May 4, 2020

With infected patients seeking emergency care at hospitals due to the global COVID-19 outbreak, now more than ever, rigorous infection control measures need to be incorporated into high-risk clinical areas such as emergency departments.

At Gresham Smith, we specialize in healthcare design, including hospital emergency departments and freestanding emergency departments. In this post, I explore how our interior designers approach infection control in EDs, highlighting some best practices for the incorporation of surface finishes—a key design feature that minimizes the transmission of infection, creating a safer physical environment for patients, family members and clinical staff alike.


Seam-less Design: Flooring

The interior design of a healthcare facility can greatly influence the transmission of healthcare-associated infections (HAIs), with any nooks, crannies or crevices serving as potential reservoirs for bacterial growth and viruses like COVID-19, making it difficult for staff to disinfect these hidden places.

For this reason, floor finishes, which are likely to come into direct contact with bloodborne pathogens or other body fluids, are a part of an emergency department’s overall infection control risk management strategy. Therefore, floors in resuscitation rooms and treatment bays should be surfaced with resilient, smooth and impervious materials that are corrosion-resistant and easy to clean.

To eliminate the seam where the flooring meets the wall—a hot spot where hazardous bacteria and mold often lurk—we typically recommend that our clients incorporate an integral cove base system into the design. Waterproof and antifungal, integral cove bases eliminate the 90-degree angle between the floor and the wall, promoting a sterile environment while facilitating ease of maintenance for staff.


An integral cove base system eliminates the 90-degree angle between the floor and the wall, promoting a sterile environment in this ED exam room.


In response to the coronavirus pandemic and the need for heightened infection control, new products are being developed for hospital spaces, and we’re keeping our clients informed about the latest to hit the market—especially products that facilitate long-term infection control.

One such product is a Clean Corner System by Gerflor USA that delivers—just as it indicates—a clean floor at all angles, even in hard-to-reach internal corners, providing excellent hygiene and making it another good choice for ED applications.

As ED corridors are heavily trafficked and subject to extensive wear and tear, we typically recommend a homogeneous sheet vinyl floor surface because of its durability and ability to wear evenly. Made of a single layer, this no-wax option is easy to install, stain-resistant, and holds up well against the harsh chemicals necessary to kill pathogens without significant corrosion. And that all equals a longer shelf-life and less maintenance for staff.

It’s important to note that although sheet vinyl flooring has fewer seams, it typically has a seam every 78 inches. Therefore, we make sure each seam is heat-welded so it becomes flush with the flooring and prevents mold and bacteria from growing within the seams.


Homogeneous sheet vinyl is a good choice for heavily trafficked areas such as ED corridors. 


Durability & Resilience: Wall Surfaces

We are also extremely mindful of the wall treatments that we include in EDs. For example, incorporating impact wall protection is an important design application in high-traffic areas such as emergency department treatment bays, as carts and equipment coming in and out of the space often bump and nick into the walls.

Without this type of protection, bacteria can hide in any damaged areas. Nonporous in nature, impact wall protection is durable, resilient and water-resistant, making it easier to clean and less susceptible to pathogen contamination.

Of course, materials used in an ED also need to have an aesthetic that allows them to promote health and well-being—especially in public-facing spaces such as reception and waiting areas. If we want to dress up an area using wall coverings, for example, we first determine their “disinfectability” and that they are bleach-cleanable, which not only helps us meet the guidelines needed for infection control but also minimizes an institutional feeling in the space.


In addition to infection control, aesthetics need to be considered in public-facing spaces such as waiting areas.


A Solid Solution: Countertops

High-touch surfaces such as countertops are an ideal site for cross-contamination. That is why we typically specify solid surface or quartz countertops in EDs, as they are devoid of the pores and seams commonly found in surfaces such as plastic laminate. In fact, studies have shown that the coronavirus can live on plastic laminate countertops for up to 36 hours.

Simply put, solid surface and quartz are more hygienic, although they can come with a higher price tag than other surfaces of a more permeable nature. However, clients are budgeting for infection control a lot more these days.


Solid-surface and quartz countertops are a more hygienic choice in areas such as nurse stations. 


Crossing the Finish Line

Although the coronavirus pandemic has highlighted the need for amped-up infection prevention and control measures in hospital spaces, patient, staff and family safety, along with the management of HAIs, has always been at the forefront of Gresham Smith’s healthcare design practices.

And whether it be an emergency department, a hospital or a medical office building, every project represents an opportunity for us to think ahead in terms of infection control and how each end-user is ultimately going to utilize a space—especially in the future in terms of growth.

With the advent of COVID-19, I can foresee a day when health systems will apply the infection control standards of an ED to a less critical facility such as a medical office building. These standards may even transcend the healthcare setting and cross over to places such as schools, shopping malls and restaurants, as we look for ways to keep our populations safe during the greatest healthcare challenge in more than 100 years.

And it’s not too much of a stretch to think that the lessons we’ve learned as healthcare designers may serve us well in terms of hope, as the world navigates uncharted territory in search of solutions.