum (HTM) 56: Building component series: Partitions. UK: TSO.


Tofle, R.B., Schwartz, B., Yoon, S., Max-Royale, A., 2003. Color in healthcare environments: A critical review of the research literature. California: The Coalition for Health Environments Research (CHER).  
NHS Estates, 2005. Health Technical Memorandum (HTM) 60: Ceilings. 2nd ed. UK: TSO.


Ulrich, R. S. P., Zimring, C. P., Zhu, X., Dubose, M., Seo, H. B., Choi, Y. S. and Joseph, A. P., 2008. A review of the research literature on evidence-based healthcare design (Part II). Health Environments Research & Design Journal, 1(2008), 61-125.  
NHS, National Services Scotland, 2006. Scottish Health Technical Memorandum (SHTM) 61: Building component series: Flooring. Scotland:Health Facilities Scotland.


Welsh Health Estates, 2009. Health Building Note 04-01: Adult in-patient accommodation. Cardiff, Wales:Welsh Health Estates.  
NHS, National Services Scotland, 2007. Scottish Health Facilities Note 30: Infection control in the built environment: Design and planning. (Version 3). Scotland:Health Facilities Scotland.


NHS, National Services Scotland, 2009. Scottish Health Technical Memorandum (SHTM) 61: Building component series: Flooring. Scotland:Health Facilities Scotland.


2. Websites: Further reading
PricewaterhouseCoopers LLP (PwC) in association with the University of Sheffield and Queen Margaret University College, 2004. The role of hospital design in the recruitment, retention and performance of NHS nurses in England. (Full report). [pdf] Edinburgh: Commission for Architecture and the Built Environment (CABE). Available at: <nowiki>http://webarchive.nationalarchives.gov.uk/20110118095356/http:/www.cabe.org.uk/files/therole-of-hospital-design.pdf</nowiki> [Accessed 9 April 2014].


Tofle, R.B., Schwartz, B., Yoon, S., Max-Royale, A., 2003. Color in healthcare environments: A critical review of the research literature. California: The Coalition for Health Environments Research (CHER).


Error! Hyperlink reference not valid.(Health Technical Manuals  – United Kingdom)  
Ulrich, R. S. P., Zimring, C. P., Zhu, X., Dubose, M., Seo, H. B., Choi, Y. S. and Joseph, A. P., 2008. A review of the research literature on evidence-based healthcare design (Part II). Health Environments Research & Design Journal, 1(2008), 61-125.


Error! Hyperlink reference not valid.(Precautionary Lists of Building Ingredients related to health effects and risks)
Welsh Health Estates, 2009. Health Building Note 04-01: Adult in-patient accommodation. Cardiff, Wales:Welsh Health Estates.


Error! Hyperlink reference not valid.(Sustainable Flooring benefits Hospitals in a variety of ways) <nowiki>http://www.GreenhealthMagazine.org</nowiki>
=== 2. Websites: Further reading ===


<nowiki>http://greenhomeguide.com</nowiki> (Are Engineered wood products from Decorative Flooring a low VOC product? Joel Hirschberg, 2011) <nowiki>http://gbcsa.org.za</nowiki> (IEQ rating tools)  
Error! Hyperlink reference not valid.(Health Technical Manuals – United Kingdom)


<nowiki>http://www.green-buildings.com</nowiki> (Green Flooring: Linoleum, Marmoleum and Vinyl – Claire Maloney, LEED Green Associate, Cornell University 2013)  
Error! Hyperlink reference not valid.(Precautionary Lists of Building Ingredients related to health effects and risks)


<nowiki>http://www.healthcaredesignmagazine.com</nowiki>  (Five need to know trends shaping healthcare Design – K. Edmundson, 2011) <nowiki>http://www.carpet-rug.org/documents/technical-bulletins</nowiki> (Carpet Treatments) <nowiki>http://www.floorworx.co.za</nowiki> (Vinyl wall cladding and protection manufacturer) <nowiki>http://www.polyflor.co.za</nowiki> (Vinyl wall cladding and protection manufacturer) <nowiki>http://www.sassda.co.za</nowiki> (South African Stainless Steel Development Association)  
Error! Hyperlink reference not valid.(Sustainable Flooring benefits Hospitals in a variety of ways) <nowiki>http://www.GreenhealthMagazine.org</nowiki>


<nowiki>http://greenhomeguide.com</nowiki> (Are Engineered wood products from Decorative Flooring a low VOC product? Joel Hirschberg, 2011) <nowiki>http://gbcsa.org.za</nowiki> (IEQ rating tools)


PHOTOGRAPHIC AND ILLUSTRATION CREDITS
<nowiki>http://www.green-buildings.com</nowiki> (Green Flooring: Linoleum, Marmoleum and Vinyl – Claire Maloney, LEED Green Associate, Cornell University 2013)


<nowiki>http://www.healthcaredesignmagazine.com</nowiki> (Five need to know trends shaping healthcare Design – K. Edmundson, 2011) <nowiki>http://www.carpet-rug.org/documents/technical-bulletins</nowiki> (Carpet Treatments) <nowiki>http://www.floorworx.co.za</nowiki> (Vinyl wall cladding and protection manufacturer) <nowiki>http://www.polyflor.co.za</nowiki> (Vinyl wall cladding and protection manufacturer) <nowiki>http://www.sassda.co.za</nowiki> (South African Stainless Steel Development Association)


Cover photo:  R. van Rensburg
== Photographic And Illustration Credits ==


Fig.1-2 M. Swinney
Cover photo: R. van Rensburg


Fig.3 G. Abbott- CSIR  
Fig.1-2 M. Swinney


Fig.4 R. Cubbin based on Life Cycle
Fig.3 G. Abbott- CSIR


Floor Cost Table – by Nora®,
Fig.4 R. Cubbin based on Life Cycle


USA  
Floor Cost Table – by Nora®,


Fig.5 R. Cubbin
USA


Fig.6-7 M. Swinney  
Fig.5 R. Cubbin


Fig.8 R. van Rensburg
Fig.6-7 M. Swinney


Fig.9-14 M. Swinney  
Fig.8 R. van Rensburg


Fig.15 R. van Rensburg
Fig.9-14 M. Swinney


Fig.16 R. van Rensburg  
Fig.15 R. van Rensburg


Fig.17 R. van Rensburg  
Fig.16 R. van Rensburg


Fig.18-24 M. Swinney  
Fig.17 R. van Rensburg


Fig.25 R. van Rensburg  
Fig.18-24 M. Swinney


Fig.26-27 M. Swinney
Fig.25 R. van Rensburg


Fig.28 C. Hudson
Fig.26-27 M. Swinney


Fig.29 R. van Rensburg
Fig.28 C. Hudson


Fig.30 M. Swinney
Fig.29 R. van Rensburg


Fig.31 R. van Rensburg
Fig.30 M. Swinney


Fig.32-34 M. Swinney
Fig.31 R. van Rensburg


Fig.35 R. Cubbin
Fig.32-34 M. Swinney


Fig.36-38 M. Swinney
Fig.35 R. Cubbin


Fig.39-40 R. van Rensburg
Fig.36-38 M. Swinney


Fig.41 M. Swinney  
Fig.39-40 R. van Rensburg


Fig.42-44 R. van Rensburg
Fig.41 M. Swinney


Fig.43 M. Swinney  
Fig.42-44 R. van Rensburg


Fig. 44 R. Cubbin
Fig.43 M. Swinney


Fig.45 M. Swinney  
Fig. 44 R. Cubbin


Fig.45 M. Swinney


<br />
[[Category:Crosscutting Issues]]
[[Category:Crosscutting Issues]]

Revision as of 16:01, 20 April 2026

Context

1. Overview – Finishes in the healthcare environment

Building finishes account for a large proportion of the overall cost of constructing a healthcare facility. According to Shohet et al. (2002), interior finishing and interior construction accounts for 32% of the initial budget. Maintenance and cleaning of finishes adds substantially to the ‘whole-life costs’ of finishes within a hospital or healthcare facility.

Despite this, finishes are often treated as optional and purely aesthetic components of the building and the spaces within it. When budget constraints are implemented, the finishes are usually the first area to suffer. Institutions will often standardise finishes across a spectrum of rooms/facilities for economy in replacement and/or cleaning regimes.

Interior finishes, however, play a vital role in the healthcare environment,

and contribute substantially to the delivery of healthcare service and the protection of staff and patients.

Interior finishes play a vital role in a healthcare facility, as proper wall

treatments can contribute to the

creation and maintenance of a positive

therapeutic environment for patients

(Mayer, 2005)

In a study conducted by PricewaterhouseCoopers LLP (PwC) in association with the University of Sheffield and Queen Margaret University College, 2004, the comments from the majority of people who visited hospitals, including staff and patients, included “ cold, depressing, dehumanising, Kafkaesque, dirty, smelly, frightening, impersonal, confusing, dull shabby, windowless, grim, stressful…”. While it is a fact that most patients interviewed may have been negative as a result of their being ill, it does highlight a problem of the inhumane and

threatening appearance of hospital environments “UNTIL THE GERM THEORY WAS DEVELOPED, (historically) where even more attention should be paid MORE MEN WERE DYING FROM SMALL WOUNDS

AND DISEASES THAN FROM MAJOR TRAUMAS to creating a caring atmosphere.

ON THE FRONTLINES. BUT AS SOON AS GERM

It is this paradigm shift that is required when THEORY WAS DEVELOPED A WHOLE NEW considering and selecting finishes. The role of finishes in PARADIGM, A BETTER WAY OF UNDERSTANDING

WHAT WAS HAPPENING MADE DRAMATIC

a healthcare facility has become as important an aspect SIGNIFICANT MEDICAL IMPROVEMENT

of design as room sizes and relationships.

Building finishes are usually seen as a separate and final application to the building structure (Dean, 1996). There are however, instances where the finish is integral to the structure. These documents therefore include finishes and materials in such cases.

2. Suite of documents

This document forms part of a series of documents addressing internal materials and finishes in health facilities, which in turn forms part of the suite of documents created under the IUSS Project. The aim of the materials and finishes suite of documents is to provide guidance on design and specification for the various building components where current legislation, including the National Building Regulations, does not adequately cover suitability of finishes in the healthcare facility context.

While the guidelines speak mostly of new building work, most of the principles are consistent with refurbishment projects to existing buildings as well.

  • Other IUSS health facility guides in this series include:

Internal Floor Finishes.

  • Internal Ceiling Finishes
  • Joinery and Storage Systems (to follow)
  • Doors and Ironmongery (to follow)
  • Sanitary Ware (to follow)
  • Signage and Way-finding (to follow)

These guidelines are updated and revised periodically, and can be accessed at www.iussonline.co.za

The primary objective of this technical guide is to assist decision-makers with the selection of ‘appropriate’ wall finishes in the health facility context.

The guide looks at the context (Part A), then examines various selection criteria (Part B), then summarises technical information of various wall finishes (Part C) to assist with assessing the best finish for the facility. Finally, the selection criteria are grouped together to form performance categories (Part D) and a matrix of rooms, which indicates the most relevant performance category. The guide also examines various protection types to walls, including bump-rails and corner protection.

3. Policy context

This document offers guidance on the selection of appropriate wall finishes in health facilities. While the aim is to inform project and design teams about the wide range of considerations to take into account when selecting finishes, it does not diminish the responsibility of the design team to comply with all applicable professional and regulatory obligations and to specify materials and finishes ‘fit for purpose’.

Some of the pertinent regulations are the following:

  • National Building Regulations and Building Standards Act, 1977 (Act 103 of 1977) amended 30 May 2008
  • SANS 10400, Code of Practice for the application of the National Building Regulations, first rev. August 1990
  • R158, Government Notice dated February 1980 (updated March 1993) Regulation pertaining to control of private hospitals, (revised 5 November 1996, but not gazetted).
  • R187, Regulations governing private health establishments, Western Cape, 22 June 2001

The design principles on the above documents must be taken into account alongside the recommendations of this document. Furthermore, the South African National Standard (SANS) 10400 addresses numerous aspects

involving materials and finishes. (Refer specifically to Parts J and T.) Current SANS applicable are as follows:

Other provincial policy documents are also applicable:

  • KwaZulu-Natal, Department of Health Policy Document for the Design of Structural Installations, Rev.7, January 2013
  • Eastern Cape Department of Roads and Public Works and Department of Health Hospital Design Guide, Rev. August 2004

PART B - SELECTION CRITERIA

1. Scope

Healthcare facilities are complex buildings with spaces varying from general offices to highly specialised treatment areas. Each of these spaces has a specific need in terms of how the wall finishes should perform and how they can affect the perceptions and comfort of the user. Of the three dimensions of wall, floor and ceiling, the walls are most likely to be touched by the occupants, making them an important factor in terms of infection control. These and other criteria are discussed in more detail under selection criteria (Section C).

The healthcare environment is increasingly becoming a ’wheeled‘ environment, with everything from patients to equipment being moved on wheeled chairs, beds or trolleys of some kind. The wall finishes should be able to resist the accidental impact of trolleys and other objects. This is achieved by the inclusion of wall protection at strategic points. This guide examines the range of protection types available, and the advantages and disadvantages of their applications in the healthcare

setting.

The type and scope of activity in a space is one of the main factors that

govern the selection of wall finishes in a healthcare facility.

(Onaran, 2009)

The following three basic categories of wall finishes should be considered:

1. Liquid applied coverings

This includes paints such as PVA and enamel.

2. Flexible coverings

This includes vinyl cladding, linoleum, cork, carpet or wallpaper.

3. Hard, pre-formed finishes

This includes timber panels, ceramic and porcelain tiles, and the use of glass/glazed panels.

Each wall finish has different applications, resultant benefits and disadvantages. The various characteristics would need to be weighed against the functions of the various rooms within a healthcare facility.

2. Environmental aspects in the choice of finishes

A guide of finishes would be incomplete without highlighting the environmental aspects in the choice of finishes. This is an extremely broad factor that covers the following:

  • Embodied energy of materials
  • Life cycle costing and sustainability
  • Toxicity and the effects of indoor environment quality

2.1. Embodied energy of materials

The term embodied energy refers to the total energy measure required to manufacture a product. This includes the following:

  • Harvesting/mining of the raw material
  • Processing the material
  • Manufacturing the product
  • Transporting/delivering the product to the manufacturing plant, retail outlets and finally the end-user
  • Labour or mechanical energy spent on placing the product in its finished position

Life cycle costs are described as the social, economic and environmental costs of a material or product from cradle to grave – that is, from the

extraction of the raw ore needed to

make it, through the manufacturing, to the end use to disposal or

recycling (Daniel D. Chiras. The New Ecological Home, 2004).

Buying locally produced materials is an easy and achievable way to lower the embodied energy of a building. The table below gives an indication of the embodied energy of various typical building materials. Embodied energy of common wall finishes (and substrates)

While health facility design may limit your selection of materials in terms of other performance factors, which are more critical, every opportunity to reduce the embodied energy of materials should be pursued. Manufacturers increasingly aim at reducing embodied energy and the carbon footprint in the manufacture of their products. This is driven by the market demand and designers can contribute by choosing materials that support green initiatives in this regard.

2.2. Lifecycle costing and sustainability

The durability of materials is a key element in the life cycle cost assessment. A product may have a low embodied energy, but requires more frequent replacement in the building.

Specifiers should investigate the service life of materials with the respective manufacturers, to establish its lifespan. This element should also be highlighted to funders who often place more emphasis on reducing the capital cost of a facility, without considering the long-term cost.

The graph below indicates how capital outlay costs compare to lifespan costs – emphasising the importance of life cycle costs. Sustainability should be considered in all four stages of product life:

2.3. Toxicity and effects on indoor environment quality

Indoor Environment Quality (IEQ) is one of the nine categories of the Green Building Council of South Africa’s Green Star TM Rating Tools. These rating tools are used to assess the environmental performance of a building and/or materials. By improving the IEQ, the wellbeing of the occupant is protected.

IEQ is measured in terms of the following:

  • Internal noise levels (this is discussed in more detail under Selection Criteria: Acoustics)
  • Mould prevention (this is discussed in more detail under Section Criteria: Humidity)
  • Volatile organic compounds (VOCs)

Materials such as paints and polyvinyl-chlorides can emit VOCs (gasses) when finishes are new and then reduce over the lifespan of the product. Sealants and adhesives also give off VOCs, thus having a negative effect on indoor air quality.

VOCs can cause irritation and odour annoyance and could lead to behavioural, neurotoxic, hemotoxic and genotoxic effects (Meininghaus et al., 2000;

Hoskins, 2003; Hodgson et al., 2000).

According to Hoskins (2003), VOCs can be carcinogenic, depending on the compound.

When considering the toxic impact on the environment in which the wall finish will be installed, the finish as a whole (complete with sealants, substrate material and adhesives) must be taken into account.

Another important aspect to consider is the use of nontoxic materials in mental health facilities, where

patients are prone to chew and ingest any material that can be uplifted off surfaces, from paint to flooring.

Every effort must be made when specifying materials and finishes in these facilities to ensure that materials and their junctions are well secured and cannot be peeled back or picked off by patients. The toxicity of the material and/or content should be carefully considered to ensure it is appropriate for its location. The specifier should clarify the toxic content with manufacturers to ensure that these materials are safe and fit for this purpose.

3. Evidence-based design

Determining which criteria to apply when selecting finishes appropriate for health facilities could be very subjective. However, in recent years, there have been substantial advances made by various researchers in providing scientific evidence for the impact of the healthcare environment on healthcare outcomes. Many studies, such as Ulrich et al. (2008), demonstrated connections between the design of facilities and the effect on patients, staff and the public utilising healthcare buildings. This has led to a growing understanding of what the priorities in designing health facilities.

Extensive research by The Center for Health Design (CHD) FIGURE 5

Research Coalition on evidence-based Design led to the

evidence-based design glossary, Phase 1 Report Healthcare Environmental Terms and Outcome Measures, November 2011.

Various unrelated research papers were gathered with interesting results. These included the following:

  • Environmental factors influencing the contamination of inanimate surfaces, including interior finish materials of flooring and furniture, as well as surface cleaning methods (Anderson, Mackle, Stoler and Mallison, 1982; and Lankford, Collins, Youngberg, Rooney, Warren and Noskin, 2006).
  • Reducing background noise in operating theatres and the impact on surgical errors (Moorthy, Munz, Dosis, Bann &and Darzi, 2003).
  • Multiple environmental factors affecting patient fall rates (Calkins, Biddle and Biesan, 2011; and Becker et al., 2003).
  • Patient satisfaction with quality of care when sound-reflecting ceiling tiles were replaced with soundabsorbing tiles to reduce noise (Hagerman and Colleagues, 2005).
  • Positive visual distractions including windows, nature photographs, etc. and the effect on patients’ restless behaviour in waiting rooms (Nanda, 2010; and Pati and Nanda, 2011).
  • Nurses’ exposure to daylight correlating to job satisfaction (Alimoglu and Donmez, 2005).
  • Noise as a source of stress and its negative impact on staff (Morrison, Haas, Shaffner, Garett and Fackler, 2003).

“Ideal features of surfaces that satisfy sustainability, infection prevention and safe patient outcomes include

cleanability, resistance to moisture and

reducing the risk of fungal

  • Textile materials containing microbial agents (Takai et al., 2002).
  • Aesthetic appeal and its effect on patient and staff satisfaction and patient waiting (Becker and Douglass, 2008).

An overview of these studies identified the following selection criteria:

  • Infection prevention
  • Cleaning and maintenance
  • Safety
  • Indoor air quality – humidity
  • Indoor air quality – emissions
  • Acoustics
  • Aesthetics

Although all these factors are important, the specific functions of each space or room will re-order the priority of fulfilling each aspect.

To assist with establishing these priorities and assessing the effects of each criterion, these are examined in more detail in the next section.

4. Selection criteria

4.1. Infection prevention

The South African Patients’ Rights Charter (1997) states: “Everyone has the right to a healthy and safe environment that will ensure their physical and mental health or wellbeing including … protection from all forms of environmental danger, such as pollution, ecological degradation or infection.”

According to a survey conducted by Rohde (2002), materials and finishes have in the past been selected according to the following characteristics in declining order of importance: aesthetics, durability, ease of maintenance, client preference, initial cost, cost of maintenance, infection control, ease of installation and life cycle cost.

Selecting the correct finish is a complex process with many aspects to consider, and the many and varied room types in a health facility extend the options. However, in healthcare facilities, the importance of the effect of a particular finish on the prevention of infection control must be prioritised. While it is understood that not every area of a hospital or health facility will carry infection prevention as the highest priority, this aspect remains the most pressing issue in the selection of finishes in health facilities.

The rising incidence of healthcare-associated infections (HAIs) in hospital and medical facilities supports the view that the selection of materials must first address infection prevention. This impacts on the choice of materials in two aspects. The first is whether the surfaces are likely to become reservoirs for infectious agents.

This is a function of the surface conditions and structure of the finish. The second is the ability to clean the finish, which is discussed in the next section.

The Center for Disease Control in the United States quoted statistics in 2010 of one out of every 20 hospitalised patients contracting HAIs, particularly in relation to sepsis and pneumonia.

Although there is no known direct evidence linking HAIs in patients to particular finishes, there have been numerous studies conducted on microbial counts on floor finishes – particularly in soft textiles such as carpets. Beyer and Belsito (2000) proved that carpets acted as a

reservoir for fungi and bacteria.

Lankford et al. (2006) examined different wall finishes after inoculation with Vancomycin-resistant Enterococci (VRE) and compared the results after seven days. The types of wall finishes tested included latex-based paint, enamel paint, vinyl, micro-perforated vinyl (with paper backing) and textured wallpaper. The report showed that all finishes still harboured some VRE pathogens that could be transferred through hand contact. The wallpaper and micro-perforated vinyl (used for printing large-scale wallpaper graphics) showed no reduction at all, indicating that the pathogens were harboured by these finishes. After cleaning and disinfection, results showed that latex paints did not clean as well as enamel paints.

In order to keep wall finishes from transmitting harmful bacteria, they should be easy to clean and able to withstand

repetitive wear and frequent germicidal decontamination, and have the ability to repel moisture

(Lankford et al., 2006).

The selection of finishes is still strongly linked to adequate cleaning and disinfection routines, and the location

of the finish in terms of its performance. Notwithstanding, it is recommended that perforated finishes be avoided where patients are at greater risk of infection. Below is a table adapted from New South Wales Health: Infection Control Policy (PD 2007-035), which sets out patient risk categories:

When selecting finishes for a room/area that has an extreme or high infection control risk, special care has to be taken to select an appropriate finish. Nosocomial infections can be acquired in hospitals, nursing homes, rehabilitation centres and extended care facilities. Especially susceptible patients are immuno-compromised patients, the elderly and young children. These infections can be caused by unclean or non-sterile environmental surfaces.

Wall finishes that resist the spread of infection have qualities that can be summarised as follows:

  • Smooth
  • Impervious
  • Joint-less/seamless

On the opposite side of this spectrum, where infection prevention is the lowest priority, wall finishes have the following properties:

prevented from multiplying. For cleaning to be effective, the finish must be able to withstand regular and fairly vigorous cleaning.

Sufficient access to all areas of the finish or adversely the absence of any inaccessible gaps, voids and joints is of critical importance to prevent breeding areas for bacteria, etc.

A further aspect to consider is the level of disruption required to clean walls regularly. While textile finishes can reduce cold and institutional environments, they would be totally unsuitable in areas with a high infection control risk and a high incidence of soiling. It is also important for the paint or wall finish manufacturer to convey the cleaning and maintenance requirements to the end-user or institution for product guarantees to remain.. An effective cleaning regime is the primary means of defense in terms of controlling infection.

Wall finishes that are easily cleaned and have low dirt retention can be summarised as follows:

  • Low maintenance
  • Washable

4.3. Fire safety

The South African National Standard (SANS) 10400 lists specific requirements for hospitals and medical facilities with regard to the classification of internal finishes, irrespective of whether the area is sprinklerprotected or not. These materials are to achieve a Class 2 rating when tested in accordance with SANS 10177-3. The exceptions are the emergency routes where Class 1 is required.

Note that these requirements are not room-specific, and are therefore considered a global requirement in the overall building, rather than for an individual space. The specifier would need to consult the fire regulations applicable to the building type and confirm that the products meet these requirements. The definitions in SANS 10400: Part A read as follows:

E2 Hospital: Occupancy where people are cared for or treated because of physical or mental disabilities and where they are generally bedridden.

E3 Other institutional (residential): Occupancy where groups of people who either are not fully fit, or who are restricted in their movements or their ability to make decisions, reside and are cared for.

E4 Healthcare: Occupancy which is a common place of long-term or transient living for a number of unrelated persons consisting of a single unit on its own site who, due to varying degrees of incapacity, are provided with personal care services or are undergoing medical treatment.

The requirements for finishes are set out in Part T of SANS 10400, and include the following: bathing or food preparation. These rooms generate more moisture than others, and as a result require moisture-resistant finishes. If the wall finishes are hygroscopic, these finishes can be prone to mildew and

mould growth. Surfaces must remain dry and clean in order to prevent the growth of fungus (Hodgson et al., 2000).

Non-porous materials that do not absorb water are essential in these areas. These materials should also withstand regular cleaning, and should be able to withstand regular exposure to the moisture. Indoor air quality may be compromised by microbial contaminants such as mould, bacteria, allergens, chemicals, etc. in

the air, which can affect the health of people. Where this is a requirement in wall finishes, this property is listed as:

High humidity

High humidity is considered as 25–100% relative humidity over an air temperature range of 10–30°C. A suitable finish should be able to withstand sustained contact with water vapour/water in these conditions.

(Normal conditions would be considered as 25–65% relative humidity over air temperature range of 20–25 °C).

(National Health Services Health Technical Manual HTM56: Partitions)

Emissions from materials

As discussed under environmental aspects, the kind of wall finish installed can affect the environmental quality of the interior if VOCs are given off – commonly referred to as off-gassing.

These VOC emissions can be given off by:

  • the product itself;
  • the adhesives used to fix the product (for example, in the case of vinyl cladding or tiles);

Proper moisture control is essential in order to reduce health risks and sick building syndrome in an enclosed space (Mortenson et al., 2005).

  • the sealants/grouts used to finish; and
  • the cleaning solutions required for regular maintenance.

The smell of the interior of a new car – enjoyed by many – is an example of plasticisers that have evaporated (emissions that affect the indoor air quality). Various methods for measuring VOCs have been developed since the increase in awareness of these emissions and their influence on indoor air quality. The Green Building Council of South Africa awards points in the IEQ13 category where interior finishes minimise the contribution and levels of VOCs in buildings – with reference to paints, adhesives/sealants and carpets/flooring, where these products meet the indoor environmental quality (IEQ) levels as outlined.

The IEQ14 section measured the formaldehyde minimization, which is common with composite wood products. In addition, the MAT-7 section recognises the reduction of PVC products in the building materials used.

It should be noted that primary VOCs decline quickly in the short term (less than one year), while secondary emissions can continue for the lifespan of the product, and should also be kept in mind when assessing this aspect of materials. Timing of the testing will yield very diverse results.

Patients with respiratory weaknesses such as asthma are most likely to be

affected by VOC emissions. High-risk patients would benefit from materials that do not contribute to their condition. The ultimate goal of reducing emissions in the manufacture of building products should be to create a better and healthier environment for the patients and users of the facility.

However, the ‘order of magnitude’ should also be applied when using low VOC emissions as a criterion to select finishes. The use of vinyl sheeting, for example, may result in higher VOC emissions than, for example, ceramic tiles, but the infection control benefits of the seamless finish of the vinyl will outweigh the risks of VOC emissions. (More fatalities in patients have been linked to infection control issues than to VOC-emissions issues.)

The achievement of low VOC emissions should be a global criterion for a healthcare building rather than for one or more specific rooms, hence a separate criterion has not been listed for this item. More details on the VOC emissions of the individual wall finish types are provided in Section C.

4.5. Acoustics

Noise in health facilities is mainly generated by the following:

  • Impact sounds, for example, pedestrian and wheeled equipment, • bedrails moved up and down, doors closing and opening, footfalls, etc.
  • Airborne sounds, for example, talking, medical equipment bleeps and alarms, nurse calls, PA system, etc.

Acoustical engineers at John Hopkins University found that the average (continuous level equivalent, LAeq) daytime hospital noise levels have risen from 57dBA in 1960 to 72dBA in 2006, with night-time sounds increasing from 42 dBA to 60 dBA over the same period. (HermanMiller Healthcare, 2006). An average motorcycle noise level measures 85 dB. The World Health Organization recommended an LAeq value of 30 dBA for ward areas.

“People who work in noisy environments for long shifts day in and day out, also have similar

stress-induced experiences. They

report everything from exhaustion to burnout, depression and irritability.”

S. Mazer –

Studies have shown that high levels of noise have negative physical and psychological effects on patients, disrupting sleep, increasing stress and raising blood pressure levels (Cmiel et al., 2004). The University of Michigan released a news brief in November 2005, showing that chronic noise increased the risk of heart-attacks in patients by 50% for men and 75% for women. The negative effect of chronic noise extends to staff as well. While the presence of electronic devices and healthcare apparatus, designed to give audible signals and alarms to the

nursing staff of the patient’s vital signs, architects and health facility planners need to make an effort to minimise this effect of noise and alarm fatigue.

Long straight passages are perfect echo corridors, often amplifying noise levels. Disturbances in the sound path help limit the sound transmission by, for example, creating steps in the ceiling level or changing direction in the passageways.

According to Cmiel, et al. (2004), noise levels can reach those similar to jackhammer levels at nurses’ stations during shift changes Consideration should be given to applying acoustic materials to these areas to maximise sound absorption where possible.

Recesses to accommodate noisy equipment can also be treated acoustically to reduce reverberation. Distance is also a good strategy (where feasible) as sound intensity decreases with distance, provided that the room dimensions and surfaces are designed so that there is very little reverberation.

Wall finishes that absorb sound, or at least do not contribute to noise levels,

used in conjunction with sound-absorbent ceiling finishes should be used in key areas such as nurse restrooms or waiting areas where infection control requirements would not be as critical. In areas where sound reduction is rated as a high requirement (for example, ICU and general wards), this factor would be listed as “High acoustic”

4.6. Aesthetics

Research results from CABE, 2004 and 2005, King’s Fund, 2004, and Leather, Beale and Lee, 2000, all highlight the need for an integrated, holistic and sympathetic hospital aesthetic. Tofle et al. (2004) also emphasised the role of colour in healthcare environments. Key results show that the architectural setting, including finishes, has an effect on the patient’s experience, as well as the recruitment and retention of staff – a happy staff is more motivated to care for patients, who in turn recover more quickly. Paediatric wards particularly give an opportunity to set a playful scene and help young patients feel at ease. In public areas, more emphasis may be required for an attractive and welcoming interior.

Coloured and vinyl wallpaper can be used to good effect in passageways and public areas to set anxious patients at ease and create a cheerful atmosphere.

Colours and patterns can be used in wall finishes in health facilities for the following practical and aesthetical purposes:

  • To improve the ‘institutional/cold’ interior look of the facility, room or area
  • To be used for wayfinding, for example, colour-coding each department
  • To create ’spaces’ by giving individuality to a specific area within a large open area

However, the following is to be considered:

  • Excessive combination of colours and patterns is inappropriate in certain areas/rooms such as operating theatres.
  • Some patterns and colours could impact negatively on certain patient groups, for example, the elderly or mentally ill.
  • The wall finish must be adaptable should the space usage result in the need to change the aesthetics.

Where aesthetics is a primary requirement, this factor will be listed as:

  • High aesthetics

PART C - TECHNICAL INFORMATION – WALL FINISH TYPES

1. Liquid coverings

The quality of the wall finish (especially with liquid finishes such as paint), are only as good as the quality of the substrate. A poor quality plaster will not only affect the aesthetics, but also the integrity of the smooth impervious finish. Plaster cracks will be carried through almost all paints, and any crack can become a reservoir for bacteria. Bonding liquids could be used to some extent, but due to poor plaster sands and a lack of plastering skills, it is recommended that double plaster or skimming to finish a plastered wall be specified at the outset. (If the first plaster skin is approved, the second coat could be omitted.)

1.1. Paint (emulsion or oil-based)

  • General description and properties

Paint is easily applied by a roller to a plastered wall surface. Following a primer and undercoat, three coats of paint are usually applied. Two-coat plaster is especially recommended where enamel paints are used, as any defects will be highlighted with these highgloss type paints.

“Wall finishes do change, due to changes in management or taste,

and it is usually the first surface to be ’replaced’ or changed.”

(Vittori, 2002)

Paint types include emulsion paints which are water-based and produce a matt or silk effect – such as PVA. Oil-based paints like enamel dry to a hard, glossy finish that is impervious to water.

Paint is fairly inexpensive when compared to other wall finishes. FIGURE 14

Infection prevention

The seamless finish produced by painted plaster makes this finish ideal for areas where infection prevention is paramount. There are no joints or crevices to encourage growth of microbes. Any mechanical damage can, however, lead to small cracks, and it is important to protect vulnerable areas. This is discussed in more detail under ‘Protection’. Studies have shown that PVA can be degraded by filamentous fungi, such as algae, yeasts, lichens and bacteria (Cappilelli and Sorlini, 2008). Paints with mould inhibitors and nano-technology enhancements are available on the market. Oil-based paints are more suited to areas that require high infection prevention criteria as the surface is impervious to water, oil and other fluids.

Cleaning and maintenance

The enamel and velvet sheen paints are highly washable, durable and stain-resistant. PVA can also be washed, but is not as stain-resistant or impervious and therefore not suitable in treatment areas. Paint is a low maintenance finish that requires re-application every few years (more often if mechanical damage occurs). Special attention should be given to the placement of switches and sockets in walls, as these areas are regularly touched, and can become infection-control risk areas if not kept clean. The smoother the surface, the easier it is to clean.

Fire safety

Paint is considered a non-combustible finish as the thickness of the paint is usually less than 0.5 mm. Refer to the manufacturer’s specifications and consult with SANS Part T to check the compliance and fire-resistance.

Indoor air quality: Humidity

Paints are generally not adversely affected by a reasonable amount of moisture being generated by the presence of taps or wet fittings in a room. Oil-based enamel paints are more resistant to moisture when compared to water-based PVA-type paints, and are therefore more suitable in wet or humid environments.

Indoor air quality: Emissions

The strong odour of a newly painted room is an indication of the high VOC emissions. Low-odour paints are marketed by manufacturers, and products with reduced or zero VOCs are being produced. Due to the increasing range of products and suppliers, the level of emissions should be checked with the manufacturer (refer to product-specific literature).

Acoustics

The hard surface of painted walls reflects sound and does not contribute to the impact of noise reduction or absorption. Where acoustics is a priority in a room or facility, other sound-absorbing products and finishes should be combined with the painted walls to achieve improved acoustics.

Aesthetics

Paint is available in an extensive range of colours, and this is one of the great advantages of using paint. It provides a flexible means of adapting a space to suit the function of the room – from calming colours in a staff restroom, to cheerful and inviting colours in a doctor’s waiting room.

The effect of colour on healing has been well documented by Tofle et al. (2004).

Colour can also be used for the coding of areas – to demarcate different departments or floors of a multistorey building. It can be effective in establishing zones for public and staff use. Paint can also be used to introduce colour for features or emphasis.

Private sector health facilities often make use of colourbranding for their facilities, and the use of specific combinations of colours becomes identifiable with the brand.

In public health facilities, the support of the Department of Health in the use of colour in this regard is paramount, as historically, decisions about colour have been based on ease of maintenance and whether new paints can match existing colours.

The colour codes and type of paints should always be included in the as-built documents to assist managers to obtain the correct paint.

1.2. Epoxy coatings

General description and properties

There are two main types of epoxy coatings – water-borne and solvent-borne coatings. Both types have improved properties compared to water- or oil-based paints, including the following:

  • Chemical and abrasion resistance
  • Outstanding adhesion to a variety of substrates
  • Excellent toughness, hardness and flexibility
  • Superior dimensional stability
  • Heat resistance

Water-dispersed epoxy coatings are resin-based wall coatings of between 0.3 and 0.5 mm thick. A primer or pore-filler coat is first applied to smooth plaster, followed by two coats of epoxy wall coating applied with a roller. This creates an impermeable seal on the wall surface with a gloss finish.

The use of water in lieu of solvent in the coating means less hazardous material for the environment, and reduced odours/fumes.

Solvent-borne epoxy paints are more economical, but should not be exposed to extensive sunlight as this leads to chalking and degradation. The solvent-based epoxy coating is also toxic when wet, unlike the water-borne version, but once dry, the solvent-borne epoxy coating is also non-toxic. Special precautions need to be taken when applying this product. Primers are also required, and solvent-based epoxy coatings can be applied with a roller, brush or airless spray.

Infection prevention

The water-borne epoxy resin coatings have been tested under ISO 14644, which classifies different materials according to their cleanliness in terms of the particle and airborne molecular contaminants that are emitted or released by the finished product. This is critical in industrial environments where optical or electronic goods are manufactured, or where food is processed. Water-dispersed epoxy resin wall coatings are one such product that satisfies the criteria and is approved for use in ‘cleanroom’ settings.

Cleaning and maintenance

The impermeable finish is smooth and non-porous, making it easy to clean, highly washable, durable and stain resistant. Colour variation in different batches of solvent-based epoxy coatings is expected.

Fire safety

Since the epoxy finish is less than 0.5 mm, it is considered a non-combustible finish (once dry). Refer to the manufacturer’s specifications, and consult with SANS Part T to check compliance and fire-resistance.

Indoor air quality: Humidity

Epoxy coatings have good water-resistance and are suitable for use in moist/humid areas as the finish is hydrophobic and prevents the ingress of moisture.

Indoor air quality: Emissions

Solvent-borne epoxy coatings produce a strong odour in a newly painted room, unlike water-dispersed epoxy coatings. The development of water-dispersed epoxy coatings has been hastened by the move away from VOC emissions in paints to meet air quality standards.

Acoustics

The hard surface of epoxy-painted walls reflects sound and does not contribute to the impact of noise reduction or absorption. Where acoustics is a priority in a room or facility, other sound-absorbing products and finishes should be combined with the painted walls to achieve improved acoustics.

Aesthetics

Epoxy coatings are available in a muted range of pastel colours. Although the colour range and variety is more limited than regular paints, the comparative expense of epoxy coatings usually means it is used for its superior performance properties, and less likely for its aesthetics.

2. Flexible sheeting

Vinyl wall cladding, as in the case of vinyl floor sheeting, is manufactured from a combination of vinyl resin and various additives, such as the following:

  • Plasticisers – used to make the sheet more flexible.
  • Stabilisers – to minimise degradation and discoloration.
  • Pigments – for colours and patterns
  • Fillers – such as lime or other locally available material

Vinyl cladding is generally 1.25 mm thick, but sheeting that is 2 mm in thickness can also be used. Depending on the manufacturer, it is supplied in 1.2 m- or 2 m-wide rolls. Vinyl cladding is sometimes used as a dado cladding in passageways or high-traffic areas due to its durable, resilient and impervious finish.

Vinyl cladding can be supplied with a specialised polyurethane-resistant (PUR) surface treatment. This coating improves resistance to staining and cleaning chemicals and supports indentation recovery.

Infection prevention FIGURE 18

Vinyl sheeting, as a material, has been found to inhibit the growth of

bacteria, and particularly Methicillin-resistant Staphylococcus aureus (MRSAs). The welded joints prevent dust or dirt from congregating in areas that are difficult to clean, and the integral skirting supports this seamless appeal. This has made vinyl sheeting very suitable for use in healthcare facilities. However, the adhesives behind the cladding are important for the success of this wall finish from an infection-prevention aspect, as any lifting away from the wall or failure in the application of the adhesive will create voids in which bacteria or insects can breed. If the wall is mechanically damaged in any way, even the finest of cracks will provide the access needed to these voids. Ends should be well sealed and any area at risk of being damaged should be protected. Refer to the section on bump-rails and protection.

Cleaning and maintenance

The cladding is easily washed, which contributes to its performance as a hygienic wall finish. Vinyl cladding is not easily damaged, and when treated with a polymer dressing/surface treatment, is low-maintenance. When maintained properly, the sheets have a long lifespan, and are therefore fairly cost-effective in comparison to other wall finishes. Cladding with PUR treatment requires only spray-and-dry buffing for general cleaning, although water-based dressings are beneficial. Special cleaning solutions are used for heavy staining, but abrasive cleaning methods should not be used. If portions of the wall cladding are damaged, replacement of a section is difficult as the stripping off of adhesives may require re-plastering prior to applying the new cladding.

This is also very disruptive in high-use areas. Colour matching is also difficult when replacing panels as colour batches will vary.

This is, however, a low-maintenance, flexible covering that is not likely to crack with small movements in the wall.

Cleaning should always be carried out in accordance with the manufacturer’s specifications to comply with material warranties. The specifier should ensure that these instructions are included in handover packs issued to the building owner/user when occupation takes place.

Fire safety

In terms of SANS 10400, operating theatres, ICUs, high-care or critical care units, and maternity delivery units are required to have walls with a fire-resistance of 120 minutes. The effect of the finish, in conjunction with the wall structure, should be checked with the manufacturer for compliance in this regard.

Indoor air quality – Humidity

Vinyl sheeting is well suited to areas of high humidity, and wet areas such as sluice rooms.

Indoor air quality – Emissions

Some manufacturers have addressed VOC emissions in their products and indicate a pass in VOC emissions tests as well as Building Research Establishment (BRE) A+ ratings. Materials are 100% recyclable or contain a percentage of recycled materials. Each supplier will differ, and the specifier should check these aspects when considering a product. VOC emissions of adhesives and sealants, where applicable, are also to be considered.

Aesthetics

Vinyl wall cladding is available in subtle pastel colours that can contribute to creating a calming/soothing effect. The application of cladding requires skill to apply and if the substrate plaster is not completely smooth below the surface, the vinyl cladding will amplify imperfections and could look unsightly.

Acoustics

Vinyl sheeting is softer than tiled surfaces, with better sound absorption qualities than hard finishes.

2.2. Wallpaper murals

General description and properties

Digitally printed wallpapers are becoming more popular in public areas of health facilities. These murals can be custom-sized and printed to any image and can make a strong contribution to introduce outdoor and nature scenes where external windows and natural light is not possible. The murals are supplied in panels that

generally overlap and are glued to a substrate that should be smooth, sound and dry. A lining paper can be applied prior to the finish paper. Wallpapers generally have a textured matt finish, which can be cleaned. Selfadhesive papers which are PVC-free are also manufactured. The wallpaper generally has a latex-saturated paper backing.

Infection prevention

While some wallpapers can be cleaned, micro-perforated vinyl, which is commonly used for large-scale digital prints, were found to perform poorly when inoculated with pathogens. These wallpaper murals should not be used in areas where patients are immuno-compromised, especially if the prints can be touched easily. The joints between the panels – although sealed with the glue used to affix the mural, mean that the surface is not seamless. By applying a clear varnish sealing coat over the product, the infection prevention is improved.

Cleaning and maintenance

Light cleaning with a soft, non-abrasive cloth – which can be damp – will allow for regular cleaning, but the wallpapers are susceptible to stains. Any mechanical damage to the mural will be difficult to repair. The location of these murals should be carefully considered, as the images will lose their effect if bump-rails run clear across the image. If well cared for, though, the murals require little maintenance.

Fire safety

Self-adhesive wallpapers have been tested in accordance with EN13501-1:2007 and were classified as B-s1, d0 (fire behaviour (B), smoke production (Class 1), flaming droplets(0)). In terms of SANS 10400, operating theatres, ICUs, high-care or critical care units and maternity delivery units are required to have walls with a fire-resistance of 120 minutes. The effect of the finish, in conjunction with the wall structure, should be checked with the manufacturer for compliance in this regard.

Indoor air quality: Humidity

The paper constituents of this product and the micro-perforations make it unsuitable for use in high-humidity areas.

Indoor air quality: Emissions

The adhesives used to install the wallpaper are often high in VOC emissions, although PVC-free self-adhesive papers are produced. In comparison to paints, however, the emissions are lower.

Acoustics

Wallpaper is softer than tiled surfaces, with better sound-absorption qualities than hard finishes. Thicker and heavily textured papers will aid sound absorption.

Aesthetics

The aspect of aesthetics is where wallpaper scores well. The use of high-resolution photographic images in murals can contribute almost as much as a real view of a natural environment. This is useful where external windows are not feasible. This can also be used to good effect in staff restroom areas, cafeterias or foyers.

3. Hard preformed coverings

3.1. Porcelain or ceramic tiles

General description and properties

Porcelain and ceramic tiles generally provide a durable, aesthetically acceptable wall finish that is moistureresistant. A wide spectrum of tiles is available in varying sizes, material composition, quality and cost, resulting in varying performance. Porcelain and/or ceramic tiles are most commonly used in health facilities in wet areas, such as bathrooms, kitchens, and utility and cleaning areas due to the impervious quality and performance under wet conditions. The use of unglazed tiles is not recommended in health facilities as these absorb moisture and other fluids, which may be present in kitchens, mortuaries, etc.

The specifier should research the actual tile carefully, ascertain if the product is imported, what long-term stocks would be available, and ensure the tiles have been sufficiently cured. Where possible, the specifier should use full-bodied porcelain tiles rather than glazed porcelain or ceramic tiles. This is evident in the following comparison between the general properties of the two tile types:

Full-bodied porcelain tile:

  • Colour is throughout, as the term ’full-bodied‘ implies.
  • Squareness of tiles is consistent with minor deviations.
  • Tile sizes are consistent with minor deviations.
  • Smaller joints can be used, due to tile size consistency.
  • Flatness of tile face is consistent.

Glazed ceramic tile:

  • Colour is a glaze on top of the tile that can wear or chip off.
  • Tile sizes can vary.
  • Squareness of tiles can vary.
  • Wider joints are required, due to size and squareness inconsistencies.
  • Tiles are often not flat and edged surfaces tend to dip, resulting in rough surfaces.

Infection prevention

Although an individual tile unit complies with selection criteria such as being impervious and easy to clean, a finished tiled wall, including grout and movement joints, provides a less favourable result in terms of the following:

  • Grout in the joints is porous and can retain moisture, which encourages the growth of mould.
  • Grout joints pose a potential infection-control risk in small cracks and openings that form between the tile edge and the body of the grout.
  • Tiles may crack and chip when trolleys bump against them, creating small cracks where moisture can be retained and microbes can grow.
  • Replacement of these damaged tiles or re-grouting is disruptive to the daily operations of the facility, and matching existing tiles can be difficult.

Anti-fungal grout will contribute to the control of mildew, but cannot replace good maintenance regimes.

Cleaning and maintenance

Porcelain wall tiles generally need to be cleaned with water and a cleaning agent. For oily spatter in hospital kitchens or body fluids or chemicals in laboratories or mortuaries, appropriate cleaning is required. The ease of cleaning, as well as the durability of the tiles under rigorous cleaning regimes, makes a tiled wall suitable in areas where splash-back is common – such as above sinks and hand basins.

Fire safety

Porcelain is non-combustible in terms of SANS 10400: Part T. In terms of SANS 10400, operating theatres, ICUs, high-care or critical care units and maternity delivery units are required to have walls with a fire resistance of 120 minutes. The effect of the finish, in conjunction with the wall structure, should be checked with the manufacturer for compliance in this regard.

Indoor air quality: Humidity

The polished or glazed surfaces of the tiles make them highly suitable and unaffected by high humidity in the room. However, as mentioned above, the joints are susceptible to moisture-retention and encourage mould and microbe growth in the minute cracks and gaps. Proper scrubbing and regular maintenance will inhibit fungal contamination. The use of epoxy grout is recommended (and not cementitious grout). Epoxy grouts are resinbased, and repel moisture, which inhibits the growth of mould.

Indoor air quality: Emissions

Porcelain tiles and cementitious grout (not recommended in health facilities) do not generate VOC emissions, but some adhesives, other grouts, sealants and cleaning agents generate VOC, which affect the indoor air quality. The production of tiles has a high-energy input, with high sustainability production costs and production emissions.

Acoustics

Tiled walls are hard surfaces that do not absorb any sound and will contribute substantially to noise in the healthcare setting. This is due to the reflective surfaces on walls, causing echoes. Where the function of the room does not warrant special attention to acoustics, and other criteria have priority, then tiled walls are suitable.

Aesthetics

Tiles are available in a wide selection of colours, shapes and sizes. This allows for visually appealing, non-institutional aesthetics in health facilities. Since the surfaces do not scratch or scuff easily, the aesthetic appeal is durable. A variety of stainless steel or PVC tile-in trims are available to finish the edges of tiles on walls or reveals. These also provide some protection to the exposed edge.

3.2. Timber panelling

General description and properties

Timber panelling creates a warm, welcoming environment and can be used in certain areas of healthcare facilities.

The most common locally available timber is meranti and pine, which is available in various standards and quality. The versatility of the timber products provides almost unlimited options in terms of cladding walls or creating features from wood, ranging from standard tongue-and-groove planks to slatted battens and perforated acoustic panels. The timber is usually varnished or painted for internal use. Engineered timber products are also available with melamine and veneer finishes.

Infection prevention

Timber is a source of nutrients to bacteria, and good maintenance and cleaning will be needed to ensure that mould and other bacteria are prevented from establishing. Timber would not be suitable for areas where a seamless finish is required due to the jointing. Acrylic resin-based anti-bacterial varnish may extend the lifespan of the timber.

Cleaning and maintenance

The timber panelling is usually finished with varnish or sealant that is water-resistant and therefore washable, but access to narrow grooves may limit the effectiveness of cleaning. Occasional re-varnishing would be required, which could be disruptive to the activities in such areas. Engineered medium-density fibreboard (MDF) wall panels do not require repainting if clad, but should not come into contact with water.

Fire safety

Timber is combustible, and in terms of SANS 10400: Part T, internal finishes can be combustible, but must comply with Class 2 (Part T: Table 9), except in emergency routes, where Class 1 is required. Specific requirements are listed for operating theatres, ICUs, high-care or critical care units and maternity delivery units in that these areas are required to have walls with a fire resistance of 120 minutes. The extent and effect of the timber finish, in conjunction with the wall structure, should be checked for compliance in this regard.

Indoor air quality: Humidity

Well-varnished timber will be protected from the effects of moisture, but generally timber should not be used in rooms where humid and moist conditions persist. MDF wall panels are not suitable for humid or wet areas.

Indoor air quality: Emissions

Timber is a natural product that does not emit VOCs, but the finishing specification, such as varnish, is often a source of VOCs. Engineered timber products, such as MDF board, contains a higher resin-to-wood ratio than any other urea-formaldehyde pressed wood product, and is recognised as being the highest formaldehydeemitting pressed wood product. (US Environmental Protection Agency). These VOCs are fairly quickly dissipated. Refer to product-specific literature.

Aesthetics

The warmth of wood grains, with their natural beauty and range of timber hues, is a sought-after aesthetic that is being replicated in many other finishes, such as ceramic tiles, vinyl and wallpaper. Original wood finishes are unique without production pattern repetition. This is the appeal of timber.

Acoustics

Slatted or perforated timber panels are well suited to rooms that require acoustic performance, such as conference rooms, prayer rooms or quiet spaces. Perforated surfaces aid in reducing the retransmission of sound and can assist where many other surfaces are hard and reflective.

Glazed partitions

General description and properties

There are areas in the healthcare environment that can benefit from the use of glazed partitions to improve the visual supervision of the occupants – for example, in isolation or paediatric wards. All glass in healthcare facilities must have safety glazing, but some additional protection should be included at critical heights where bump-rails would normally be fixed. This can be done using the aluminium frames and mullions at the correct heights.

Provision must be made for blinds or curtains to allow for privacy or room darkening when needed. Glass also brings the opportunity to allow natural light into deep spaces where external windows cannot be accommodated. Alimoglu and Donmex (2005) reported that nurses’ daily exposure to daylight correlated positively with job satisfaction. Berry and Parish (2008) reported that nursing staff who worked in a new unit that featured (among other aspects) more natural light, were more satisfied and less stressed. Stress negatively reflects on staff job satisfaction, which in turn correlates with staff turnover.

Exposure to daylight reduces depression among patients, decreases length of stay, improves sleep and circadian rhythms, lessens agitation among dementia patients, and eases pain (Joseph 1999).

Infection prevention

Glass is impervious and unaffected by moisture or water, and is easy to clean, making this a useful wall finish in high-infection control areas. The key is in how the joints are treated. Welds on frames should be continuous – leaving no gaps or small apertures for moisture or bacteria to gain access. Gaskets in the aluminium frames must seal the junctions with glazed panels to support proper cleaning. Blinds should be encapsulated in double glazing to maintain the hygienic finish.

Micro-perforated vinyl stickers can retain moisture and harbour pathogens, and special attention to cleaning procedures for these areas should be highlighted.

Cleaning and maintenance

Glass walls require occasional washing, but the glass is waterproof and unaffected by most cleaning agents and acids. Glass can also be supplied with proprietary films that ’self-clean‘ by using sunlight and rain to wash off organic dirt. These are suitable for external glazing only.

Fire safety

Both glass and aluminium (cast or extruded) are categorised as non-combustible materials in terms of SANS 10177-5. Internal finishes can be combustible, but must comply with Class 2 (Part T: Table 9), except in emergency routes, where Class 1 is required. Specific requirements are listed for operating theatres, ICUs, high-care or critical care units and maternity delivery units in that these areas are required to have walls with a fire resistance of 120 minutes.

Indoor air quality: Humidity

Glazed walls are well suited to humid environments as they are unaffected by moisture.

Indoor air quality: Emissions

While the production of glass may emit VOCs, glass is inert and impermeable and does not emit VOCs. Coatings to the framework may, however, emit low VOCs. Refer to productspecific literature.

Aesthetics

In a well-maintained facility, glass walls can give a clean, open feel to the healthcare environment. The aesthetics can be improved by what lies beyond the glazing – especially if there is a view to be admired. An open configuration provides the caregiver or visitor with a more ‘global’ view of the unit, and allows immediate assessment of the status. This transparent

FIGURE 30 aesthetic can improve order and cleanliness standards in the facility.

Acoustics

Glass is a hard, reflective surface that will not absorb sound, but possibly add to noise scatter.

4. Bump-rails

Beds, food trolleys, medicine trolleys, drip stands, mop buckets and wheelchairs are just some of the types of wheeled equipment common in

the hospital or healthcare environment. This often leads to accidents and FIGURE 29 mechanical damage to walls, corners and exposed edges. Bump-rails should be specified and fitted in key areas to minimise repairs and prolong the wall finishes. In addition, bump-rails are useful behind chair-backs in waiting areas, where scuff marks are common.

Most damage to walls will be prevented by running a bump-rail at around 900 mm above the floor (to the centreline), with a depth of 200 –300 mm. The areas behind beds or cots can be deeper at around 600 mm. Some trolleys also have projections at low level, and the equipment to be used in the particular area should be considered when setting heights and spacing of bump-rails.

Some bump-rails simply consist of sheeting of only a few millimetres thick, cladding the wall at a particular height, but the offset type of rail that projects

FIGURE 31 away from the wall is more effective in protecting the surface, as the force of the impact is difficult to predict or contain. These projecting rails have the added benefit of providing a handhold for patients who are walking in the passage.

The different types of commonly used bump-rails are summarised below.

4.1. Laminated or solid timber bump-rails

General description and properties

Timber bump-rails are relatively inexpensive and easy to manufacture and fit. These can be routed, and shaped into solid timber sections, or smooth laminated timber sections. The benefit of using timber is that sections that may become damaged are easy to replace. The use of timber creates a warm, welcoming environment. The most common locally available timber is meranti and pine, which is available in various standards and quality. The timber is usually varnished for internal use.

Infection prevention

Timber is a source of nutrients to bacteria, and good maintenance and cleaning will be needed to ensure that mould and other bacteria are prevented from establishing. Timber would not be suitable for areas where a seamless finish is required due to jointing, small ledges and recessed areas. Acrylic resin-based anti-bacterial varnish may extend the lifespan of the timber.

Cleaning and maintenance

The timber panelling is usually finished with varnish or sealant, which is water-resistant, and therefore washable, but access to narrow grooves may limit the effectiveness of cleaning. Occasional re-varnishing would be required, which could be disruptive to the activities in such areas.

Aesthetics

The warmth of wood grains with their natural beauty and range of timber hues is a sought-after aesthetic, which is being replicated in many other finishes, such as ceramic tiles, vinyl and wallpaper. Original wood finishes are unique without production pattern repetition. This is the appeal of timber.

4.2. Extruded PVC bump-rails

General description and properties

Pre-formed rigid PVC bump-rails are fitted over aluminium retainers with rubber inserts, which help absorb any impact. The PVC covering is

scratch-resistant with a textured surface. These rails can either be flush-mounted against the wall with an overall thickness of about 20–35 mm, or mounted on aluminium brackets at regular centres, usually less than one metre apart, and standing 50–100 mm proud of the wall surface. Continuous timber backing rails can also be fitted where anti-ligature options are needed in mental health facilities.

The bump-rail size can vary between 50–200 mm in height. Injection- moulded plastic joiners and end-caps are available in matching colours.

Hollow, rigid extruded PVC bump-rails are also available, with PVC brackets, but these should only be used with solid timber inserts as the unsupported PVC has been known to become brittle over time. Flexible PVC hand-rail covers are also manufactured to fit over steel brackets, with a width of 50 mm.

Infection prevention

Vinyl/PVC provides no nutrient source for bacteria in which to thrive, and regular cleaning will ensure a hygienic product. Special attention should be paid to cleaning hand-rails as these have more angles and recesses and are more likely to be touched.

Cleaning and maintenance

The manufacturer’s instructions must be followed for cleaning procedures and products to prolong the lifespan of the bump-rails. If a section becomes damaged, the relevant section can be replaced, although colour may vary slightly.

Aesthetics

The PVC bump-rails are available in a wide range of colours to complement the interior colour scheme. Bump-rails also provide an opportunity to introduce bolder colours, and can be used as markers to follow or define different departments.

4.3. Tubular stainless steel bump-rails

General description and properties

Stainless steel bump-rails are sturdy, hard-wearing, easy to clean and an elegant solution for wall protection. Tubular bump-rails for internal areas should be manufactured from Grade 304 stainless steel, and are usually 32 mm in diameter. A wall thickness of 2 mm is recommended to withstand impact. External rails in coastal regions should be made from Grade 316 stainless steel. Material test certificates should be requested from the supplier to indicate the manufacturer, grade, chemical and mechanical specifications. All joints should be specified as fully seamwelded, including where stanchions are fixed to the rail and fixing plates. The screws/bolts and nuts used for fixing the flanges must be the same grade as the tubular rail. Flanges should be a minimum of 6 mm thick. All welded joints should be cleaned of residue prior to pickling and passivation. The TUNGSTEN INERT GAS (TIG) process of welding should be specified as this produces a better-quality weld on a wider range of thicknesses of stainless steel sheeting.

Best corrosion-resistance will be achieved by pickling all fabricated items using commercially available products. The item is then thoroughly rinsed with water to remove all traces of acid and is then passivated with nitric acid passivating solution, and rinsed again.

Infection prevention

Stainless steel provides no nutrient source for bacteria in which to survive, but dirt build-up on the surface can become a source of bacteria. Although copper has better anti-microbial properties than stainless steel (Noyce, Michels & Keevil, 2006), stainless steel is a more durable and costeffective solution and performs better than most other materials in terms of preventing the transmission of pathogens.

Cleaning and maintenance

Stainless steel is a very low-maintenance product that has longevity superior to most other products available. However, like any surface, the build-up of dirt and dust will affect the performance and lifespan of the product and regular cleaning is required. Stainless steel should be cleaned with a soft cloth, regular household dishwashing liquid and warm water. In coastal areas, stainless steel finishes should be cleaned every four weeks, and every 4–6 months in inland areas. Without regular cleaning, the protective chromium-oxide film will be contaminated by dirt build-up on the surface, thus trapping these corrosive agents.

Aesthetics

Stainless steel creates an impression of cleanliness, with its smooth, shiny surface. The seamless rails also add to the hygienic appeal. This bump-rail solution has been used widely in hospital environments.

4.4. Cladding to medium density fibreboard substrate

There are various cladding options when using MDF board as a substrate for bump-rails. The surface finish products can be moulded around the MDF substrate, and the shape and size is only limited by the ability of the cladding to follow the radii of corners and edges.

Suitable adhesives would need to be considered and should be checked with the respective manufacturers of the cladding product selected. The rear of the bump-rail should be fitted with melamine or similar covering to prevent moisture ingress and balance the board.

These bump-rails can be fitted flush against the wall, or fixed with a purpose-made bracket or timber spacer behind them.

Engineered timber products, such as MDF board, contain a higher resin-towood ratio than any other urea-formaldehyde pressed wood product, and is recognised as being the highest formaldehyde- emitting pressed wood product (US Environmental Protection Agency). These VOCs are fairly quickly dissipated.

The cladding options commonly used for bump-rails include the following:

Vinyl sheeting

The advantage of using vinyl on a bump-rail is that the joints can be welded for a seamless finish. This is beneficial in terms of infection control. Mechanical damage can cause fine cracks that would be difficult to repair without replacing a section. The vinyl finish can also match the floor sheeting if required.

Refer to sections on vinyl flooring or wall cladding for general descriptions and performance of vinyl.

Solid surfacing

These smooth resin-based finishes are heated and moulded to the substrate, allowing for seamless curves and corners. Small cracks due to mechanical damage on solid-surfacing can be easily repaired by sanding and resealing. These cracks could present an infection-control risk, as these fine apertures can be difficult to see, and moisture can penetrate to the substrate below and become a reservoir for bacteria.

The solid-surfacing is available in a wide range of colours from vibrant flat colours to stone-speckled patterns and translucent pigmented options. Since this product can be used on joinery and counters, the bump-rails can be made from matching or complementary colours.

Carpeting

Carpet cladding on bump-rails will contribute to sound absorption, but is not recommended in clinical areas as bacteria can be retained in the fibres, and these textile finishes are difficult to keep clean. Refer to sections on carpeting for general descriptions and performance of carpets.

Stainless steel cladding

Stainless steel sheeting can be bent or curved to follow simple profiles, and can be glued with appropriate adhesive, as well as mechanically fixed with screws. Edges should be sealed with silicone. The stainless steel cladding should not be less than 1.5–1.6 mm thick on bump-rails to be able to withstand impact. Standard finishes include brushed satin (matt) or a bright annealed (shiny) polished finish. A brushed satin finish will be less likely to show fingerprints, while a shiny finish will easily reveal fingerprints. Both finishes should be cleaned with a soft cloth, warm water and regular household dishwashing liquid at least once every four weeks.

Refer to the section above on stainless steel tubular bump-rails for general descriptions and performance of stainless steel.

5. Corner protection

Protection is needed on external corners and exposed edges of walls in healthcare facilities, as these areas are generally subject to more impact than walls in straight runs. The detail must be considered in conjunction with the bump-rail, as the two items will meet at the corner. The bump-rail can be continuous in the horizontal line, with the corner protection only covering the

FIGURE 41 wall below. Alternately, the corner protection can be continuous in the vertical line, and the bump-rail can stop short of the corner on each side. A projecting bump-rail will still afford some protection to the corner, over and above the corner protector plate.

Corner protectors should cover at least 1 m from the floor, but where taller food trolleys or laundry trolleys are used, the full height of the wall may need to be protected.

5.1. Stainless steel corner protectors

Stainless steel corner protectors are fitted to exposed corners using stainless steel screws and adhesive, and are usually 50 x 50 mm in size, depending on the detail of the bump-rail at the corner. The corner edges should be rounded as they can be very sharp.

A thickness of 1.5–1.6 mm is recommended to give best impact protection. Refer to the section above on tubular steel bump-rails for general properties, performance, cleaning and other recommendations for the specification of stainless steel. Grade 304 is recommended for internal areas. Screws used for fixings must be the same grade as the angle.

Columns are also high-impact areas in open spaces, and stainless steel sheeting provides a neat solution where rigid aluminium, timber or MDF substrates cannot be fitted to such tight curves.

5.2. Vinyl corner protectors

Proprietary systems of vinyl corner protection are available on the market in rigid extruded high-impact resistant PVC. Some systems can be supplied with aluminium retainers where higher impact is expected.

These PVC corner protectors have a fine textured scratch-resistant finish, and are available in 50 x 50 mm or 70 x 70 mm sizing and are 1.2 mm thick. Standard heights are 1.2 m high.

They are fixed using approved adhesives, but screws can also be used. A range of colours is available to match the PVC bump-rails.

PART D - PERFORMANCE

1. Performance categories

The properties described in the selection criteria in Section C above have been listed in the table below, and then grouped into five performance categories that would satisfy the requirements in various areas in a healthcare facility.

Table 2

WALL PROPERTIES PERFORMANCE CATEGORY

1 2 3 4

Smooth   O O

Impervious   O O

Jointless/seamless  O O O

Textured O  O O

Perforated O  O O

Jointed O O O O

Low maintenance    

Washable/easily cleaned    O

Suited to high humidity areas O 

O 

 

Acoustic priority O   

Aesthetic priority O   

Legend/Key:

– indicates this property is required for the class

– indicates this property is not required for the class

O – indicates this property is an optional requirement for the class Examples of wall finishes for Class 1 (typical area – operating theatre):

  • Enamel paint, epoxy coating, vinyl cladding or glazed partitions in special applications, etc.

Examples of wall finishes for Class 2 (typical area – dirty utility or ablution):

  • Enamel paint, epoxy coating, porcelain or ceramic tiles, etc.

Examples of wall finishes for Class 3 (typical room – passage, restroom or waiting room):

  • PVA paint, glazed partitions, wall-paper, timber panels or enamel paint, etc.

Examples of wall finishes for Class 4 (typical area – plant room):

  • PVA paint, enamel paint, epoxy coating, etc.

Refer to Table 2 – Matrix of recommended wall performance categories to establish what performance category the wall of the room in question will require.

2. Performance categories recommended per room

Department Room Name Wall Performance

1 2 3 4 5

Acute Inpatient Wards (Adults) Circulation Space     

Cleaners’ Room     

Consulting Room     

Day Lounge (patients)     

Dirty Utility Room (Sluice)     

Duty Room     

Equipment Store     

General Ward (single or multi-bed)     

Isolation Ward     

Kit Room     

Linen Room     

Office     

Patient Ablutions     

Patient-assisted Ablution     

Staff Ablutions     

Staff Change Room     

Staff Restroom     

Surgical Sundries Store     

Treatment Room     

Waiting Area (public)     

Ward Kitchen     

Ward Nurses’ Station     

    

Administration Department Circulation     

Cleaners’ Room     

Offices/interview rooms     

Reception     

Boardroom     

Stores     

Kitchenette     

Records Room     

Print room     

Staff WCs     

Waiting Area (public)     

    

Casualty and Trauma Circulation     

Cleaners’ Room     

Consulting Room     

Dirty Utility Room (Sluice)     

Duty Room     

Equipment Store     

Hazmat Shower     

Minor Theatre /Suture Room     

Observation Area     

Office     

Patient Ablutions     

Patient-assisted Ablution     

POPS Suite     

Public WCs     

Reception/Nurses’ Station     

Rehydration Area     

Resuscitation Area     

Scrub Area     

Department Room Name Wall Performance

1 2 3 4 5

Staff Ablutions and Ablutions     

Staff Restroom     

Surgical Sundries Store     

Waiting Area (public)     

    

Central Sterilising and Supply Department (CSSD) Dirty Utility     

Chemical Store     

Circulation     

Cleaners’ Room     

Dirty Linen     

Office     

Packing     

Plant Room     

Staff Change Room     

Staff Restroom     

Staff WCs     

Sterile Storage     

Sterilisation (autoclaves)     

Trolley Wash     

Washing and Disinfecting Area     

    

Community Health Centre Circulation     

Cleaners’ Room     

Consulting Room     

Delivery Room     

Dental Surgery     

Dirty Utility Room (Sluice)     

Dispensary     

Duty Room     

Equipment Store     

Guard House or Security Kiosk     

Isolation/Separate Nursing Ward     

Linen Store     

Observation Area     

Office     

Offloading/Holding area for Pharmacy     

PABX /Server Rooms     

Patient Ablutions     

Patient-assisted Ablution     

Pharmacy     

Plant Room     

POPS Suite     

Public WCs and Change Rooms     

Reception/Nurses’ Station     

Records Room     

Recovery Area     

Rehydration Area     

Resuscitation Area     

Staff Ablutions     

Staff Change Room     

Staff Restroom     

Surgical Sundries Store     

Treatment Room     

Trolley Bay (entrances)     

Department Room Name Wall Performance

1 2 3 4 5

Ultrasound Room     

Ward     

Waiting Area (public)     

X-Ray Room     

    

Day Clinic (Department) Circulation Space     

Cleaners’ Room     

Consulting Room     

Dirty Utility Room (Sluice)     

Duty Room     

Equipment Store     

General Ward (single or multi-bed)     

Kit Room     

Linen Room     

Office     

Operating Theatre     

Patient Ablutions     

Patient Waiting     

Recovery Area     

Scrub Area     

Setting Area     

Staff Ablutions and Change Room     

Staff Restroom     

Surgical Sundries Store     

Treatment Room     

Waiting Area (public)     

Ward Kitchen     

Ward Nurses’ Station     

    

Dental Unit (Department) Circulation Space     

Cleaners’ Room     

Consulting Room     

Dental Surgery     

Dirty Utility Room (Sluice)     

Equipment Store     

Panoral Room     

Patient Ablutions     

Reception /Office     

Records Room     

Staff Ablutions     

Staff Restroom     

Surgical Sundries Store     

Waiting Area (Public)     

    

High Care or Cardiac Care Unit (HC/CCU) Circulation     

Cleaners’ Room     

Dirty Utility     

Duty Room     

Equipment Store     

Isolation Ward     

Linen Room     

Nurses’ Station     

Open Ward Area     

Patient Ablutions     

Staff Change Room     

Department Room Name Wall Performance

1 2 3 4 5

Staff Restroom     

Staff WCs     

Surgical Sundries Store     

Ward Kitchen     

    

Intensive Care Unit (ICU) Circulation     

Cleaners’ Room     

Dirty Utility     

Duty Room     

Equipment Store     

Isolation Ward     

Linen Room     

Nurses’ Station     

Open Ward Area     

Patient Ablutions     

Staff Change Room     

Staff Restroom     

Staff WCs     

Surgical Sundries Store     

Ward Kitchen     

    

Kitchen – (Main Hospital) Bulk Dry Goods Store     

Chemical Store     

Cleaners’ Room     

Cold Room/Freezer specialised

Cooking Area     

Cutlery/Crockery Store     

Dishwashing and Potwashing Area     

Food Preparation Area     

Office     

Plating /Serving Area     

Receiving Area     

Staff Ablutions     

Staff Restroom     

Trolley Wash Area     

    

Laboratory

(Pathology/Cytology/

Haematology/Chemistry)

(Biosafety Level 2)

Blood and Blood Products Store     

Cell and Tissue Laboratory     

Cytopathology Sample Storage     

Clinical Material Store     

Disposal Area (dangerous materials)     

Drug and Vaccines Store     

Flammable Goods Store (external)     

Gas Cylinder and Pressure Vessel Store     

Hazardous Substances Store     

Histopathology Laboratory     

Microbiology Laboratory     

Offices     

POCT consulting room     

Reagents /Chemical Stores     

Records Rooms     

Sample Collection Laboratory     

Department Room Name Wall Performance

1 2 3 4 5

Specimen Reception and Sorting rooms     

Stores (protective clothing/equipment)     

Staff Ablutions     

Staff Change Room including lockers     

Staff Restroom     

    

Laundry – (Main Hospital) Assembly, Packing and Dispatch     

Chemical Store     

Circulation     

Cleaners’ Room     

Office     

Pressing     

Sorting     

Staff Ablutions     

Staff Restroom     

Stores     

Washing Room     

    

Maternity /Delivery Department Baby Bathing Area     

Circulation     

Delivery Suite     

Dirty Utility Room     

Duty Room     

Equipment Store     

First Stage Room     

Kit Room     

Linen Store     

Milk Kitchen     

Nurses’ Station     

Nursery     

Patient Ablutions     

Staff Change Room     

Staff Restroom     

Staff WCs     

Surgical Sundries Store     

Viewing Area     

Waiting Area     

Ward Kitchen     

Wards     

    

Mental Health Facility Body Room     

Children's Play Area     

Clean Utility     

Cleaners’ Room/Station     

Consulting Room     

Counselling Room     

Dirty Linen     

Dirty Utility (Sluice)     

ECT Procedure Room     

En Suite Bath/Shower Room     

Equipment Store     

Group Therapy Room     

Department Room Name Wall Performance

1 2 3 4 5

Gymnasium (OT and Physio)     

IT Room     

Kit Room     

Linen Store     

Medicine Store     

Multi-Purpose Hall     

Nurses’ Station     

Office     

Patient-assisted Bathroom/Shower     

Patient Dining Room     

Patient Laundry     

Patient Lounge     

Pharmacy     

Quiet Room     

Records Room     

Seclusion Room     

Security Control Room     

Security Search Room     

Staff Change Room and WCs     

Surgical Sundries Store     

Treatment Room     

Wards     

Ward Kitchen     

Waste Disposal Room     

    

Mortuary Blue Room     

Circulation Space     

Cleaners’ Room     

Dirty Utility     

Instruments Room     

Linen Room     

Medical Observation Room     

Office     

Pathologist Change Room     

Post-Mortem Room     

Staff Change Room     

Staff WCs     

Viewing Room     

Visitors’ Waiting Room     

    

Neonatal Intensive Care Unit (NNICU) Circulation     

Cleaners’ Room     

Dirty Utility     

Duty Room     

Equipment Store     

Incubator Ward Area     

Isolation Ward     

Linen Room     

Milk Kitchen     

Mothers’ Rest Area     

Nurses’ Station     

Staff Change Room     

Staff Restroom     

Staff WCs     

Surgical Sundries Store     

Department Room Name Wall Performance

1 2 3 4 5

    

Operating Theatre (Department) Circulation     

Cleaners’ Room     

Dirty Utility     

Duty Room     

Equipment Store     

Nurses’ Station     

Operating Theatre     

Post-Operative Recovery Area     

Pre-Operative Holding Area     

Scrub-up Area/Room     

Setting Room     

Staff Change Room     

Staff Restroom     

Staff WCs     

Surgical Sundries Store     

    

Outpatients Department Reception /Nurses’ Station     

Admissions Room     

Baby Changing Area     

Children’s Play /Waiting Area     

Circulation     

Consulting Room     

Dirty Utility Room     

Duty Room     

Equipment Store     

Kitchenette     

Linen Store     

Offices     

POPS Room     

Public Ablutions     

Records Room     

Staff Ablutions     

Staff Change Room     

Staff Restroom     

Surgical Sundries Store     

Treatment Room     

Waiting Areas (public)     

Wheelchair storage area     

    

Paediatric Ward Child-assist Ablution     

Circulation Space     

Cleaners’ Room     

Consulting Room     

Dirty Utility (Isolation)     

Dirty Utility Room (Sluice)     

Duty Room     

Equipment Store     

General Ward (single or multi-bed)     

Isolation Ward     

Kit Room     

Linen Room     

Milk /Ward Kitchen     

Nurses’ Station     

Office     

Department Room Name Wall Performance

1 2 3 4 5

Parent Ablutions     

Play Area (patients)     

Staff Change Room     

Staff Restroom     

Staff WCs     

Surgical Sundries Store     

Treatment Room     

    

Pharmacy/Dispensary Cleaners’ Room     

Bulk Stores     

Circulation Space     

Counselling Cubicle     

Dispensary     

Liquid Filling Room     

Office     

Offloading Bay     

Patient Waiting Room     

Schedule Drugs Strong Room     

Staff Change Room     

Staff WCs     

Tablet Packing Room     

Vacolitre Stores     

    

Physiotherapy Department Audiology Testing     

Circulation     

Consulting Room     

Equipment Store     

Gymnasium     

Kitchenette     

Occupational Therapy Room     

Patient Ablutions     

Reception     

Speech Therapy     

Staff Restroom     

Staff WCs     

Treatment Room     

Waiting Area     

    

Primary Health Clinic Circulation     

Cleaners’ Room     

Consulting Room     

Delivery Room     

Dirty Utility Room (Sluice)     

Dispensary and Pharmacy     

Duty Room     

Equipment Store     

Guard House or Security Kiosk     

Linen Store     

Observation /Rehydration Area     

Office     

Public Ablutions     

Plant Room     

POPS Suite     

Reception/Nurses’ Station     

Records Room     

Department Room Name Wall Performance

1 2 3 4 5

Staff Ablutions and Change Room     

Staff Restroom     

Surgical Sundries Store     

Treatment Room     

Trolley Bay (entrances)     

Waiting Area (public)     

    

Radiology (Diagnostic) Bucky Room (general X-ray Room)     

Change Cubicles     

Circulation     

Cleaners’ Room     

CT /MRI Scan Room     

Dirty Utility /Sluice     

Fluoroscopy Room     

Fluoroscopy Control Room     

Inpatient Waiting Area     

Kitchenette     

Linen Room     

Mammogram Room     

Office     

Patient Ablutions     

Public Waiting Area     

Porters and Wheelchair/Trolley Parking     

Reception     

Records Room     

Server Room     

Staff Restroom     

Staff WCs     

Stores (Equipment/General)     

Ultrasound Room     

Telemedicine Room     

Viewing Room/CR Room/Reporting Area     

    

Nurses’ Residences Ablutions     

Bedrooms     

Circulation     

Kitchenette     

Lounge     

Offices     

Public Ablutions     

Reception     

Stores     

Waiting Areas (public)     

    

Definitions

1. Terminology

Aggregation Collected together from different sources and considered a whole.

Ambulant/ambulatory (of a patient) Being able to walk or move around; not being confined to a bed.

Bacteriostatic A word used to describe the property of a material that claims to inhibit the multiplication of bacteria.

Bariatric Describing the condition of obesity.

Bonded Chemically attached or fused in layers.

Emulsion In the context of paint – referring to water-based paint that is not shiny when dry.

Guarantee A document setting out a promise of quality made by a manufacturer or the provider of a service, a formal promise that a product will be repaired free of charge if it breaks or fails within a particular period or that substandard work will be redone.

Homogenous Consisting of things of similar type throughout.

Heterogeneous Consisting of various layers or types throughout.

Hygroscopic Readily absorbing moisture from the atmosphere.

Hydrophobic Water-repellent.

Impervious Not allowing passage through (usually of water/moisture).

Interstices Small holes or perforations.

Jointed Junctions which may be open or covered, but not completely sealed and smooth.

Jointless Without joints or having joints that are sealed by materials and methods that make the whole surface imperious and prevent the collection of dirt and bacteria in the joint.

Olfactory Relating to the smell or the sense of smell.

Perfusion Inject liquid into tissue or organ by circulating through blood vessels in the body.

Polyamide Aa synthetic polymer made by the linkage of an amino group of one molecule and a carboxylic acid group of another, including many synthetic fibres such as nylon.

Resilient finish The quality of a material to spring back quickly into shape after being bent, stretched or squashed.

Seamless A surface without open joints or junctions, or where such joints are completely sealed and smoothed to create a continuous and whole membrane.

Smooth surface A flat surface without projections, indentations or perforations such as a brush-painted plastered surface.

Textured A surface finish that is not smooth, but has a fissured/embossed or ridged finish.

Vitrified To change a material into glass, under high heat and other conditions.

Washable A term implying that a finish can be repeatedly and regularly cleaned using water and water-diluted cleaners without detrimental effect to the finish.

Warranty A written promise to repair or replace a product that has a manufacturing fault. This commonly comes with conditions and is limited to a time-frame given at the time of purchase.

2. Abbreviations

BRE Building Research Establishment

CHD Center for Health Design

ENT Ear, Nose and Throat

HAI Healthcare-associated infections

HDF High-density fibreboard

IAQ Indoor Environmental Quality IEQ Indoor Environmental Quality

IUSS Infrastructure Unit Systems Support

MDF Medium-density fibreboard

MRSA Methicillin-resistant Staphylococcus Aureus, which is a common skin bacterium that is resistant to a range of antibiotics otherwise referred to as multi-drug resistant bacteria

NDoH National Department of Health

OoM Order of Magnitude

PMIS Project Management Information System

PMSU Project Management Support Unit

PUR Polyurethane-resistant

PVC Polyvinyl-chloride

RC Recommendation Committee

SANS South African National Standard

TIG Tungsten inert gas

VOC Volatile organic compound

VRE Vancomycin-resistant Enterococci (drug-resistant bacteria that can lead to HAIs)

References

1. Bibliography

Alcorn, A. and Wood, P., 1998. New Zealand building materials embodied energy coefficients database. (Volume II-Coefficients). Wellington, New Zealand: Centre for Building Performance Research.

Cement & Concrete Institute (CCI), 2009. Sand-cement screeds and concrete toppings for floors. [pdf] Midrand, South Africa: CCI. Available at:

http://www.afrisam.co.za/media/13770/Sand_cement_floor_screeds_and_concrete_toppings_for_floors.pdf[Ac cessed 9 April 2014].

Center for Health Assets Australasia, 2009. Floor coverings in healthcare buildings. (Technical series TS-7 version 1.1). New South Wales:NSW Health.

Dean, Y., 1996. Finishes. 4th ed. Harlow, UK: Addison Wesley Longman Ltd.

Department of Health (DH), 2010. Core elements: Health Building Note 00-03: Clinical and clinical support spaces. UK: DH.

Department of Health (DoH), 1980. Regulations governing private hospitals and unattached operating theatres. (Government notice No. R.158 of the Health Act, 1971. (C.63). Cape Town South Africa: Government Gazette.

Department of Health Finance and Investment Directorate Estates and Facilities Division, 2006. Health

Technical Memorandum 61: Building component series flooring. [pdf] London: The Stationery Office. Available at: http://www.wales.nhs.uk/sites3/Documents/254/HTM%2061%202006.pdf [Accessed 9 April 2014].

Department of Health Gateway Review, Estates & Facilities Division, 2011. Performance requirements for building elements used in healthcare facilities. (Version:0.6:England). [pdf] Leeds: HMSO. Available at: http://www.derbyshirelmc.org.uk/Guidance/8941-England-8941_0.6_England.pdf [Accessed 9 April 2014].

Department of Health, n.d. R&D project B(04)02: Developing an integrated system for the optimal selection of hospital finishes. Aberdeen, Scotland: Department of Health.

HermanMiller Healthcare, 2006. Sound practices: Noise control in the healthcare environment. (Research summary/2006). Zeeland, Michigan: Herman Miller.

Joseph, A., 2006. The impact of light on outcomes in healthcare settings. Concord, CA: The Center for Health Design. Available at: http://www.healthdesign.org/sites/default/files/CHD_Issue_Paper2.pdf [Accessed 9 April 2014].

Joseph, A., Malone, E., Pati, D. and Quan, X., 2011. Healthcare environmental terms and outcome measures: An evidence-based design glossary. Concord, CA:The Center for Health Design.

Jung, W.K., Koo, H.C., Kim, K.W., Shin, S., Kim, S.H. and Park, Y.H., 2008. Antibacterial activity and mechanism of action of the silver ion in staphylococcus aureus and escherichia coli. Applied and Environmental Microbiology, 74(7), pp.2171-2178.

Lavy, S., 2010. Facility managers’ preferred interior wall finishes in acute-care hospital buildings. In: CIB, 18th CIB World Building Congress: Facilities management and maintenance. Salford, United Kingdom, 10-13 May 2010. Salford, United Kingdom: CIB.

Makison, C. and Swan, J., 2005. The effect of humidity on the survival of MRSA on hard surfaces. (R&D report B(03)02). [pdf] London: Estates and Facilities Division of the Department of Health. Available at: http://www.wales.nhs.uk/sites3/Documents/254/B(03)02%20MRSA.pdf [Accessed 9 April 2014].

Nanda, U., Malone, E. and Joseph, A., 2012. Achieving EBD goals through flooring selection & design. [pdf] Concord, CA:The Center for Health Design. Available at:

http://www.healthdesign.org/sites/default/files/chd_achieving_ebd_goals_through_flooring__design_final_0.pd f [Accessed 9 April 2014].

NHS Estates, 2005. Health Technical Memorandum (HTM) 56: Building component series: Partitions. UK: TSO.

NHS Estates, 2005. Health Technical Memorandum (HTM) 60: Ceilings. 2nd ed. UK: TSO.

NHS, National Services Scotland, 2006. Scottish Health Technical Memorandum (SHTM) 61: Building component series: Flooring. Scotland:Health Facilities Scotland.

NHS, National Services Scotland, 2007. Scottish Health Facilities Note 30: Infection control in the built environment: Design and planning. (Version 3). Scotland:Health Facilities Scotland.

NHS, National Services Scotland, 2009. Scottish Health Technical Memorandum (SHTM) 61: Building component series: Flooring. Scotland:Health Facilities Scotland.

PricewaterhouseCoopers LLP (PwC) in association with the University of Sheffield and Queen Margaret University College, 2004. The role of hospital design in the recruitment, retention and performance of NHS nurses in England. (Full report). [pdf] Edinburgh: Commission for Architecture and the Built Environment (CABE). Available at: http://webarchive.nationalarchives.gov.uk/20110118095356/http:/www.cabe.org.uk/files/therole-of-hospital-design.pdf [Accessed 9 April 2014].

Tofle, R.B., Schwartz, B., Yoon, S., Max-Royale, A., 2003. Color in healthcare environments: A critical review of the research literature. California: The Coalition for Health Environments Research (CHER).

Ulrich, R. S. P., Zimring, C. P., Zhu, X., Dubose, M., Seo, H. B., Choi, Y. S. and Joseph, A. P., 2008. A review of the research literature on evidence-based healthcare design (Part II). Health Environments Research & Design Journal, 1(2008), 61-125.

Welsh Health Estates, 2009. Health Building Note 04-01: Adult in-patient accommodation. Cardiff, Wales:Welsh Health Estates.

2. Websites: Further reading

Error! Hyperlink reference not valid.(Health Technical Manuals – United Kingdom)

Error! Hyperlink reference not valid.(Precautionary Lists of Building Ingredients related to health effects and risks)

Error! Hyperlink reference not valid.(Sustainable Flooring benefits Hospitals in a variety of ways) http://www.GreenhealthMagazine.org

http://greenhomeguide.com (Are Engineered wood products from Decorative Flooring a low VOC product? Joel Hirschberg, 2011) http://gbcsa.org.za (IEQ rating tools)

http://www.green-buildings.com (Green Flooring: Linoleum, Marmoleum and Vinyl – Claire Maloney, LEED Green Associate, Cornell University 2013)

http://www.healthcaredesignmagazine.com (Five need to know trends shaping healthcare Design – K. Edmundson, 2011) http://www.carpet-rug.org/documents/technical-bulletins (Carpet Treatments) http://www.floorworx.co.za (Vinyl wall cladding and protection manufacturer) http://www.polyflor.co.za (Vinyl wall cladding and protection manufacturer) http://www.sassda.co.za (South African Stainless Steel Development Association)

Photographic And Illustration Credits

Cover photo: R. van Rensburg

Fig.1-2 M. Swinney

Fig.3 G. Abbott- CSIR

Fig.4 R. Cubbin based on Life Cycle

Floor Cost Table – by Nora®,

USA

Fig.5 R. Cubbin

Fig.6-7 M. Swinney

Fig.8 R. van Rensburg

Fig.9-14 M. Swinney

Fig.15 R. van Rensburg

Fig.16 R. van Rensburg

Fig.17 R. van Rensburg

Fig.18-24 M. Swinney

Fig.25 R. van Rensburg

Fig.26-27 M. Swinney

Fig.28 C. Hudson

Fig.29 R. van Rensburg

Fig.30 M. Swinney

Fig.31 R. van Rensburg

Fig.32-34 M. Swinney

Fig.35 R. Cubbin

Fig.36-38 M. Swinney

Fig.39-40 R. van Rensburg

Fig.41 M. Swinney

Fig.42-44 R. van Rensburg

Fig.43 M. Swinney

Fig. 44 R. Cubbin

Fig.45 M. Swinney

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