Floor maintenance: A scientific approach to slip/fall prevention

While studies show that elderly and infirm people often slip and fall because of reasons related to their age, medication, illness, or other physical conditions, there is a way for nursing home management to execute a measurable, documented, scientific program to prevent incidents by addressing floor condition and related environmental factors. Regularly measuring the slip resistance of floors provides coefficient of friction (COF) data—a numerical, objective basis to improve and maintain floor safety. There are three steps to slip/fall prevention involving COF data collection:

  1. Measuring and recording the condition of floors.

  2. Improving and then maintaining that condition to a desired benchmark level through effective treatments and routine care.

  3. Regularly auditing/documenting the state of floors to help ensure (and demonstrate) the proper degree of due diligence and care (the opposite of negligence) and compliance with safety norms.

Mastering Measurement

Initially, it is important to benchmark the wet COF of the floor surface. Wet COF is basically a measurement that records how slippery the floor surface is when it is wet or contaminated. This should be done by a trained, certified operator to ensure that the test measurement is reliable.

Several organizations, including the National Floor Safety Institute (NFSI, https://www.nfsi.org), use or recommend a device called the BOT-3000, or Binary Output Tribometer (https://www.uwtlp.com). This is the only U.S. tester that has passed the rigorous precision and bias requirements of the American Society for Testing and Materials and is capable of measuring both static and dynamic COF. BOT is automated, and thus largely eliminates operator error since it does not depend on manually sliding a sled or test material across the surface, and it produces both digital readouts and printouts of results for documentation purposes.

Figure. Treated tile, A; untreated tile, B

Once a baseline COF has been established and corrections have been made to bring the floor up to the desired safety compliance benchmark (e.g., 0.5, 0.6, or 0.8 COF), regular audits should be performed to help ensure that the floor is being maintained properly or to prompt corrective adjustments as needed.


A written and enforced floor safety policy and procedures guide will improve floor safety while demonstrating management commitment to prevention. The policy/guide should address common causes of slips and falls, such as poor worker training, lack of weather contingency planning, inconsistent hazard identification, inappropriate footwear, and improper cleaning of floors, among other factors. It should thoroughly detail how to perform—and document—measurement, improvement, and maintenance of floors.

In a newly planned facility, carefully review the specification of floor surfaces. Eliminate inappropriate types of flooring in the design stage of floor selection and, as needed, establish traffic controls or restricted areas in facilities.

If an existing floor’s COF demonstrates that it is slippery when wet, consider applying a specialized treatment or product to the surface that increases wet slip resistance. Two product categories have proven effective in raising slip resistance on wet surfaces, and thus provide an excellent means to help ensure floor slip safety in general:

  1. Surface modifiers raise traction levels of mineral-containing floors (marble, ceramic tile, stone, quarry tile, etc.).

  2. Mop-on cleaners/treatments raise traction on finished and other floors.

Surface modifiers use chemical processes to alter the physical properties of an unfinished mineral-containing floor or surface, improving the coefficient of friction. The process creates micropores or imperceptible tread patterns, rendering tile and stone floors safer to walk on when wet. Applying a penetrating sealer makes the surface more resistant to soil. Slip resistance lasts several years with proper regular cleaning. Application should be handled by professionals. Surface modifiers are also very effective on porcelain or ceramic tubs and showers.

Mop-on cleaners/treatments are high-performance, pH-neutral cleaners with proprietary ingredients that raise the slip resistance of finished and other floors. These products are provided by several manufacturers, but be sure to ask for test documentation to validate product claims and effectiveness. Although recommended dilution ratios must be followed, relatively unskilled employees can apply these water-based treatments for routine cleaning and maintenance of slip resistance.

Learning From Incidents

If you have already experienced resident slips and falls at your facility, examining both qualitative and quantitative loss data will help identify how, where, and under what conditions incidents have occurred so that remedial efforts can be properly planned and directed. Performing physical inspections of incident areas may offer insight on causes, enabling a more focused and effective loss-control process.

Qualitative analysis examines conditions, frequency, severity, and other patterns: What type of footwear was being worn? Was there a contaminant on the floor? Was appropriate room signage in place (see “Signage Helps”)? Could this have been a trip/fall, instead of a slip/fall? What time of day did the event occur?

From a fiscal viewpoint, quantitative analysis determines the value or amount of the losses, projected direct losses based on past losses, and estimates of the overall future cost of risk. This enables projecting return on investment based on the cost of loss control measures versus projected costs of “business as usual.”


By implementing a scientific, measurable, audited, and documented program that identifies and prevents the causes of slips and falls, you will reduce injuries, as well as the trauma of expensive claims. Moreover you will be protecting your employees, patients, customers, and future business prospects from harm.

Kenneth Fisher is an adviser to the National Floor Safety Institute (NFSI). He serves on the NFSI/ANSI B-101 committee, which is establishing a test method for measuring wet static coefficient of friction (SCOF) of common hard floor materials. He is chairman of a subcommittee (NFSI/ANSI B-101-2), that is developing a standard for chemicals and treatments for hard tile surfaces. He served on ASTM’s F-15 Committee dealing with slip/fall issues. He also provides consulting services for Nu-Safe Floor Solutions, Inc., an international floor safety management company.

For further information, phone (800) 275-7771 or visit https://www.nu-safe.com. To send your comments to the author and editors, e-mail fisher1007@nursinghomesmagazine.com


Signage Helps

Consider placing signs in patient/resident rooms and other areas to raise safety awareness. Helpful in-room signage can be worded as follows (also see sign graphic):

“Please Help Prevent Falls by:

  • Keeping bed in low position, with wheels locked

  • Keeping room free of clutter

  • Keeping personal items and call light within reach

  • Ensuring adequate lighting

  • Calling for help if assistance is needed.”


American National Standards Institute (ANSI), https://www.ansi.org

American Society for Testing and Materials (ASTM), https://www.astm.org

Binary Output Tribometer https://www.uwtlp.com

National Floor Safety Institute (NFSI), https://www.nfsi.org

Topics: Articles , Operations , Risk Management