Health care challenges

Plenty of opportunity if you mind the details

FEW SEGMENTS OF THE CONSTRUCTION INDUSTRY are as hot as health care right now. I’ve been involved in a lot of resilient floor projects in health care from the specification, installation and inspection side, and have seen failure and success.

Christopher Capobianco

Depending on the use and the budget, resilient flooring in health care varies from vinyl composition tile (VCT) to heat-welded, flash-coved sheet goods and a lot of products in between. Even within these categories there are sub categories some times.

For example, under VCT there is the standard tile, and other such “premium” products as VET, HVT, quartz tile, homogeneous vinyl and others that have higher vinyl content for better performance, larger tile sizes and better visuals than standard VCT. The same holds true for the solid vinyl tile (SVT) category. Homogeneous SVT often looks like VCT but performs better, and the printed film, clear wear layer SVT (sometimes called LVT) have realistic visuals such as wood looks.

Finally, many designers are looking outside of the vinyl category to PVC-free products such as rubber, bio-based, polyolefin and linoleum tile and sheet products.

Proper planning, substrate preparation and installation can result in beautiful resilient floors for health care environments.

There has never been more variety in resilient floor tile than there is today, and each has unique methodology for installation and maintenance. This is important — adhesive selection and initial maintenance are NOT all the same!

In many trips to hospitals and health care facilities, I have seen many resilient floors that really made me unhappy, often because of substandard installation. Here are a few examples.


In health care, sheet products have to be heat welded and often are flash-coved for sterile environments. These are very specialized skill sets for installers; be sure your installation team is up to the task. Welding at too high a speed or too low a temperature causes gaps from welds that don’t hold.

Trimming the weld before it has cooled causes dirt catching seams that are lower than the flooring surface. In both of these cases, the entire purpose of welding for a sterile flooring surface is lost and it’s VERY difficult to repair.


I’ve seen more bad resilient floors because of adhesive issues than any other reason. The wrong adhesive and too much adhesive are the top examples. You don’t need much of a good quality acrylic adhesive to adhere SVT, rubber or sheet goods, but assuming “more is better” or making a simple mistake like using the same trowel that you did for the VCT or carpet can ruin the job. Indentations from adhesive displacement, tile shifting or adhesive oozing at tile joints are prime examples of what happens.

This rubber tile buckled because the patching compound was applied right over adhesive
residue and did not hold.

While we are talking about adhesive displacement, let’s look at adhesive selection. With the stresses put on floors in medical facilities, how the floor gets adhered can make a big difference in performance. Beds are heavier and have smaller wheels than ever, which is very tough on floors. There is also a lot of equipment getting rolled across the floors, and in both cases the flooring can usually take the load, but the adhesive may not be able to.

If the floor dents or buckles under this type of stress, it is rarely the fault of the material, and may be preventable with the right adhesive, such as a hard setting epoxy or a thin application of spray adhesive. Many manufacturers recommend this, but it may or not make it into the specification. I urge architects to consider this, but if they don’t specify adhesive specifically, the nature of competitive bidding is that the less expensive option gets used.

Find out how the space will be used, and double check the flooring manufacturer’s specs. If you are not sure, have a conversation with the flooring manufacturer. I’ve inspected more than a few indentation complaints where this recommendation was not followed, and the flooring contractor was held responsible.


Right up there with adhesive issues are substrate problems under resilient floors. In new construction, problems with concrete that is not yet dry continue to be a problem industry-wide. Substrates contaminated with paint, pipe cutting oil or other surface contamination can stain the floor or break the adhesive bond.

Improper heat welding technique causes gaps in seams that ruin a sterile environment.

Renovation projects also have their issues also when it comes to substrate preparation. If an old floor is being removed and a new one installed, the old adhesive needs to be removed as well. It’s not enough to just skim coat over the old adhesive! Contaminated concrete can prevent the bond of a patching compound to the substrate.

Follow manufacturer’s instructions and the industry standard ASTM F 710, “All concrete floors shall be tested for moisture regardless of age or grade level…” and also “…be free of dust, solvent, paint, wax, oil, grease, residual adhesive, adhesive removers, film-forming curing compounds, silicate penetrating curing compounds… and other foreign materials that might prevent adhesive bond.”* Make sure your substrate is clean, smooth and dry!


I’d be remiss if I didn’t mention the challenges of installing flooring in active construction sites. For hospital construction it seems to be worse than any other type of building, probably because there is a tremendous amount of plumbing, wiring, furniture and equipment all getting installed in these spaces, often at the same time as finishes like ceilings, floor and wall coverings. I have often marvelled how many trades work seemingly on top of each other. I’ve seen cases where that was unmanageable and others where everyone made it work.

The important thing is to be very firm about the floor coverings being left alone for the first day or two so the adhesive can cure or dry. Then, they should be covered with paper and wood panels so they do not get damaged. It’s important to discuss this when planning the job. If the flooring is installed into wet adhesive, it needs some time to set before you do anything — often two days.

If you cover it right away, somebody is bound to roll something across the floor while the adhesive is sill wet, and even if it is covered with wood panel, resulting in denting or shifting. Once you are ready to cover the floor, sweep first so any soil or grit doesn’t get ground in. Also, use brown paper before placing wood panels on the floor because the panels can be abrasive and may scratch the floor.


Finally, we have the issue of initial maintenance. Many resilient floors require some type of finish to be applied before they can be put into use. I’ve gotten pulled into a number of disputes over WHO was supposed to be doing the initial maintenance. It’s often assumed that that is part of the installer’s scope of work, which is not always the case because some installers do it and some don’t.

If you don’t do maintenance, make sure to exclude it from your bid and be clear with the general contractor about this point. Also, many products do not require a finish these days. If that is the case, be sure everyone is clear about that because it may be assumed that you are required to “wax the floor, because that’s what we always do.”

Finally — be aware that the finish coating may not be a standard acrylic floor finish. Polyurethane coatings are being used more and more frequently and this is a more detailed process.

Health care is still a strong market for our industry but there is a lot to know. Pay attention to all of the details, know your products, keep the lines of communication open and you can do well.

Christopher Capobianco has been in the floor covering industry since the 1970s in roles including retail and commercial sales, technical support, consulting, journalism, education and volunteer work. He currently is part of the sales team for Spartan Surfaces in New York City. Contact him via

* ASTM F 710 Standard Practice for Preparing Concrete Floors to Receive Resilient Flooring., 610-832-9585

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