The Best Healthcare Furniture for Cleanability

In a recent blog post, we introduced an American Society of Health Care Engineering (ASHE) publication titled Using the Health Care Physical Environment to Prevent and Control Infection, written for designers and healthcare professionals alike. 

This research initiative created an evidence-based best practice guide to help health care organizations create safer healing environments. As it relates to furniture, the guide introduces design recommendations with a simple goal —help provide easier means of cleaning for better outcomes.

From modular healthcare casework to bedside cabinets to one hundred percent custom architectural products, Shield Casework is the leading manufacturer of acrylic solid surface healthcare furniture and equipment.

Our first article focused on the durability of acrylic solid surface. Today’s article focuses on cleanability — the second of five furniture surface characteristic recommendations outlined in the evidence-based best practice guide — and how acrylic solid surface is a superior material for cleaning and disinfecting.

Why Healthcare Furniture Needs Cleanability

Cleanability is central to a safety first mindset when designing healthcare spaces to avoid adverse events. An article from Anjali Joseph and Ellen Taylor in healthcare design magazine talks about how "healthcare systems have many underlying conditions that interact in complex ways and may result in adverse events, such as injuries, errors, and infections. These are known as “latent” conditions that contrast the visible “active” failures. These latent conditions often go undetected. And those that exist in the physical environment are often incorporated into facilities during planning, design, and construction."

Designing or specifying the best healthcare furniture and equipment for it’s cleanability can be an effective, proactive action to help prevent adverse effects in healthcare environments (and arguably anywhere). Understanding the material makeup and construction of these products help you make purchase decisions that support a project’s infection control risk assessment (ICRA).

Cleanability in design can also make chief financial officers smile. In an industry that spends over forty million dollars per month on construction healthcare organizations can put that money to better use by significantly reducing costly furniture replacement. Furniture failure costs both time and money. Consider the amount of people hours wasted on simply disposing failed products. Now combine those hours with the back-and-forth engagement with your dealer or manufacturer on replacements, receiving the product, and then installing it. Was the product covered under warranty or did you have to pay for it?

Wouldn’t life be easier if manufacturers created long-term healthcare solutions? Healthcare organizations who have made the switch to Shield Casework's acrylic solid surface design typically have a storage room full of “healthcare furniture" that has succumbed to an early death by cleaning and daily abuse. One of the world's largest centers devoted exclusively to cancer patient care has recently converted their bedside cabinet standard to Shield’s 100% acrylic solid surface product for that very reason.

What's the Big Deal?

Using acrylic solid surface furniture and equipment is strategic and intentional. We’ve talked about what acrylic solid surface sheet goods are made of, which make it a solid, homogenous, non-porous, and microbial-resistant material. These aren’t just buzz words. It’s unique composition is a big deal because it eliminates common failure points typical in other “healthcare furniture” — seams and substrates — which can be detrimental to healthcare furniture cleanability.

Laminates vs. solids

Shield Casework offers laminated components in it’s products as a design option for integration with a variety of aesthetics. Laminates, whether it be a high pressure laminate (HPL) or low pressure laminate (LPL), provide a decorative, cleanable finish over an uncleanable composite wood-based panel (CWP) substrate. Regardless of how the laminate is applied, there’s still seams where two or more materials come together over uncleanable, porous substrates.

On any given drawer face, door, or general rectangular-shaped fully-laminated surface component there are twelve edges that create seams. Now consider the box in which these components are attached to — more seams. Normal wear and tear will degrade laminated products over time. Rigorous, regular cleaning and disinfecting procedures accelerate the process. It’s not a matter of if it fails, it’s a matter of when it fails.

An article in Healthcare Facilities Management (HFM) Magazine talks about the difference between porous and non-porous hard surfaces. "Often overlooked are details such as the material surface texture. It is shocking when one looks specifically for the texture of surface materials, how many there actually are — brushed surfaces, grooved, bumpy, laminated. Also overlooked are seams and how often two or more surface materials are combined on one product. All of this adds to the complexity of disinfection and creating a safe environment."

Even new and emerging antimicrobial laminates with “thermal healing” capabilities are susceptible, and only offer a one year warranty from the manufacturer. It’s important to note that the thermal healing process will not repair scratches and gouges. Furthermore, use of abrasive cleaners will damage the finish and can permanently reduce the stain and chemical resistance of the laminate.

The benefit of Shield’s proprietary methods of building with acrylic solid surface can eliminate seams and substrates altogether. Half-inch thick acrylic solid surface is homogenous, meaning it's the same composition from end to end. Fabrication requires a specially formulated, two-part reactive adhesive that rigidly bonds solid surface together with nearly the same performance characteristics of solid surface itself. This joinery provides an effectively seamless construction that endures clinical disinfection procedures without fail. Collectively, it’s entirely renewable to factory finish at any time, and it carries a ten or fifteen-year warranty depending on the manufacturer.

Shield Casework created acrylic solid surface casework and furniture to last a lifetime — making it some of the best healthcare furniture for not just cleanability, but durability as well. In fact, even our custom hybrid products are protected by an industry-unmatched lifetime warranty.

Acrylic solid surface resistance properties

What makes acrylic solid surface so cleanable? Let’s consider some of the resistance properties directly from our manufacturers to understand the nature of acrylic solid surface:

• Mold Resistance - Mold resistant per UL 2824 (Corian)
• Fungal Resistance - 0/No growth rating per ASTM G 21 (Staron)
• Bacterial Resistance - 0/No growth rating per ASTM G 22 (Staron)
• Chemical Resistance - No permanent effect when left in contact for 16 hours. Including but not limited to ammonium hydroxide, bleach, blood, ethanol, hydrochloric acid, permanent marker ink, sodium hydroxide solution, “Betadine” solution, and over 100 other tested reagents (for a full list of Class I and Class II reagents - visit Corian)
• Flammability - Class A / Class 1 per NFPA, 101 ASTM E 84 (Corian)
• Stain and abrasion resistance - Pass per ANSI Z 124 (Staron)
• Boiling water and high temperature resistance - Pass per NEMA LD-3 (Staron)
• Radiant heat resistance - No visual effect per NEMA LD-3 (Staron)
• GREENGUARD Gold Certification - Certified for chemical emissions/indoor air quality per UL 2818 (Hi-MACS)
• Food Equipment Material - Certified to the highest level, for food contact, for all food types per NSF/ANSI 51 (Hi-MACS)

For a complete list of certifications and technical bulletins, please visit LG's HI-MACS, Du Pont's Corian, and Lotte's STARON online documentation.

Acrylic solid surface made by these manufacturers also carries health product declarations (HPD) and environmental product declarations (EPD)?

Why do we Clean Surfaces?

Now that we’ve touched on the construction capabilities and performance properties of acrylic solid surface that help support why it makes the best healthcare furniture for cleanability, let’s take a look at why we clean in the first place.

In a previous post, we talk about how clean surfaces can help prevent infection transmission. We also distinguish the difference between the two — cleaning and disinfecting.

"Multiple studies suggest that environmental contamination plays a key role in the transmission of many dangerous pathogens, such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE) and Clostridium difficile (C.diff). All three of these pathogens survive for prolonged periods of time in the environment, and infections have been associated with surface contamination in hospital rooms and of healthcare personnel’s hands. Effectively cleaning and disinfecting of surfaces in health care settings is essential to the prevention of infections." [ASHE, p.89]

"Studies also suggest that environmental contamination is an important factor in patient-to-patient transmission; data from a number of studies have found that patients admitted to a room in which the prior occupant was infected with a particular pathogen are significantly more likely to acquire that same pathogen during their hospital stay than patients who are admitted to a room in which the prior occupant was not infected. Since the patients had no direct contact, the risk is associated with the environment of the patient room." [ASHE, p.91]

Acrylic solid surface doesn’t promote the growth of microbial organisms, meaning these organisms will eventually die even without intervention. Antimicrobial surfaces — or surfaces with biocidal properties — simply accelerate the process, but even they still take time to kill surface contaminants. To our knowledge, there isn’t a surface technology that zaps germs instantly on contact like a bug zapper, which means no surfaces are exempt from regular cleaning and disinfection procedures.

Maintaining surface cleanliness within an environment is a proactive measure to better protect those who come into contact with that environment. Regular and procedural interventions that maintain surface cleanliness help prevent adverse health events from surface infection transmission.

Make a Plan

One of ASHE’s best-practice recommendations for cleaning of environmental surfaces is forming a multidisciplinary team that establishes policies and procedures regarding room cleanliness and disinfection. Make a plan with a team of diverse experts that includes “people with the knowledge and experience to make decisions aimed at improving the cleaning and disinfection of the environment throughout the entire organization.” The following disciplines should be included on the team: administration, infection prevention and control, nursing, environmental services professionals and facility management. [ASHE, pg. 93]

Here is the five stage plan the team should develop: [ASHE, pg. 15]

1. Stage 1 - [ASSESS] - Determine which chemicals will be used to clean and disinfect surfaces
2. Stage 2 - [DEFINE] - Define policies and procedures, including what the cleaning tasks are, which department is responsible for each, how often the task should be completed, and which products will be used for each task
3. Stage 3 - [TRAIN]  - Train environmental service staff and any other personnel designated to clean surfaces. (i would argue that helping your staff understand the importance of why they’re expected to clean is important as well)
4. Stage 4 - [MONITOR/MEASURE] - Effectiveness of cleaning and disinfecting should be regularly monitored, such as with direct observation, fluorescent marker systems or adenosine triphosphate (ATP) ATP bioluminescence assays.
5. Stage 5 - [REFINE] - The multidisciplinary team should conduct an analysis and evaluate new technology for environmental cleaning and assess the need and application of these new technologies in their hospital setting.

Although this is a best-practice recommendation for healthcare, this same model could be an effective approach for athletic facilities, entertainment venues, higher education institutions, and any other high traffic environments designed to accommodate unpredictable populations of potentially sick people.

Cleaning and Disinfecting Furniture and Equipment

For the purpose of this article, we’re going to focus on stage 1 of the 5-stage plan above as it relates to the cleanability of acrylic solid surface.

There are three approaches that exist for routine disinfection of hard, non-porous surfaces in patient rooms:[ASHE, pg. 89]

1. Chemical disinfection with manual cleaning;
2. Using “self-disinfecting” surfaces that are impregnated or coated with metals such as copper, silver, and germicides;
3. No-touch technology such as ultraviolet light (UV-C) or fogging with hydrogen peroxide vapor or mist.

Let's take a look at these in greater detail per the ASHE guide and as it relates to why Shield Casework's acrylic solid surface construction is a superior choice when evaluating healthcare furniture and equipment.

1. Chemical disinfection with manual cleaning

Manual cleaning using an Environmental Protection Agency (EPA) registered disinfectant is baseline in the health care setting. To avoid injury and to maximize effectiveness, be sure to follow each manufacturer’s specific instructions for use (i.e. personal protective equipment, contact times, repeated applications, residue cleanup, etc.).

The three common types of disinfectants include: [ASHE, pg. 94]

• Quaternary ammonium compounds: The most commonly used chemical disinfectants are quaternary ammonium compounds (referred to as quats) for routine cleaning and disinfection. They are bactericidal, virucidal against enveloped viruses and fungicidal, but not sporicidal and generally not mycobactericidal or effective against nonenveloped viruses.
  
  
• Sodium hypochlorite (bleach): Sodium hypochlorite (commonly known as bleach) is bactericidal, fungicidal, virucidal, mycobactericidal and sporicidal and is generally recommended for surfaces or objects contaminated with C. difficile spores.
  
  
• Accelerated hydrogen peroxide: Accelerated hydrogen peroxide has been recently introduced for surface disinfection with generally short contact times; it is bactericidal, virucidal, fungicidal, sporicidal and mycobactericidal.

How to pick disinfectants

According to ASHE, "when selecting products for cleaning and disinfection...consider the disinfectant’s spectrum of activity (kill claim), in other words, the pathogens against which it has been proven to be effective. For example, quaternary ammonium compounds are often recommended for multiple drug resistant organisms such as MRSA and VRE, while sodium hypochlorite or an Environmental Protection Agency (EPA)-registered sporicidal disinfectant is recommended to kill C. difficile spores. An EPA-registered disinfectant labeled as a tuberculocidal will also be needed."

Also, "look for products that have short contact times, a one-step cleaner and disinfectant that is compatible with surfaces, non-corrosive and that has long shelf life.” [ASHE, pg. 94]

How to apply them to surfaces

According to ASHE, "[t]he disinfectants can be applied with cotton cloths, microfiber cloths or disposable wipes. The disinfectant may be wiped with a moistened cloth, sprayed or applied with a saturated cloth soaked in a disinfectant filled bucket."

"The most important factor is that the disinfectant be applied liberally enough to achieve the appropriate wetness to ensure that the disinfectant contact time is achieved per the label’s instructions." [ASHE, pg. 94]

Effects of chemical disinfectants on acrylic solid surface

The effects of chemical disinfectants on acrylic solid surface have been thoroughly tested and well documented. Shield offers the best healthcare furniture and equipment designs made from acrylic solid surface throughout the continuum of care, in both inpatient and outpatient settings — because of its superior performance properties.

Corian offers the best technical bulletin that talks about the effects of chemical disinfectants on acrylic solid surface. Using a procedure similar to that described for testing of materials per ISO 19712-2:2007 and ANSI/ICPA SS-1-2001, testing requires the examination of a sample after 16 hours of exposure with a concave glass cover. For context, contact times for a chemical disinfectant varies, but it’s generally a range of seconds to minutes.

Quaternary ammonium compounds, sodium hypochlorite (bleach), and accelerated hydrogen peroxide - three of the most common disinfectants used in health care settings - had no effect on acrylic solid surface when used according to the manufacturer’s use-dilution directions for general disinfection.

When hydrogen peroxide was used according to the manufacturer’s use-dilution directions for high-level disinfection, the surface effect was slight deglossing. However, acrylic solid surface is renewable. The slight deglossing was removed with a simple wet Scotch-brite pad maintenance procedure.

2. Self-disinfecting surfaces

Although antimicrobial acrylic solid surface exists, it is prohibitively expensive to use at scale for complete furniture builds. These are usually reserved for countertops or high-touch components of various equipment in areas where infection control is a known issue. 

EOS surfaces manufactures an EPA-registered acrylic solid surface, EOSCU, that's embedded with a proprietary copper Cuprous Oxide blend with proven biocidal capabilities. Here's a good article from them that talks about the biocidal properties of silver and copper.

3. No-touch technology

Common no-touch sterilization technologies use devices that emit ultraviolet light or systems that produce mist or vapors of a variety of chemicals.

Germicidal ultraviolet light uses UV-C wavelength light, which is germicidal and involves breaking down the molecular bonds in DNA, thereby rendering the organism sterile. Germicidal Ultraviolet light has microbicidal activity against a wide range of pathogens, including C. difficile. Ultraviolet light was significantly less effective for sites that are out of direct line of sight.

Hydrogen peroxide misting is the aerosolizing of dry-mist hydrogen peroxide or vapor to decontaminate a room. Hydrogen peroxide systems have also shown to have microbicidal activity against a wide range of pathogens, including C. difficile.

"Multiple studies have proven the efficacy of these no-touch room decontamination systems and suggest that they may be more reliable in reducing transmission of healthcare-associated infections. These technologies should be considered for use in the health care setting as a supplement and do not replace standard manual cleaning and disinfecting of surfaces." [ASHE, pg. 92]

Here are a couple of examples of these no-touch systems.

Halosil™ offers the Halo Disinfection System®, which pairs HaloMist™, a proprietary broad spectrum disinfectant, with the HaloFogger® to ensure the uniform, dry fogging delivery of disinfectant throughout any complex space.

Clorox® offers the Total 360® System,  which pairs , with an electrostatic sprayer, with the patentedPowerWrap nozzle, to deliver trusted Clorox solutions to the front, back, and sides surfaces.

To stay informed on this blog series and the latest innovations in acrylic solid surface design, join to our mailing list.

Do you have a design project that you think would be well-suited for acrylic solid surface? Contact Shield to learn more about our custom design services or visit our products page for more information.

¹ The American Society for Health Care Engineering of the American Hospital Association. (2019). Using the health care physical environment to prevent and control infection. Pgs. 15, 89, 91-94.
Retrieved from http://www.ashe.org/resources/pdfs/cdc/CDCfullbookDIGITAL.pdf