Floor surfaces shall be easily cleanable and shall minimize the
growth of microorganisms.
Flooring material with a reflectance of no greater than 40%8 and
a gloss value of no greater than 30 gloss units shall be used5, to
minimize the possibility that glare reflected from a bright
procedure or work-area light will impinge on the eyes of infants or
Floors shall be highly durable to withstand frequent cleaning and
Flooring materials shall be free of substances known to be
teratogenic, mutagenic, carcinogenic, or otherwise harmful to human
Interpretation: While ease of cleaning and
durability of NICU surfaces are of primary importance, consideration
should also be given to their glossiness (the mirror-like
reflectivity of a surface)11, their acoustical properties, and the
density of the materials used. Reduced glossiness will reduce the
risks from bright reflected glare; acoustic and density properties
will directly affect noise and comfort.
Materials should permit cleaning without the use of chemicals
that may be hazardous, since it may not be possible to vacate the
space during cleaning.
Transition surfaces that do not obstruct mobility, are durable,
and minimize noise and jarring of equipment should be provided at
the intersection of different flooring materials.
Materials suitable to these criteria include resilient sheet
flooring (medical grade rubber or linoleum) and carpeting with an
impermeable backing, heat- or chemically-welded seams, and
antimicrobial and antistatic properties. Carpeting has been shown to
be an acceptable floor covering in the hospital and the NICU and has
obvious aesthetic and noise reduction appeal, but it is not suitable
in all areas (e.g., around sinks or in isolation or soiling
utility/holding areas). Small floor tiles (e.g., 12 inch squares)
have myriad seams and areas of non-adherence to the sub-floor. These
harbor dirt and fluids and are a potential source of bacterial and
Much is known regarding the effects of chemicals such as mercury
on human health and development. Additional efforts should be made
to exclude persistent, bioaccumulative toxic chemicals (PBTs) such
as polyvinyl chloride (PVC) from healthcare environments. PVC or
vinyl is common in flooring materials including sheet goods, tiles,
and carpet. The production of PVC generates dioxin, a potent
carcinogen, and fumes emitted from vinyl degrade indoor air quality.
Dioxin releases are not associated with materials such as
polyolefin, rubber (latex), or linoleum.
Volatile organic compounds (VOCs) such as formaldehyde and
chlorinated compounds such as neoprene also should be avoided when
selecting adhesives or sealants for floor coverings. Specify low- or
no-VOC and non-toxic and non- carcinogenic materials. Flooring
containing natural rubber (latex) should be certified non-allergenic
by the manufacturer.
Infants should not be moved into an area of newly installed
flooring for a minimum of two weeks to permit off-gassing of
adhesives and flooring materials.