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 caregivers.

Floors shall be highly durable to withstand frequent cleaning and heavy traffic.

Flooring materials shall be free of substances known to be teratogenic, mutagenic, carcinogenic, or otherwise harmful to human health.

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 fungal growth.

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.