INTERIOR SURFACING


and environmental impact, must also be considered. Technological advances have


introduced new and innovative ways to prevent bacterial colonisation on surfaces, thus reducing the incidence of healthcare-associated infections. One such technology is the development of low-surface-energy polymeric coatings that present a non-stick surface to microorganisms. Low surface energy refers to the ability of a material’s surface to repel liquids and reduce the attachment of solid particles, such as bacteria. The surface energy of a material is determined by the interactions between the molecules of the material and the surrounding environment. Materials with low surface energy have a reduced ability to interact with other materials, making them resistant to the attachment of microorganisms, and therefore easier to clean and disinfect.9


Creating a ‘non-stick’ surface In the development of hygienic surfacing materials, low-surface-energy polymeric coatings have been used to create a non-stick surface that inhibits the colonisation of microorganisms on the surface. These coatings are made from compounds like PMPFAS; poly(meth ylpropenoxyfluoroalkylsiloxane)s and PFA: poly(perfluoroacrylate)s, which are effective in inhibiting bacterial colonisation of surfaces.13


They have been shown to be


effective in reducing the risk of HAIs by inhibiting bacterial attachment to surfaces. A study conducted by Almaguer-Flores


et al into bacterial adhesion on amorphous and crystalline metal oxide coatings yielded noteworthy findings, including that coatings’ structrure significantly affected the nano-topography and surface energy. Introducing surface modifications through the deposition of amorphous or crystalline oxide coatings could be a means to rationally design implant surfaces for controlling or inhibiting bacterial adhesion. Specifically, crystalline TiO2, with a predominantly acidic nature, was found to be more attractive to negatively charged bacteria.14 These advances hold great potential for


reducing the risk of healthcare-associated infections, by creating surfaces that are more resistant to bacterial attachment, and easier to clean and disinfect. Overall, the importance of hygienic surfacing materials in maintaining a healthy and safe hospital environment cannot be overstated. Design teams are confronted with


a range of decisions when developing building designs – including selecting appropriate materials. While taking economics into account, they must also consider the social and environmental impacts of their decisions. With an increasing range of construction materials and products, coupled with the engagement of multiple stakeholders,


‘‘


Selecting hygienic surfacing materials can also play a key role in preventing and mitigating infection spread – by helping to reduce the survival of microorganisms on surfaces…


it has become challenging to make informed decisions, calling for a systematic approach to facilitate sound decision making.15 The decision-making method employed can significantly impact the outcome of the decisions taken. Decision-making processes exert a profound influence on people’s decisions, which subsequently initiate actions leading to specific outcomes. Hence, if outcomes are of significance, the decision-making method is equally crucial. In instances where decision-making becomes increasingly complex, the need for a structured, clear, and transparent decision-making method is amplified.11,15


Mindful of healthcare facilities’ ‘unique challenges’ Selecting the right materials for hospital surfaces is an essential component of creating a functional and safe healthcare environment. Architects and designers must be mindful of healthcare settings’ unique needs and challenges. For example, infection control is of the utmost importance, so materials that can be easily cleaned and disinfected without losing their structural integrity are highly desirable. Additionally, materials used in hospital interiors must be durable, and able to withstand both frequent use and harsh cleaning agents / chemicals. To achieve these aims, architectural designers follow various standards and methods to make informed decisions about material selection. For example, the WELL Building


Standard – becoming increasingly popular in healthcare design – is a certification system that focuses on the health and wellbeing of building occupants.12


several categories, including air quality, water quality, lighting, and materials. The materials category focuses on the use of non-toxic, sustainable, and hygienic materials. Using WELL-certified materials can help to improve indoor air quality, reduce the risk of toxicity, and promote a healthy environment. Health Building Notes (HBNs) are another document that provide technical standards and guidance on the design, construction, and maintenance of healthcare facilities in the UK, covering a wide range of topics – including infection control, fire safety, ventilation, and waste management. HBN guidance provides recommendations on selecting materials for use in healthcare environments, and highlights the importance of selecting


ones that are easy to clean and disinfect, have low porosity, and do not support microbial growth.16


Additionally, other


organisations, such as the American Society for Healthcare Engineering (ASHE), provide guidance on material selection for healthcare facilities.17


It covers


Evidence-based design One of the most common approaches deployed in the healthcare sector is Evidence-Based Design (EBD) – which utilises empirical evidence in the design process to create built environments that enhance human health, safety, and wellbeing. EBD has been increasingly used in the design of healthcare facilities, and involves conducting research on the impact of environmental factors such as lighting, acoustics, ventilation, and ergonomics, on human health. Designers then use the research to inform their decisions on materials, layouts, and other aspects of the built environment. The use of EBD in healthcare design has been shown to positively impact patient outcomes, staff wellbeing, and even financial performance. Studies have shown that healthcare facilities designed using EBD principles have lower rates of healthcare-associated infections, fewer medication errors, and improved patient satisfaction. However, some challenges exist with the use of EBD in the design process – such as the availability and quality of research studies. It can be difficult to find studies directly applicable to the design project at hand, or with sufficient sample sizes and controls. Additionally, implementing EBD in the design process can be costly and time- consuming, requiring additional research and collaboration between different fields.18,19


Despite these challenges, EBD


remains a valuable tool for architects and designers in healthcare. MCDM is a method used to evaluate and prioritise alternatives based on multiple criteria. It is a decision-making tool that helps to select the most suitable solution among various options by taking into account multiple criteria that can be conflicting or have different levels of importance. The MCDM method allows decision-makers to identify and evaluate various criteria simultaneously, considering both qualitative and quantitative factors.17 In the context of selecting hygienic materials for hospital interiors, MCDM can be used to weigh their pros and cons based on criteria such as hygiene, durability, sustainability, and cost.


March 2024 Health Estate Journal 59


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