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January 2021

Designing for behavioral and mental health using patient safety risk assessment

Designing for behavioral and mental health using patient safety risk assessment preview

Behavioral and mental health (BMH) includes many conditions and a multitude of centers for treatment. The level of concern for the safety of patients and staff due to the design of the built environment is not the same in all parts of a behavioral health facility.

When designing a facility, best practice is to use a patient safety risk assessment (PSRA) matrix. This tool relates an opportunity for a patient to be alone to a level of risk of self-harm.

A combination of these factors help to determine the level of risk involved with each room in the facility.
PSRA chart
Credit: Hunt/Sine

The PSRA is a simple tool that helps to breakdown the different levels of care in BMH facilities.  The chart is created by measuring a patient’s intent for self-harm in relation to the room’s level of observation. 

The level of concern for the safety of patients and staff due to the design of the built environment is not the same in all parts of a behavioral health facility.

These are more easily defined between low-risk and high-risk zones, and many facilities further divide them by levels.

Level 1: Areas where patients are never allowed or are under constant supervision like staff and service areas.

Level 2: Areas where patients are highly supervised such as corridors, counselling rooms, cafeterias, and activity rooms.

Level 3: Areas where patients spend time with minimal supervision such as lounges or day rooms.

Level 4: Areas where patients spend a great deal of time alone, such as showers, toilets, patient rooms and seclusions rooms.

Level 5:  Areas that require special consideration where staff interacts with newly admitted patients that present potential unknown risks or where patients may be in a highly agitated condition. Due to the unknowns, these areas fall outside of the risk map and require special considerations for patient safety. Such areas include high risk intake, seclusion rooms, examination rooms and admission rooms. 

Discover additional behavioral and mental health resources
Posted: 1/5/2021 3:51:18 PM by Jesse Wade | with 0 comments

Update on Biocides: There is No Silver Bullet

Biocides preview

In recent years, the arguments for and against the use of biocides have intensified. Some pro-biocide organizations (typically manufacturers utilizing biocides in their products) are making bolder claims than ever before. In the absence of firm evidence tosupport these claims, however, there are concerns that these additives may be having no positive impact on infection control. At the same time, newly published research is painting an increasingly worrying picture regarding the long-term effects of these substances on human and animal health, and on the environment. These issues are being debated widely by academics and regulatory bodies throughout the world.

This piece will aim to outline the arguments presented by organizations on both sides. It will provide an update on the regulatory status of silver biocides, from bodies including the European Chemical Agency’s Biocidal Products Committee and the US Food and Drug Agency. Lastly, it will explain Altro’s current policy regarding use of biocides.

Pro-biocide claims

Organizations on both sides of the divide agree on the need for effective infection control, particularly in sites such as hospitals and commercial kitchens. Those for and against the use of biocides differ, however, on the best practice recommended for hygiene in these environments. They also disagree about the effectiveness (and therefore the advisability) of using biocides.

For some years, organizations backing the use of biocides in areas where infection control is paramount have argued thata range of silver-based additives used in products for healthcare environments are capable of slowing the growth of bacteria, mildew and mold. The process they describe is one in which silver ions block the ‘food’ required by the bacteria by interfering with the surface of the microbes and coating them. These organizations argue that incorporating silver ions into products used in the hospital or commercial kitchen will reduce the spread of infection.

Anti-biocide arguments

Organizations opposed to the use of biocides, however, argue that the use of these substances needs much tighter regulation, because the extremely widespread (and largely uncontrolled) use of these chemical additives in the world today leads to antimicrobial resistance.

The World Health Organization has identified antimicrobial resistance as a major risk to human life and is urging countries to collaborate in a global action plan to tackle the problem. The WHO factsheet explains: 

Antimicrobial resistance happens when microorganisms (such as bacteria, fungi, viruses, and parasites) change when exposed to antimicrobial drugs (such as antibiotics, antifungals, antivirals, antimalarials, and anthelmintics). Microorganisms that develop antimicrobial resistance are occasionally referred to as“superbugs.”

As a result, medicines become ineffective and infections persist in the body, increasing the risk of spreading them to others.

Antimicrobial resistance occurs naturally over time, usually through genetic changes. However, the misuse and overuse of antimicrobials is accelerating this process.1

The extremely widespread use of biocides threatens to speed up antimicrobial resistance because increased exposure means increased opportunity for genetic mutation within the bacteria. WHO stresses that this is not a problem of the future, but an immediate health risk. Data published by WHO’s Global Antimicrobial Surveillance System group in January 2018 revealed ‘widespread occurrence of antibiotic resistance among 500,000 people with suspected bacterialinfections across 22 countries.’ The most commonly reported resistant bacteria include E.coli and Salmonella, among others.

Linking maintenance and mutation

Genesis Biosciences, a company involved in the development of new ‘eco-benign’ antimicrobial products, explains that a key problem with today’s most commonly used biocides is the long-term contact between biocide residues and the bacteria they are designedto kill. The company states that, ‘because the residues contain sub-lethal concentrations of the biocidal product, the targeted bacteria are becoming more resilient against the products used to treat them’. In other words, the more ‘competitive’ bacteria (often those associated with serious health problems) are not entirely destroyed by the biocide. Instead, they can remain in contact with the biocide over an extended period, if traditional hygiene processes are not followed stringently. This close contactbetween the bacteria and the chemical designed to kill it creates an ideal environment in which the bacteria can mutate and develop resistance. We all remember the claims about 99.9% of germs being killed by strong cleaning fluids. It is now understood that the remaining 0.1% of bacteria is the long-term risk factor. A particular concern is that use of products containing biocides could lead to a harmful relaxation of cleaning regimes in areas where hygiene is critical, if reliance on the infection controlcapabilities of the products leads to complacency.

In recent years, a number of scientific studies have contributed towards a better understanding of the processes of mutation involved in the development of antimicrobial resistance resulting from biocideuse, in addition to the environmental impact of biocides leaching into water resources. A research project carried out at the University of Cardiff, for example, concluded that ‘exposure to triclosan (0.0004%) was associated with a high risk of developingresistance and 1
cross-resistance in Staphylococcus aureus and Escherichia coli(E.coli)’.2The recommendation of the Cardiff research team is that the U.S. Food and Drug Administration and European Union Biocidal Products Regulation should demand information from manufacturers on antimicrobial resistance and cross-resistance in bacteria after the use of their products.

Regulatory decisions

The United States regulatory body has already taken action regarding biocides. On September 9th, 2016, the United States Food and Drug Administration (FDA) banned the incorporation of triclosan and 18 other antimicrobial chemicals in household soap products. In 2017, it banned companies from using triclosan in over-the-counter health care antiseptic products without premarket review. The reason given was that manufacturers had failed to provide the FDA with sufficient proof that triclosan was safe and effective in the light of research into long-term health risks, such as antimicrobial resistance.

European regulatory bodiesare also taking action. The Biocidal Products Committee (BPC) of the European Chemical Agency (ECHA) has been examining the use of silver copper zeolite, silver sodium hydrogen zirconium phosphate and silver zeolite in a range of different products. Decisions are still pending for floor and wall covering products but, in October of 2018, the ECHA BPS decided not to approve the use of silver compounds in disinfectant products.

The committee opted for ‘non-approval’ as there was insufficient evidence to suggest that biocides were effective under dry conditions. The BPC of the ECHA stated, for example, (with regard to silver sodium hydrogen zirconium phosphate):

“Generally, the antimicrobial effect of polymer materials containing silver active substances is dependent on how much of the silver is released. A precondition for the release of silver is a solvent, i.e. a liquid that the material comes into contact with. A dry polymer material surface will not release any silver ions and thus will not exert an antimicrobial effect.”3

In other words, while the committee accepted that biocides might be effective if a surface is immersed continually in a solvent solution, and remains wet for a period, it was not proven that biocides had any antibacterial effect where surfaces are dry. In the absence of this proof, the committee decided not to approve the use of biocides in the disinfectant product category.

While a decision is yet to be made regarding floor and wall coverings, the decision regarding disinfectant productshas important implications. Flooring and wall coverings are typically employed in environments that are predominantly dry, 2Rebecca Wesgate, Pierre Grasha and Jean-Yves Maillard, ‘Use of a predictive protocol to measure the antimicrobial resistance risks associated with biocidal product usage’, American Journal of Infection Control44 (2016), pp. 458-64.3European Chemical Agency Biocidal Products Committee, ‘Opinion on the application for approval of the active substance: Silver sodium hydrogen zirconium phosphate, Product type: 2ECHA/BPC/211/2018, 17thOctober 2018.
particularly in healthcare sites. Therefore, there is every reason to believe that the ECHA BPC will reach a similar non-approval decision regarding the use of biocides in floor and wall coverings, within the next two to three years, when scientific examination of other product categories reaches completion.

Altro’s policy

For manufacturers such as ourselves, the decision to include or remove biocides has been at the top of the agenda for nearly a decade, so our policies reflect our response to the latest research from academics and regulatory bodies. Traditionally, customers have been keen to have antibacterial additives included in wall and floor coverings. In an industry sector where research and technology is advancing rapidly, it is understandable that suppliers and specifiers welcomed this apparent opportunity to solve major issues. Our technical teams follow scientific and regulatory evidence relating to our products on an ongoing basis, however, as part of our duty to customers and end users. A key question for us has been whether it would be better to remove biocides from all of our product ranges, irrespective of customer demand.

A breakthrough in recent years has been the development, by scientists, of new testing protocols for biocides, which are revealing new insights and calling earlier findings into question. Responding to the latest evidence from teams of academics and bodies such as the ECHA BPC, we decided back in 2012 that inclusion of biocides could be discontinued in our resilient flooring ranges, as they had no positive impact on hygiene. Use of biocides in Altro wall cladding products was also reviewed. In 2012, we decided to exclude biocides when designing new Altro wall cladding ranges, and began to supply specific geographical markets (notably the USA and Nordic markets) with biocide-free materials. Today, we do not include any biocides in our products. Inclusion of biocides is only one aspect of infection control, however. We continue to focus on hygiene as a key aspect of our research and development.

Key takeaways

In conclusion, research involving currently available additives suggests that specifiers and customers should not consider biocides a ‘silver bullet’. However, end customers can continue to rely on solid gold best practice for all areas where infection prevention is paramount. Research has confirmed the critical importance of hand hygiene, which has been shown to have far greater impact on infection control than was generally thought. Irrespective of whether biocides are incorporated into products, good cleaning regimes that physically remove the microbes from surfaces remain the most effective way to ensure hygiene criteria are met, even in critical hygiene areas. To make this possible, it is advisable to look for impervious, grout-free wall coverings, such as Altro Whiterock, with a smooth, easy-to-clean surface. A thorough cleaning regime on impervious surfaces such as this, with supporting good hand hygiene, is the answer.

Download the Update on biocides: there is no silver bullet
Posted: 1/22/2021 5:34:58 PM by Jesse Wade | with 0 comments

Hygienic surfaces that make cleaning and sanitizing your commercial space easier

Hand holding a spray bottle of cleaner

Commercial businesses have a great responsibility to provide a safe and hygienic space for both customers and employees. After all, even a vague appearance of dirt, dust, or grime in a commercial space can completely undermine the trust of customers and staff, posing a huge risk to customer satisfaction, comfort, experience, and overall ratings. From a business standpoint, this dissatisfaction can cost a commercial business a lot. The bottom line is that cleanliness and effective sanitation procedures should be a top concern for business owners who intend on experiencing long-term success.
And while regular cleaning is always necessary, property owners can get ahead of the work by integrating smart designs into the building’s design, making it easier (and faster!) to keep the commercial space clean. Take a look at just a few of the ways that smart interior design choices can help save business owners time and money on keeping the commercial area clean.

Easily Cleanable Flooring

Installing flooring that can be easily swept, sprayed, and mopped clean is an easy way to get ahead of the workload. Smooth surfaces, like vinyl flooring, are especially beneficial in public areas that see regular foot traffic requiring routine cleanings, such as restaurants, cafes, barbershops, spas, and any commercial spaces with customer restrooms. Surfaces with ridges or paneling can be difficult to clean thoroughly, as crevices and gaps can harbor hard-to-reach grime that builds up over time.

Smooth Wall Surfaces

Similar to the reasoning behind installing smooth flooring, smooth walls are a smart choice for commercial spaces. Smooth walls can be disinfected and wiped clean much faster than textured wall surfaces, like board and batten paneling, stucco, or mosaic tiling — all of which can create little gaps and crevices for dirt, dust, grime, and mold to collect. Smooth walls simply cut down the cleaning time required for employees to keep the space squeaky clean.

Integrate Simple Curves Instead of Beveled Edges

The floors and walls aren’t the only aspects of interior design that can benefit from streamlined decor choices. Handrails, light switches, doorknobs, armrests, and table edges are all high-contact surfaces, which will need regular cleaning. Choosing simple, curved designs over intricate designs with beveled edges can cut down on cleaning time and allow for a more efficient clean. This may require the interior design concept to adopt a more modern aesthetic, but the choice will certainly pay off in the long run when it comes to cleaning costs and effort.

Light Colors Boost Visibility

Boosting visibility across surfaces and decor can allow employees to identify when certain areas need special attention and a deep cleaning. Therefore, light colors, like cream, white, and beige, are often more adapted for commercial spaces than dark colors, which can hide dirt, spills, stains, and smudges much easier. Boosting visibility is also relevant when selecting materials. For example, glass is preferential to dark fabric, which is more difficult to see and clean.

Airflow Entry/Exit Points 

Finally, it can be beneficial to pay extra attention to airflow entry and exit points in commercial spaces. Vents, windows, and fans are all great at collecting dust, which can quickly build up and become an eyesore, not to mention compromising air quality and ventilation. Commit to a deep cleaning of these areas at least once per season, such as when sealing windows for the winter or cleaning the air ducts in the spring, in addition to the strategic placement of vents and airflow ports during the commercial building design process.
With intentional design, routine cleaning can be faster and more efficient for commercial spaces.
Skylar Ross is a contributor to the Innovative Materials blog. He is a content writer for the construction and home improvement industries with an interest in landscaping, outdoor remodeling, and interior design. Skylar is focused on educating homeowners, contractors, and architects on innovative materials and methods of construction that increase property value, improve sustainability, and create a warm and welcoming ambiance.
Posted: 1/22/2021 9:24:19 PM by Jesse Wade | with 0 comments

Important building design considerations for a commercial food processing plant

Food processing plant and worker

Any time food preparation is involved in a commercial space, there are extra considerations that must be taken to ensure that the highest safety standards are adhered to and that the building will serve as an efficient workspace. Hygienic surface cleaning, airflow, floor drainage, and safe working conditions are all elements that can be impacted by a building’s interior design.

When it comes to selecting wall and flooring designs for commercial food processing plants, there are some key aspects to consider to build a space that is both safe and productive. Take a look at a few of the essential considerations that can help boost safety and efficiency in a commercial food processing plant.

Reduce Slippage for a Safe Workspace

Professional food prep often requires several employees who are constantly moving about the production area. Line cooks, preppers, bulk suppliers, and packaging coordinators are constantly on the move and there are often liquid spills involved, leading to a common risk in commercial kitchens — slips and falls. Not only can slips cause serious harm and injury to employees, but they can also damage products and equipment, not to mention slow down the overall production. Creating a safe workspace is essential for employees to feel confident at work, which is why slip-resistant flooring, quick cleanups, and other flooring designs that prevent slippage are all a must in commercial food processing plants.

Easy Drainage Solutions

Another way to help keep the floor safe and clean is to install an effective drainage system, such as meat processing floor drains, that can help remove spilled liquids from the floor faster. Drain layout and dispersal is essential in the flooring design process for commercial food processing plants, as a smart layout can quicken drainage and help create a safer workspace.

Hygiene-Friendly Surfaces

Keeping the workspace clean and hygienic is another essential aspect of food processing plants. Builders should choose smooth interior surfaces that are capable of quick and effective cleaning. For example, tilt up construction can be a beneficial choice, as it provides a sleek, smooth surface that can be wiped down and disinfected easily, unlike textured walls that feature gaps or beveled surfaces — these surfaces can be difficult to reach and provide hidden areas for mold growth to occur.

Wall Protection for Commercial Kitchens

Wall protection should be another consideration when building the interior walls for a commercial food processing plant. Not all wall types are ideal for cooking and food prep areas, which often endure considerable exposure to heat, moisture, grease splatter, and smoke. Durability, heat-tolerance, fire-resistance, and moisture-resistance are some of the qualities that should be prioritized when selecting a type of wall for a commercial kitchen.

Safe and Effective Airflow

Adequate airflow is another important component that comes into play with designing commercial food processing plants. High temps, humidity, and smoke are everyday occurrences of many commercial kitchens. Airflow is essential to remove smoke and provide a safe workplace for employees. In addition, stagnant air can increase the risk of mold development, which can be a huge problem for food prep areas. In other words, securing consistent airflow is a must for commercial food processing plants to be successful. 

Industrial dampers can help maximize ventilation so that the food processing plant maintains a safe environment for staff and produce storage. In addition to including dampers, the placement of these airflow solutions should be strategic in order to maximize their effectiveness, and therefore should be included during the initial stages of building design.

By taking all of these elements into consideration during the building design process, builders can effectively create safe and efficient work environments for the commercial production of food.

Skylar Ross is a contributor to the Innovative Materials blog. He is a content writer for the construction and home improvement industries with an interest in landscaping, outdoor remodeling, and interior design. Skylar is focused on educating homeowners, contractors, and architects on innovative materials and methods of construction that increase property value, improve sustainability, and create a warm and welcoming ambiance.

Posted: 1/29/2021 4:21:26 PM by Jesse Wade | with 0 comments