The key to engineering the “bones” of a healthcare facility, including the floor structure, is flexibility-identifying the expectations for the facility in the years to come and planning so that you can translate them to a structure that will work for the owner. You'll be designing well above code minimum requirements in planning for anticipated loading and vibration in some spaces. Early in a project, we create a structural flexibility plan. We work with the owner and the architect to identify the zones where particular loading and vibration requirements will occur. Recently, we've started to see owners providing for load and vibration capabilities over the entire footprint of the operational floors. One reason is that we're seeing more and more imaging modalities being distributed to different departments throughout the facility-for example, hybrid surgical suites and other nontraditional locations. There is some cost upfront to doing this, but it is relatively small compared with the cost of long-term operations or of having to disrupt a particular area of the facility and retrofit.
Are there any special concerns regarding the variety of floorcovering products available?
In planning for the variety of floorcoverings that are available for use these days, the main concern from an engineering standpoint is the interface between the concrete slab and floorcovering adhesives that may be used. With the moisture that is given off by concrete as it cures, you have to make sure that this accommodates the floorcovering, both by specifying the concrete mix and by proper sequencing of installation.
What are considerations regarding the building's structure?
Different considerations come into play in selecting a structural system between concrete versus steel. Steel can offer less flexibility during construction in that changes to the structure after a mill order and fabrication can be costly. Concrete is mixed and forms are built as the job proceeds, which allows more flexibility in that late changes can have less of a cost impact. Also, because a concrete structure has more inherent mass and stiffness than a steel structure designed for the same loads, it gives better vibration control from the start. Flexibility concerns are different post-construction, though, as a steel structure can accommodate field welding whereas concrete requires drilled anchors. In short, there are pros and cons to both basic structural types when considering future flexibility.
Vice President, Miami Children's Hospital, Miami
In determining floorcovering, how do you balance aesthetics, safety, and maintenance?
This is a very delicate balance, and we are constantly challenged. But it's always safety first. What is the place (in terms of aesthetics, safety, and maintenance) of carpet these days?
We use very minimal amounts of carpet.
We use carpet tiles for their flexibility and ease of change. We make sure to choose a type that is microbial-approved for infection control.
We typically use this type of flooring in high traffic areas where we cannot use terrazzo or areas that would be suspect for body fluids.
We do not use much of this at all as it is too hard to make it look nice.
We use vinyl in the secondary corridors of our facility.
We do not use linoleum.
Wood or faux wood?
We use very little of wood or faux wood flooring.
What considerations and options are available for ceramic tile floors?
We like to use tile if they are not too slippery.
What are today's considerations for sustainability?
We look very closely and weigh the sustainability issues to do that which makes sense. We have a very aggressive sustainability program at Miami Children's Hospital.
Raymond T. Braun
Vice President-System Facilities, University Hospitals Health System, Shaker Heights, Ohio