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Hospital administrators, designers and builders increasingly turn to fiberglass reinforced composite shower systems for ADA compliance, added safety, easier maintenance and cost savings

By Ed Sullivan

With a keen eye on cost containment and patient liability, hospital designers are finding new ways to address the need for patient comfort and safety while lowering construction and maintenance costs. One noteworthy effort is the movement among architects, contractors and administrators to rethink their approach to the design and installation of shower enclosure.

There are a number of issues surrounding the choice of traditional tile-surround showers versus advanced, pre-molded, fiberglass reinforced composite shower systems. The major concerns include providing for patient safety, compliance with ADA access requirements, offering compatibility with designers' aesthetic requirements, and meeting today's construction methods and standards – all while adhering to ever-tightening budget constraints. Other requirements that should not be overlooked include durability and maintenance requirements.

Ever-increasing risks and demands
Just as no area in the home poses more threat to an individual's safety than the shower, the risk is even more problematic in hospitals. For example, safety devices such as grab bars and railings must be sufficiently strong to support the pulling weight of heavy patients, which in some cases might include those weighing over 300 lbs. If an obese patient who suffers osteoporosis happens to lose his or her balance and tear out a grab bar, the consequences could be devastating injury for the patient and costly liability for the hospital.

Meeting modern ADA access requirements and local building codes also impacts shower design and could even present additional safety challenges. For instance, since "roll-in" showers are needed for access of patients in wheelchairs, the use of low- or no-threshold shower entries runs the risk of having water leak out onto the floor beyond the shower stall¾creating a slippery hazard for hospital personnel and guests.

Design aesthetics have also become more important these days. Many hospital administrators prefer that their hospital rooms appear more "residential" and less institutional looking, which they feel is more conducive to patient and visitor comfort; both of which may contribute to patient recovery. Aesthetic room design encourages the integration of attractive shower and bathroom facilities, while also taking maintenance and sanitation concerns into account.

In designing any shower enclosure, providing for current construction methods is important, especially where timing and costs are concerned. In some cases hospitals require fast-track construction performance, so both installation and availability of materials, along with ease of installation, become frequent concerns. Renovations may pose special problems not only because of upgraded building codes or ADA requirements, but also because showers may be required where such facilities didn't exist before. In the face of ever-escalating construction costs, meeting all of the above requirements is continually challenging designers.

New challenges require new solutions
Traditionally, ceramic or porcelain tile-surround shower stalls have been in use in hospitals throughout the world for centuries. Yet, current demands give rise to second-guessing the use of tile, as newer fiberglass shower systems oftentimes do a better job of meeting today's varied requirements.

"To accept that traditional tile shower enclosures are the best solution for new hospital installations or renovations means the assumption of costs, procedures and potential service problems that may otherwise be avoidable," says Jon Franklin, Senior Project Architect and Vice President of FKP Architects, Inc., Houston, TX. Founded in 1937, FPK is one of the nation's leaders in healthcare facility architectural design.

A $354 million expansion and renovation of the Texas Children's Hospital at Texas Medical Center in Houston, the nation's largest pediatric facility, became a test bed for Franklin's point of view. He was assigned the design of the hospital's west tower expansion, a 15-story addition to the existing five-story hospital building. There were eight "bed" floors with 251 private patient rooms, many of which required one of four different shower designs. The Diagnostic Testing floors, which made up the rest of the project, also required showers.

"The best of today's fiberglass shower units offer innovative design features and accessories that provide comfort and safety while assuring compliance with ADA standards," says Franklin. "While the design aesthetics and ease of installation were also important factors, safety is paramount, and we found both were quite obtainable with fiberglass showers."

Convinced that they could meet safety and ADA requirements, as well as the Houston building codes, Franklin specified the Best Bath line of fiberglass shower units made by Fiberglass Systems of Boise, Idaho.

Best Bath has recently introduced a line of "hospital-grade" fiberglass reinforced composite shower systems that feature an installation system that adheres the showers to the sub-flooring in virtually any weather. They come with 1/2-inch, heavy-duty plywood backing on the walls into which grab bars and other safety accessories can be securely affixed. Unique to this new grade of shower modules is the increased structural integrity of the structure, made possible by a much more substantial laminate schedule and a total encapsulation of the plywood core. This innovation lengthens the expected life of the showers substantially while still realizing the benefits of lowered installation and maintenance costs.

"I like their roll-in design that features a collapsible neoprene ‘water dam' threshold that allows wheelchairs to roll right over it, yet keeps the water in the shower," says Franklin. "With some other designs we'd had trouble meeting the state requirements or had cleanup problems because water splashed onto the floor outside the shower."

"Patient safety is a paramount goal that can be successfully met with fiberglass showers," adds Architect Jim Carlisle, AIA with Mahlum Architects in Seattle, another healthcare facility design specialist. "Showers are almost inherently dangerous. Since hospital patients usually have some infirmity, and elderly patients may have arthritis or another disability, showers that feature easy access and safety features are especially appropriate."

The durability available with fiberglass showers is attested to by their use in facilities designed for bariatric (extreme overweight) patients at Oaks Surgical Hospital in Thousand Oaks, California. Bob Herzog, AIA, of hospital designer Boulder Associates (Boulder, CO and Sacramento, CA), comments on the challenge of providing showers for patients weighing 300-400 lbs.

"We specified these showers because they have heavy plywood backing – as opposed to the standard wafer-board or particleboard backing – that can withstand the impact and weight on hand rails and grab bars," Herzog explains. "Most safety bars are designed to withstand a 200-lb. lateral loads without ripping off the wall. The needs of many patients at this hospital go well above that. So, while we used to typically specify a tile surround and wood backing in the wall, we deemed the fiberglass Best Bath models to be safer, and they are considerably less expensive."

Meeting the need for aesthetics
The ability for fiberglass showers to offer a non-institutional appearance is an important plus to many architects and facility owners.

"At Texas Children's Hospital there are provisions for Mom and Dad to come stay with the child," Franklin says." Because families would be staying there, we tried to get away from the institutional look as much as we could."

"This was a fast-track project, so there was no room for showers that came up short on either looks or performance," Franklin continues. "We wanted consistent quality and uniform dimensions in the showers. The Best Bath fiberglass units we used met that requirement. We selected four different models, all of them with tile-like patterns. When we presented the concept to the nurses, they agreed that it looked very good, almost residential-looking. So, I created a ‘closed' spec for those units. We had the plumbing engineer specify exactly what we wanted – no substitutions."

Franklin was also impressed that he could get all the needed accessories from the same shower manufacturer, including the seats, grab bars the curtain bars and soap dishes.

"They are all part of the assembly," explains Franklin. "The order was completely prepared at the factory, so there was less coordination required by the contractor. The tile pattern made it look better overall and the way the flanges are designed made the unit trim-out better than conventional showers I've had to detail around."

Jim Carlisle says Mahlum Architects has also been moving toward fiberglass showers for the past five years.

"We are finding fiberglass models to be much less expensive and somewhat more trouble-free than ceramic tile installations," he says. "Fiberglass showers seem to have few leakage problems and are easier to install."

"Compared with other ways to build, it is much more convenient for architects to know they can specify a shower system that installs quickly and easily," concurs Franklin. "This was especially appealing on the fast-track Children's Hospital project. The whole process was simplified by our ability to quickly get drawings finished and to the contractor so that he could begin building. By the time we would have been detailing the inside of conventional tile showers, the contractor on this project had already started framing for the fiberglass units. The plumber was able to rough in the shower with good speed, and there was no need to have a tile setter come in and prep the job and then set all the tiles. I'm sure it improved the speed and therefore it was a cost-savings for the owner to have pre-formed fiberglass showers."

Franklin especially prefers to use fiberglass shower systems in renovation situations, where problems meeting new codes and ADA requirements can pose formidable obstacles.

"When you're renovating an existing building, you need to meet slope requirements, yet you don't have the ability to slope the floor for a shower pan," points out Franklin. "However, you can put a fiberglass unit right on top of the floor, and with the ‘water dam' threshold design you can meet handicapped requirements without having to chip out the existing concrete to create a slope. So those particular models are a very good solution for renovation projects."

While not an urgent concern in the design phase, fiberglass shower systems are mold and mildew resistant – because there is no grout – making them easier to keep clean than tile showers. However, hospital administration immediately recognizes the resulting reduced maintenance and housekeeping demands.

Challenges met
With all of the benefits offered by the best of today's fiberglass shower systems, hospital goals and objectives – such as improving patient safety and comfort, conformity to ADA requirements, greater design latitude, and improved control of construction and maintenance costs – have all become more attainable.

For more information, contact Best Bath Systems, 4545 Enterprise, Boise, Idaho 83705; Phone (800) 727-9907; Fax (800) 627-0929; Email hospitalsales@best-bath.com; Visit the web site www.best-bath.com.