Hospitals and health centres can be risky environments. Even after years of health and safety regulation and advice, slips, trips and falls are all too common, costing the NHS £133m each year. And it’s not just patients who are taking a fall more than 1,600 healthcare staff suffered a major injury in 2009/10 because of slips, trips and falls, often on wet or contaminated floors. It is a huge issue for health services apart from the distress, these injuries are expensive to treat and can lead to costly litigation and compensation claims.
In March 2013, the Department of Health in its Health Building Note HBN-00-10 updated its recommendations in respect of performance requirements for building elements used in healthcare facilities. It includes a subtle but important shift of emphasis that places greater responsibility on building commissioners, architects, designers, specifiers and contractors to recommend and choose the right flooring to reduce the risks of slips and trips. Failure to make a proper risk assessment and identify and use the most appropriate flooring available could expose anybody in the project chain to a liability claim in court.
The new regulations, legal requirements and standards are designed to ensure that flooring used in NHS estates is fit for purpose. For example:
Floors in hospital streets must be capable of withstanding loads from heavy-wheeled and intense pedestrian traffic
Carpet should be avoided in clinical areas and only considered in non-clinical areas once a risk-assessment has been carried out and a clearly defined cleaning and maintenance programme is in place
Floors in operating theatres should be able to withstand the movement of heavy mobile equipment and frequent spillages, cleaning and disinfection
Floors in entrance areas should be slip-resistant in all weather conditions
Flooring must be slip-resistant even in what are deemed to be dry areas, as they too could become wet or contaminated
All flooring, including slip-resistant, should be capable of being cleaned to agreed hygiene standards
In essence, floor design and specification should focus on enhancing patient safety and should help to reduce the number of accidents whether in new build or refurbishment projects. Crucially, these considerations now not only apply when a floor is specified and laid but also apply over the passage of time. According to the new guidance: There should be evidence that healthcare providers are monitoring slip resistance levels at regular intervals throughout the service life of a floor in order to identify any changes.
Flooring that has been installed for some time does not necessarily perform to the same standard as flooring straight from the factory, especially in respect of slip-resistance. There are a number of possible reasons including incorrect cleaning or contamination but number one is that some flooring just isn’t made to last or to perform to the same standard across the whole of its lifetime.
Products with a thin slip-resistant coating or embossed surface (which technically qualify them as safety flooring) can wear away quickly, leaving users at greater risk and site owners vulnerable to claims. Too many safety floors, even those that claim high slip-resistance, can become slippery after just a few months as their thin coatings or embossed surfaces can wear down.
Altro is campaigning for objective slip-resistance information to be available on all safety flooring products, including indicators of how long they perform at safe levels. There is currently no legal requirement for product life slip-resistance information or even an agreed industry standard on how to measure it. Reputable manufacturers have tested their products over the course of years and should be happy to provide the results to customers. We want to see more customers asking for that level of information to ensure they are protected for years to come.
Understanding the various rating systems for slip-resistance is the first step. New floor coverings will often be classified with an R Value, particularly in Europe, or a Slip- Resistance Value (SRV), more common in the UK; some manufacturers provide both.
The R Value is a result of the Ramp test. A person in work boots walks on an inclined ramp covered in motor oil; the flooring is put into a classification depending on what angle of incline produces the first slip. The lowest classification is R9, for an angle of between 6 and 10° rising to R13 for no slippage until above an angle of 35°.
There are a number of concerns about this measure. To start with, the most common contaminant encountered is water, not motor oil, and most people wear ordinary shoes rather than work boots. What’s more, each classification group covers a range of angles that have very different coefficients of friction at their lower and upper ends, so slip-resistance will vary considerably within one classification. Importantly the R Value can only measure a product’s performance in the lab when
it is new not in situ a few years in.
Altro’s preferred measure and the one recommended by the Health & Safety Executive (HSE), particularly in the healthcare sector is the Pendulum Test, which measures the coefficient of friction between the heel of the shoe and the floorcovering. It does this by swinging a dummy heel over a set length of flooring in a controlled manner to produce the Slip Resistance Value. An SRV of 36 or above represents a low slip risk, and is the HSE minimum classification for safety flooring.
One of the greatest advantages of the Pendulum Test is that it allows site owners to instigate a regime of regular testing to ensure that slip-resistance remains optimum: the new regulations mean they need to know if a floor is failing to provide ongoing slip-resistance. Site owners need to know that their floor surfaces are safe for users now and into the future. Specifiers, architects and designers (and those who offer them advice) also have to take the long view about the sustained slip-resistance of the flooring they choose in order to keep people safe and stay out of court.
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