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The Role of Flooring as a Design Element Affecting Patient and Healthcare Worker Safety

October 2014
EBD Journal Club


Harris, D. D., Detke, L. A. (2013). The role of flooring as a design element affecting patient and healthcare worker safety. Health Environments Research & Design Journal, 6(3), 95-119.


Objective: The objective of this study was to review, identify, and synthesize the literature on patient and healthcare worker safety related to flooring. The topic of flooring in the design of healthcare facilities is complex: healthcare assoicated infections, push/pull limitations, falls and fall injuries, and noise as a contributing factor to quality of care.

Background: Most hospitals have not been explicity designed to enhance patient safety. Recommendations from the Agency for Healthcare Research and Quality (AHRQ) include preventing patient falls, reducing infections, and preventing medication errors as the areas of emphasis of evidence-based design to improve patient safety and quality of care. 

Methods: A review of the literature was conducted through search engines using a predefined list of keywords to identify studies about flooring and the safety of patients and healthcare workers. Inclusion criteria included peer-reviewed theoretical and empirical studies published in English from 1982 to 2012. Final inclusion was obtained based on an analysis of research design. 

Results: Of those 27 articles that met inclusion, 7 focused on healthcare assoicated infections; 9 focused on slips, trips and falls; 7 articles foucused on noise; and 4 focused fatigue. The studies are profiled in tables and organized by environmental variable. 

Conclusions: Though a limited number of studies met the criteria for this review, the evidence base is emerging to design for safety. Recommendations for future research and practical application of design are provided. 

Keywords: Evidence-based design, literature review, patients, safety, staff