By Barbara Dellinger, Jane Rohde, Linda Gabel and Teri Lura Bennett
[Editor’s Note: This is the final installment of a three-part series on durable coated fabrics.]
Compared to hospitality or retail, the healthcare marketplace has fewer product choices because of the required attributes for healthcare environments where products often last 10 to 15 years. But post-COVID healthcare claims about durability and manufacturers upholding 10 or more years are challenging with the ongoing cleaning and disinfecting methods. Fortunately, major producers are doing more research, hosting focus groups, and testing products more rigorously under updated performance standards, specific conditions, and/or with specific cleaning and disinfecting methods before they are being introduced for specification by healthcare interior designers.
When seeking out those durable and sustainable products for healthcare settings, here are the steps to follow:
1. Ask the right questions:
o What is the application for the product?
o What are the requirements for cleaning, sanitizing and disinfecting the product, material or surface?
o What tests has the product passed?
o What tests has the product failed?
2. Look at the product specifications and evaluate technical information in the context of the healthcare application needs. If a product advertisement focuses on sustainability only, then ask about performance before specifying (and vice versa.)
3. “Made for Heavy Duty Use” terminology must be backed by performance standards and test results. Seek detailed technical information from representatives.
4. Seek lab-provided results adhering to minimum performance standards. In-house testing can validate outcomes.
Pre- and Post-Covid Material Specifications
As noted in Part 1 (linked above) of this series, for the last decade, as the super-bugs and their resistance to disinfectants used to kill them have increased in use, hospitals have been prompted to use a wider variety of more aggressive disinfection chemicals.
The products used, coupled with the healthcare facility’s protocol not to rinse the disinfectants off the surfaces have led to failures not only of coated fabrics but also of many materials and surfaces. The reason that the facility’s protocols do not allow for rinsing is that dwell time (time required for the disinfectant to kill or destroy the bacteria or virus) is often a longer period than the staff have available to clean and turn over a patient room. Even if the dwell time is four minutes, and staff has only 10 to 12 minutes to clean the entire room, they do not have time to go back over every surface with a clean, wet cloth to remove the disinfectant residual.
The pre-COVID era saw some degradation of various products but during the pandemic, enhanced cleaning protocols were implemented resulting in failures in healthcare facilities. Similar protocols in other market segments also experienced product degradation within months, such as flooring in retail. Slated for replacement in 5 to 7 years, it degraded almost immediately after cleaning several times each day. Even concrete has had negative effects from harsh disinfectant chemicals. Painted surfaces and topcoats have degraded as well. While concrete was rarely used in healthcare settings, concrete in restaurants and hospitality was damaged during the pandemic.
In healthcare facilities specifically, painted walls that had rarely been cleaned pre-COVID were cleaned with disinfectant chemicals daily and peeled. Paint colors faded or changed and oftentimes the drywall was destroyed. Stainless steel door protection panels used in hospitals on doors, elevator doors and handrails cleaned with disinfectant chemicals became streaked. Laminate transition points have always been prone to liquid penetration that causes warping. Cleaning products applied multiple times daily exacerbated the degradation.
After watching these product categories evolve in this way, many organizations are updating specifications and standards.
The Chemical Fabrics and Film Association developed the CFFA Healthcare - 201 Certification program which outlines 16 standard tests that a durable coated fabric must pass to obtain the certification mark. There is no CFFA-compliant designation, although some manufacturers use this term when their coated fabric passes only some of the tests. Designers should look for the certification mark and verify on the CFFA Healthcare–201 Certification website for products that are available and have passed all 16 performance tests.
The Business and Institutional Furniture Manufacturers Association (BIFMA) is addressing the industry issue of certifying durable coated fabrics. Currently developing ANSI BIFMA X8.1-2024 “Standard for Furniture Surfaces: Design and Durability for Cleaning, Sanitizing and Disinfecting,” the initiative seeks to define protocols and acceptance criteria for the durability of cleaning, sanitizing and disinfecting products on furniture surfaces in healthcare and contract settings. It will align manufacturers’ standards with industry practices. BIFMA’s proposal committee includes commercial furniture and fabric manufacturers, disinfecting products companies and representatives from epidemiology, the Association for Contract Textiles (ACT), CFFA, the Durable Coated Fabrics Task Group and hospital end users.
The Facilities Guideline Institute 2026 Health Guidelines Revision Committee is also considering proposed language changes for architectural details, surfaces and built-in furnishings in healthcare settings. They will evaluate materials for the impact of cleaning, sanitizing and disinfecting methods and chemicals.
Always request the latest testing procedures. If inconsistencies arise, contact the standard writing organization the manufacturer is using and or participate in a standards development committee (e.g., ASTM) to contribute to test modifications.
Designers often have to answer to healthcare system CFOs, and as a result need to prioritize life cycle cost analysis and return on investment. Remember that sustainability matters, but if a product is replaced prematurely, it loses its sustainable impact, especially if it ends up in a landfill versus recycled or reused. Remember to evaluate multi-attribute certifications and ecolabels using consensus-based standards, environmental product declarations and health product declarations. Ensure a balance between sustainable attributes and performance characteristics.
Client Culture Matters
It’s important to recognize a provider’s mission, goals and objectives, especially as they relate to performance and (or vs) sustainability.
1. Be aware of “stirring the pot.” Some healthcare systems want to break the traditional molds and are forward-thinking, while others are not horizontally integrated to support the use of new ideas and solutions. To gauge recent product recommendations’ effectiveness, consult the procurement department to verify how past product specifications have been successfully maintained over time.
2. Clarify the client’s expectations of the anticipated product service life and/or replacement cycle renovation for different types of furnishings and finishes in a hospital and other healthcare settings.
3. Understand the level of equity within a healthcare organization. If an organization is more hierarchal, it may be more difficult to achieve creative solutions. When silos are broken down, it is easier to work in integrated teams to provide a culture change that supports successful project outcomes.
4. Understand the importance of sustainable, material health, and performance requirements based on owner project requirements from the healthcare system. Balance between all the attributes is important to select an appropriate product for an appropriate location.
5. Understand the role of facilities management in contract negotiations, day-to-day management of projects, and ongoing maintenance of new projects. If a facilities director (or COO) is against something a designer proposes, and it fails, the designer’s reputation may be at risk.
6. Understand the role of the Infection Prevention team in project planning, project management, and negotiation of cleaning/disinfecting products that will be used. For example, if a Group Purchasing Organization contract is set to expire, and the cleaning products currently used are on it, how will the use of new cleaning products be decided?
7. Understand the role of Environmental Services (EVS) in product specification and maintenance:
a. Will additional staff, typically from EVS be needed to maintain certain proposed materials? It may be best to stick with a “tried and true” specification rather than force a new product (such as rubber flooring) on a culturally traditional organization and have the new product (and you or your firm’s reputation) fail because it could not be maintained properly.
b. Will the EVS director or staff be included in the design reviews? And will their advice/opinions be respected? Are they open to product support sessions regarding maintaining the new product?
8. What positive emotions are sought in a new design? How is a “healing environment” defined by this organization? These topics are usually covered in a pre-planning visioning session, but sometimes it’s difficult to change the culture with words. Look around the organization for support of the desire to change.
9. Does “Patient Satisfaction” include the environment or only CMS HCAHPS survey scores? Is there an active PFAS (patient, family and staff) focus group that includes interior designers? If not, are they open to including the designer(s)? If the answer is no, your ability to gather data or do meaningful research may be limited.
To Sum it Up…
Designers and specifiers can collaborate to determine quality specifications for healthcare products, avoiding premature failure and enhancing the anticipated product service life in numerous ways:
1. We can team up with manufacturers and professional organizations, such as AAHID, ACHA, IIDA, ASID, CFFA, ACT, BIFMA, and FGI to help promote, edit or write CEU courses on product, material and surface selection and related specification process.
2. We can continue to collaborate with groups and manufacturers outside of our comfort zones. For example, the Durable Coated Fabrics Task Group was formed because designers realized they were all experiencing the same durable coated fabric failures. We eventually broke down silos and communicated with those concerned, resulting in a collaborative approach to minimum performance standard development.
3. We can participate in standard development organizations, such as ASTM.
4. We can provide links to information on the AAHID website on company and organization resource pages.
How will you keep this dialogue going? Sound off in the comment section below!
About the authors: Barbara A. Dellinger, MA, CHID, FIIDA, EDAC, MDCID, is a principal at Dellinger Consulting LLC; Jane Rohde, AIA, FIIDA, ASID, ACHA, LEED AP BD+C, GGA-EB, GGF, is a principal at JSR Associates; Linda Gabel, CHID, NCIDQ, is a senior planner at The Ohio State University Wexner Medical Center; and Teri Lura Bennett, RN, CHID, CID, IIDA, EDAC, NIHD, is a member of the AAHID Board of Directors and 2022 president.