Operating rooms are among the most critical environments in the hospital. They are places where staff spend hours on their feet in stressful conditions and where patients in surgery are at their most vulnerable. While reducing the risk of healthcare-associated infections (HAIs) drives design in all hospital spaces, mitigating the potential for contamination in surgical spaces is absolutely crucial. This means that materials and finishes in the OR—particularly walls and flooring—are an important part of creating a safe environment.

The Facility Guidelines Institute’s Guidelines for Design and Construction of Hospitals, which outlines specific requirements for OR finishes, dictates that floors should be monolithic and seamless, which will inherently keep out more pathogens and be more easily disinfected. Walls also play an important role in creating a hygienic space. Air and fluid-borne pathogens can reach the walls, so they must be easily and routinely cleaned, as well.

Cost-effectiveness is typically a top concern of hospital administrators because ORs are often profit centers for hospitals. Materials that are difficult to sterilize or can’t stand up to rigorous cleaning protocols will require longer downtimes for cleaning or frequent repairs, resulting in lost revenue.
For designers, it’s crucial to understand stakeholders’ expectations while at the same time demonstrating the trade-offs between various finishes. In many instances, there’s a give-and-take between operational efficiency and costs of material choices.

Wall surfaces
Hospital ORs are busy places with gurneys coming in and out that can bump into and nick walls. In addition to diminishing the look of the OR, damaged areas must be patched in order to maintain a seamless surface critical to infection prevention. Cracks and nicks make it harder for staff to disinfect because pathogens can hide out in these places.

When specifying wall finishes, designers have a range of options, including paint, panels, and solid surfacing. Epoxy paint is cost-effective and easy to clean because it can withstand hot water and strong detergents, which are required for cleaning after each procedure, without incurring surface damage. However, epoxy paint is not impact resistant, making it less durable than other materials unless it’s paired with abuse-resistant drywall, which can be an added cost.

Wall panels come in a variety of options and materials, making them popular choices in terms of cost and durability. Impact wall panels and wall protection are nonporous as well as water and impact resistant, so they are easier to clean, less susceptible to pathogen contamination, and durable in terms of withstanding normal wear-and-tear.
Stainless steel wall panels are one of the most expensive options, but the material’s nonporous and impact-resistant construction (as well as chemical resistance) makes it one of the most durable alternatives that’s easy to clean. However, if a panel is damaged, maintenance must be outsourced rather than completed on-site, which increases the time frame that an OR is out of commission. Rigid plastic wall protection panels, on the other hand, are an inexpensive option. However, they require sealants for corrosion resistance, which will need to be maintained over the lifetime of the product, adding time and cost to the regular maintenance process.
Another option is hygienic wall panels. They are water and impact resistant and can be heat welded at the inside, outside, and vertical seam. They can also be heat welded to the integral base that’s formed when the flooring surface runs several inches up the wall to eliminate seaming at the floor base and reduce sharp corners. While a more expensive option, the panels’ seamless nature allows for ease of cleaning and maintenance, which keeps costs low over the lifetime of the product.
Solid surface material is nonporous and weldable as well as abuse, mold, and mildew resistant, making it a strong contender in terms of durability, and for the most part, cleanability. However, caulking and sealing is sometimes required at seams when the material cannot be “heat formed,” which shapes the material over a surface to eliminate joints.
Many hospitals will combine hygienic wall panels and rigid plastic or stainless steel wall panels with other materials to maximize the benefits of selected panels while controlling costs—or even for aesthetic reasons. For example, some hospitals may elect to do half the height of a wall in solid surface or hygienic panels to protect the bottom part of the wall against gurneys and equipment while painting the upper wall surface with epoxy.
Given that ORs are used for many hours and exposed to significant wear-and-tear, it’s crucial that maintaining and replacing flooring is both quick and easy in order to reduce OR downtime and keep surfaces hygienic.
No-wax, heat-welded, solid-vinyl tile provides easy upkeep. It has the added benefit that damaged tiles can be swapped out, making lifetime maintenance and replacement simple and cost-effective. No-wax rubber flooring is another low-maintenance and affordable option; however, it’s important to pick an option with good stain- and chemical-resistant properties to maximize resiliency and durability. Environmental services staff should be consulted regarding cleaning practices and preferred chemicals to determine which no-wax rubber flooring option aligns best with hospital cleaning protocols.
Homogenous sheet vinyl is another no-wax option that has a through-pattern construction that wears evenly—ideal for a highly trafficked area—and is relatively stain and gouge resistant. The budget-friendly option is easy to install and stands up well to most hospital cleaners without significant corrosion. This not only gives staff greater flexibility in terms of what cleaners they can use, but also means less maintenance and a longer shelf life.
Epoxy and urethane flooring typically carry a more expensive upfront cost, largely due to pure material cost as well as installation. However, because the flooring is poured resin, it provides superior protection and low maintenance with exceptional chemical and impact resistance.
Pushing finishes forward 
Designers are always asked to work within parameters or standards—including brand standards—to create consistency within healthcare facilities and even across a health system’s entire network. Yet, each OR project should also be viewed as an ideal opportunity to evaluate rapidly advancing technology in the vital arenas of flooring and wall systems.
A designer’s ability to communicate the benefits of various materials and long-term maintenance information will help guide hospital administrators to the solutions that best fit their goals and needs. Mock-ups of OR designs are also helpful by allowing the administrators and end users to test drive finishes before committing to specific products for new build-outs and renovations.
At the end of the day, designers have a responsibility to possess the knowledge required to provide solutions that help hospitals eliminate medical errors, patient injury, falls, and HAIs, seeking out cleanable, durable finishes that provide value over a lifetime in order to create and foster the safest surgical environment possible.
Emily Haynes is an interior design intern at Gresham Smith (Jacksonville, Fla.). She can be reached at Emily.Haynes@GreshamSmith.com.