Martin Duske Manager Market Segment Health Care and Sustainability, Europe

1. Reducing indoor air pollutants and toxic chemicals in hospitals- The contribution of hospital flooring - Martin Duske Manager Market Segment Health Care and Sustainability, Europe nora Systems GmbH, Weinheim, GermanyContact: martin.duske@nora.com London, September 11, 2013

2. Study on Healthy and Sustainable Flooring by Health Care Without Harm

3. Study on Healthy and Sustainable Flooring by Health Care Without Harm “The ideal resilient flooring is non-toxic throughout its life cycle, practical (hygienic and easy to clean), durable, safe, silent underfoot, visually pleasant and cost-effective.”

5. Practical experience • Hazardous and toxic chemicals • Indoor air pollution • Underfoot comfort • Installation problems • Expensive and difficult cleaning • Life Cycle Costs “The cheapest product turns out to be the most expensive option over life time”

6. Topics of this presentation • Avoiding toxic chemicals and emissions • Criteria • Certification systems and eco labels • Alternative options • Products’ surfaces and their impact on cleaning and maintenance • Systems available • Cleaning and maintenance impacts • A chemical – free cleaning and maintenance option

7. Avoiding Toxic Chemicals and Emissions • Consider the overall environmental impact of manufacture, use and disposal, including any use of toxic chemicals • Eliminate materials that use, emit or lead to production of hazardous chemicals

8. 1. Avoiding Toxic Chemicals and Emissions

9. Avoiding hazardous chemicals during lifetime • Avoid materials known or suspected to contain carcinogens, mutagens, reproductive or developmental toxicants (CMR’s), endocrine disruptors

10. Avoiding hazardous chemicals during lifetime • Avoid any material emitting volatile or semi-volatile organic compounds (VOC’s, SVOC’s), e.g. Examples: • VOC’s Formaldehyde, solvents e.g. benzene, toluene, xylene, emitting fast in the first days • SVOC’s: phtalates and halogenated flame retardants, can attach to dust particles and emit slowly over the time

11. EPD’s to 14025 give detailed documentation http://bau-umwelt.de/hp481/Environmental-Product-Declarations-EPD.htm

12. US Group Kaiser Permanente Replacing PVC by rubber

14. Eco certification of flooring • BREEAM, BRE Class A+ only Formaldehyde, no other criteria • Greenguard children and VOC’s, Ammonia, etc. School (California 1350) • M1 Finland ammonia, aldehydes and smell • French emission label VOC’s, Formaldehyde

15. Eco certification of flooring

16. Blue Angel Germany – RAL UZ 120 Criteria for resilient flooring: • Lowestlevelsof TVOCs andVOCs • Confirmedabsenceofcarcinogenic, mutagenicandreprotoxicsubstancesasto EU regulations • Additional limitsforother relevant substancestohighestrequirements (e.g. LCI list) • Absence ofhalogensandphthalatesofanykind! No PVC floorspossiblewith Blue Angel label!

17. Testing Standards

18. Chamber Test

19. Chamber Test … but chamber tests alone are very theoretical, aspects of practical use are not sufficiently considered!

20. http://www.informedesign.org/Rs_detail.aspx?rsId=3320

21. Additional criteria: The installed floor Working Group in Finland (University of Kuopio 2007) finds out: • Emission rates of volatile organic compounds (VOC) and ammonia measured from six PVC materials and four adhesives in the laboratory were compared to the emission rates measured on site from complete structures. Significant higher specific emission rates (SER’s) were generally measured from the complete structures than from individual materials….The contribution from adhesives used in the installation was clear.

22. Additional criteria: the installed floor Working Group in Finland (University of Kuopio 2007) “The testing of complete structures would also in general provide a better approach to evaluate the actual emissions from the combined materials.”

25. Summary: Avoiding Toxic Chemicals • Ecolabels can help to prove criteria of safety and sustainability • The most relevant labels should be chosen, the German Blue Angel offers the most complete criteria • However, Ecolabels are based upon lab tests only, practical experience is lacking • Package testing and certification is recommended to evaluate the actual emissions of the combined materials

26. 2. Products’ surfaces and their impact on cleaning and maintenance

27. Cleaning & Maintenance Linoleum surface 1:500 Rubber surface, 1:500 PVC surface 1:500 Source: Dr. Jürgen Schmiegel, Piepenbrock (Facility Management Company /Germany);April 2011

28. “Permanent” surface protections

29. Typical damages Surface protections cracking or worn off ….

30. Traditional floorings require stripping and coating Stripping and coating means using highly alkaline chemicals to remove old coatings and to apply a new layer of coating afterwards. This process is repeated regularlyand requires- interruption of use of the rooms for at least 24 hours- aggressive chemicals that cause disposal problems- high cleaning and maintenance budgets

31. New comparative flooring study Study: Investigation on Material andBacteriologicalCharacteristicsofResilientFlooring Materials Period: 05.05.2011 – 29.2.2012 Prof. Dr. Kurt Schilcher et al. Report: DI (FH) Markus Hochleitner

32. New comparative flooring study • Target: • Evaluation of cleaning characteristics • Testing of stability of surface protection and other product characteristics • Testing of bacteriological behaviour

33. New comparative flooring study • Methods: • Manual mopping with neutral cleaner • Machine cleaning with neutral cleaner • Machine cleaning with diamond pads (without chemicals, only water)

34. New comparative flooring study • Testing different types of flooring with different cleaning methods over 6 months: • PVC with PU coating • Linoleum with surface finish • Rubber floors without protection

35. Development of thickness of protections Thicknessofprotectivelayers after 5 months: all coatingshavedisappeared PVC 1 Lino 1 PVC 2 Lino 2 Type of coating surface finish surface finish none none Area 1: manualcleaning w. chem. Area 2: machine cleaning w. chem. Area 3: nora pads w/o chem.

36. Bacteriological Tests Escherichia Coli Bacteria Staphylococcus Aureus PVC 1 Lino 2 PVC 2 norament noraplan Lino 1 PVC 1 noraplan norament Lino 1 Lino 2 PVC 2 Recovery rates after cleaning obtained by set-off tests:no significant differences between flooring and cleaning methods

37. Teachingsfromthisstudy • Surfaceprotectionshave a veryshortlife time on floors in a hospitalenvironment. Life time shortensevenmoreifmachinecleaningisapplied • Surfaceprotectionsandfinishesare not suitablefordiamond pad cleaning • Once a protectionor finish hasbeenworn off, protectivemeasuresarerequiredtoobtainsatisfactorycleaningresults. EspeciallyLinoleum floorsneed such protectiontoavoid subsequent deterioration • The uncoatedsurfacesofthetestedrubberfloorsshowexcellentcleaningbehaviorunder all testedcleaningmethods • Bacteriologicalinvestigationsshowespeciallythatthechemicalfreecleaningmethodwithdiamond pads on rubberfloorsisat least assuitableasothermethodswherechemicalsareused • As tocleaningresultsthediamond pad cleaningsystemgives high satisfactionand also optionstoobtainglossyormatsurfaces

38. Diamond Pad Cleaning in LNK Linz Since May 2013 this hospital is maintaining the new rubber floors nearly without chemicals!

39. Diamond pad cleaning (nora pads) A chemical free cleaning method that requires only water Suitable for all cleaning machines Can be combined with manual mopping and disinfection methods Developed originally for ceramic floor and specifically adapted for nora rubber floors (not suitable on coated or porous floor surfaces)

40. Cleaning a 12 yearoldrubberfloor – onlywithwater This floor was never stripped before

41. Rehazentrum Judenburg Straßengel, Austria noraplan plus 8 years old, surface before cleaning noraplan plus 8 years old, surface after cleaning

42. Rehazentrum Judenburg Straßengel Buffing with nora Pad 1

43. LKH Judenburg Withoutchemicals

44. LKH Judenburg Mat withoutchemicals

45. Long-term effectofdiamond pad cleaning on rubberfloors Medium valuebeforethetest Long termtest Without Pad High spot Low spot 83

46. Long-term effectofdiamond pad cleaning on rubberfloors After thetest: reductionofroughness After 10 yearssimulation(3600 cycles) 84

47. Environmental Impact of Diamond Pads Diamond Pads Damage assessment including machines Diamond Pads

48. Environmental Impact of Diamond Pads Damage assessment of consumables only Diamond Pads

49. Summary: Cleaning and Maintenance • Most resilient floors on the market come with a factory-applied protective layer of PU or other and / or require regular renewal of this layer • Coatings of all kinds have a limited life time that depends on use, intensity of traffic and cleaning methods • Uncoated materials with closed surfaces such as quality rubber floors are more easy to maintain, also with diamond pads • Diamond pads do not require chemicals, just water

50. Reducing indoor air pollutants and toxic chemicals in hospitals - Summary • With adequate testing and eco-labelling it is possible to obtain non-toxic flooring materials • Package testing is an additional tool to avoid toxic emissions from complete structures • Floor cleaning methods and renewal of coatings may imply the use of aggressive chemicals • Alternatively, the closed surface of certain types of floors allows to reduce chemicals to a minimum, even with diamond pads cleaning is possible with water only