FLOORING
What is the evidence for shock- absorbing floors? We have undertaken a Health Technology Assessment comprising a review of 22 studies exploring novel floors, sports floors, carpet, and wooden sub-floors in health and care settings; this is available in full and in an abridged format.1,2
The
Figure 3: Flooring materials need to function well for people with instability and using wheeled devices.
and it has the potential to protect any part of the body coming into contact with it, so could have more of a role to play in fall- related injury prevention.
Shock-absorbing floors – some considerations Different floors will offer different degrees of shock absorbency. A high-pile carpet with a thick underlay on a wooden sub- floor is going to be more shock-absorbing than a 2 mm layer of PVC or vinyl laid on concrete, but will likely raise concerns around cleaning and infection control. Some manufacturers make floors with impact-absorbing properties that have been designed for use in sports facilities, which have been repurposed for use in healthcare settings, while some are targeting health and care settings with more purposefully designed underlays and overlays specifically aiming to prevent fall-related injuries in vulnerable people. An increased shock absorbency may also provide other benefits in the form of sound attenuation and comfort underfoot. However, like any design decision, there are trade-offs to consider. Might something that feels softer
underfoot have the potential to make people who are vulnerable to falls more unstable, and – counter-productively – increase their risk of falling in the first place?
Increased rolling resistance A softer floor surface will also increase the rolling resistance for moving wheeled objects – so might this lead to an increased safety risk of musculoskeletal injuries in staff who need to move beds, hoists, trolleys, portable scanners, and the like? How will a thicker floor transition to an area with regular flooring, and will this create a trip hazard? How compliant (shock-absorbing) does a floor surface actually need to be to protect against injuries? The issue of moving towards shock-absorbing flooring is therefore not straightforward, even before considering all the other attributes we look for in healthcare floors around sustainability, hygiene, aesthetics, and cost. A more compliant surface to land on may become a safety concern for staff manoeuvring wheeled equipment, or for patients with instability – so we need to look at the research evidence.
Figure 4:
Example of a shock-absorbing flooring underlay material.
research was led by Dr. Amy Drahota, University of Portsmouth, in collaboration with colleagues at University of Southampton, Cardiff University, the Health & Safety Executive in the UK, Simon Fraser University, and University of Waterloo in Canada. Further advisors from the NHS, Estates and Facilities personnel, members of the public, and the National Care Association, helped ensure the relevance of the research. The research was funded by the National Institute for Health Research (Award ID: 17/148/11). Ten studies, carried out in the UK, Canada, the US, Sweden, and New Zealand, have explored the difference that shock-absorbing flooring can make to the number of falls and injuries; six of these studies were carried out in hospitals, and four were based in care homes. In total, the studies analysed 11,857 falls and 163 staff injuries; four explored the use of carpet, three looked at re-purposed sports floors, five studies explored novel health floors, and one compared wooden and concrete sub-floors.
What impact do shock-absorbing floors have on patient and staff injuries?
One type of novel shock-absorbing floor may not be effective in care homes, compared with rigid flooring;3
however,
gaps still exist in knowledge. Here, we focus more on the hospital-based data. In summary, there is very low-quality evidence that shock-absorbing floors may be more beneficial than standard rigid floors for reducing fall-related injuries. Let us assume that if hospital wards (specialising in older people’s medicine) have standard rigid floors, three injurious falls will occur every day for every 1,000 inpatients on the wards. Research suggests that on average, one fewer injurious fall would occur each day if shock-absorbing floors were laid instead. Research data always contains some uncertainty, however, and so it is estimated that shock-absorbing flooring could result in between two fewer injuries per day, to about the same number of injuries per day, for every 1,000 patients. Another way to look at the data is according to the number of falls that result in injury. On a standard rigid floor in an older people’s medicine ward, we can estimate that 424 out of 1,000 falls will result in an injury. However, if we were to replace the rigid floor with a novel or sports floor, then the data suggests that on average 153 fewer falls would result in
60 Health Estate Journal August 2023
Simon Fraser University
Freepik.com
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