Lighting Design for Hospital Rooms and Nurse Stations

Light and Health: Healthcare Lighting Design for Hospital Rooms and Nurse Stations Callie Walton Texas Christian University 10 November 2017 Lighting and the Human Experience: IDFM 30503

Walton 1 Callie Walton IDFM 30503 – Lighting and the Human Experience 11/10/17 Abstract Light and Health: Healthcare Lighting Design for Hospital Rooms and Nurse Stations This research paper focuses on the factors of lighting design implemented into hospital environments that could potentially benefit both patients and staff. There are four vital components that interior and lighting designers must take into consideration when designing a hospital, which include: 1) the time, duration, and color temperature of illumination in rooms for patients opposed to employees; 2) the exposure to daylight; 3) the illumination levels in order to remove bacteria; 4) and lastly the material of the lens in light fixtures in relation to antibacterial substances. It is also important to consider the differing circadian rhythms between shift nurses and their patients. This paper will describe the differences of how designers can manipulate certain light fixtures to meet the lighting needs of both patients and staff members. Multiple case studies will provide evidence supporting the need for natural light and a consistent circadian rhythm for everyone working or visiting the hospital. The purpose of this paper is to reveal more knowledge and information researched for healthcare lighting design so designers can design hospital settings with more benefits including short length of stay for patients, higher performance in nurses, and an overall more uplifting atmosphere. Conclusions from this paper will reveal specific design techniques and fixtures for a RCP in hospital settings that agrees with the research found and collected.

Walton 2

Light and Health: Healthcare Lighting Design for Hospital Rooms and Nurse Stations Le Corbusier once said, “Doling out cosmic energy, the sun’s effects are physical and moral, and have been too much neglected in recent times” (Winter, 28). In todays’ world, given the exponential amount of information researchers have accumulated regarding design within healthcare settings, it is surprising that so little consideration is given to the role of light. Even back in the 19th century, people understood and recognized the importance of lighting design with their use of sanatoriums to expose patients with tuberculosis to solar radiation (Winter, 28).

Even during World War I, physicians promoted light therapy to heal wounds (Winter, 28).

Currently, designers show an unwillingness to use the research on lighting design to its full potential, but even with minimal exposure to this knowledge, designers can implement the important features and benefits into their projects. With that being said, there are four vital architectural lighting components that give healthcare spaces more potential in benefiting both their patients and staff in a hospital. These components include: 1) the time, duration, and color temperature of illumination in rooms for patients opposed to employees; 2) the exposure to daylight; 3) the illumination levels in order to remove bacteria; 4) and lastly the material of the lens in light fixtures in relation to antibacterial substances. These factors highlight the fact that environmental ergonomics should be given a more prominent role in hospital buildings and workplace design to support safer healthcare facilities for staff and patients.

The difference in sleep cycles between patients and employees can affect many health benefits for employees since their sleep cycle is more vulnerable to interruptions. A duration of light exposure at a specific time of day with a certain color temperature and light intensity can cause interruptions in an individual’s sleep cycle. To go into more detail, the body’s production

Walton 3 of melatonin is regulated by the hormone producing, pineal gland, which is triggered by different amounts of illumination (lux) and color temperature (K) over a 24-hour cycle (Winter, 29).

When the body is exposed to higher amounts of illumination and color temperature, the pineal gland suppresses the production of melatonin, and vis versa, when exposed to lower amount of

Fig. 1. The picture, referenced from ies.org, shows the requirements for tuning electrical light fixtures, in terms of spectrum and light level, to mimic the rendering of daylight.

illumination. The body has a natural reaction to follow the illumination cycle of daylight by suppressing melatonin in the morning and producing it at night. Considering an average amount of people spend about 87% of their lives indoors, their circadian rhythms rely on the illumination received from electrical fixtures to regulate its’ sleep cycle (Joarder, 445). Research shows in majority hospital settings, there is a reported “lower than recommended lighting standards” (Dianat et al., 1538). Visual task requirements for healthcare premises may vary significantly, with illumination levels ranging from 100lux to 100000lux for some operating areas but the Illuminating Engineering Society (IES) Lighting Handbook provides the specific standards for operating rooms (H=2000lux, V=750lx), examination rooms (H=500lx, V=200lx), and nurse stations during the day, (H=500lx, V=200lx) opposed to the night (H=100lx, V=40lx) (IES Lighting Handbook, 2011). The problem healthcare settings face is the difference in sleep cycles between nurses and their patients. Since many nurses have night shifts, their sleep cycles and circadian rhythms are shifted forward. Night shift nurses who are out of synchronization with the

Walton 4 natural light-dark cycle are also more prone to health problems. These risks are higher for nurses because their cycles are more easily disrupted by exposure to high illumination levels in the morning when they should be getting ready for bed. Therefore, exposure to bright light during the night can reduce risks of health problems for nurses who have night shifts. A research study showed that nurses preferred a 5700K color temperature when working, opposed to patients, who preferred around a 3000K color temperature when visiting or staying in the patient rooms (Cui, 631). To fully solve this health risk for nurses, while also keeping patients content with their stay, designers must recognize that healthcare spaces need controlled lighting parameters.

Overall, the general lighting needed to provide sufficient illumination for medical procedures and ideal performances from employees should provide a pleasant environment to aid patient’s recovery. To manipulate the circadian rhythm, one must know not only how to alter the spectral power distribution (nm) and light intensity (lux) in controlled parameters, but also the proper maintenance of the light fixture, to light color glare, flicker glare, flicker, and many other agitating characteristics that cause strain to the eyes (Dianat et al., 542).

While taking into consideration the color rendering scale and range of illumination levels of an electrical light fixture, the improper maintenance of a lighting installation can do even more damage to a work place. A study conducted of the lighting effects on employees showed that half of the employees working at a hospital had agitation with the maintenance and position of light fixtures in their working environment (Dianat et al., 542). This improper upkeep can include dirt build-up on the light emitting surfaces and failure to repair or replace damaged or defective luminaires, which eventually deteriorate to the point where it ceases to provide the visual conditions required. A progressive step evaluated by researchers in the lighting design field have successfully found a way to eliminate more bacteria in hospital settings with a specific

Walton 5 type of film that can be placed in light fixtures. “Antimicrobial films containing silver nanoparticles on a titania substrate have shown to have marked visible light photocatalytic properties” (Dunnill, 115). The films are successful in reducing bacteria when transformed from purple (silver oxide) to orange (silver) under three different SPD lighting conditions: UVA365nm, white light (common in UK hospitals) and UVA filtered white light (Dunnill, 115). The films under these circumstances are seen to be photocatalsts under visible light conditions, while demonstrating a 99.996% reduction in the number of viable E. coli bacteria and a 99.99% reduction in the number of MRSA bacteria (Dunnill, 121). Hospital administrators should apply these films in LED fixtures because of their ability to render different illumination levels and color easily on the spectrum. The more appropriate maintenance or installation of lighting fixtures and more appropriate combination of light colors are currently proposed as possible ways to improve lighting in the working environment. The results of proper installation and sanitation maintenance not only help light fixtures kill bacteria, but also render their correct lux and kelvin illumination and color correctly, which particularly in surgical, pediatric and general medical wards, improve the quality and production in employees work and mood (Dianat et al., 1541).

Even though lighting designers work hard to provide spaces with high functioning electrical fixtures to help keep circadian rhythms on track and health benefits high, research studies provide evidence that implementing proper daylighting techniques in any space is the most effective and useful strategy in giving clients more health benefits physically and psychologically. There are multiple case studies that provide evidence supporting the need for natural light in hospitals considering how “daylight controls circadian rhythms, affects mood and meditates chemical reactions in the body” (Winter, 29). In a recent Turkish study of 141 nurses,

Walton 6 researchers found the group of nurses exposed to daylight for at least 3 hours a day experienced less stress and more job satisfaction. This study also concluded bright light reduces depression in patients, especially with SAD and Bipolar disorders (Winter, 29). Another study that provides evidence of daylight helping patients in hospitals is a field investigation done with 263 coronary artery bypass graft (CABG) surgery patients in which researchers identified the impact of daylight exposure on patient length of stay (LoS) in the hospital (Joarder, 435). The hypothesis of this research stated an increase of daylight intensity inside in-patient rooms might reduce the patient’s LoS in hospitals. While holding other explanatory variables constant, “the coefficient estimates that when daylight is aimed above the patient’s head, their LoS reduces by 7.3 hours/per 100 lux of increase in daylight illuminance” (Joarder, 446). Overall, the stated studies conclude that patients heal faster, while employees can experience a brighter, more pleasant work environment when there is more daylight in the space. Designers should pay attention to techniques like the shape of a building, specifically the shapes of the letters: E, O, H, I, and L, and the positioning of different spaces, like avoiding placement of bathrooms near the façade, to maximize daylight in rooms for patients and areas of workplace.

While lighting design can seem complicated for the most part, it is very important that designers use this research to implement more innovative, health-beneficial spaces for their clients. Some guidelines to follow regarding lighting for patient rooms include a color temperature of 3000K and an illuminance level of 200lx. On the other hand, lighting in nurse stations should accommodate day and night shift workers by providing a color temperature around 5700K and an illumination level close to 250lx (H= 400lx, V= 280lx) throughout the beginning of their shift and a color temperature of 3000K and an illumination level close to 200lx (H= 300lx, V= 210lx) during the end of their shift. A quality lighting fixture to use to for

Walton 7 this white light source is an 8W GE Lighting 3600K, which also has a full spectrum. All fixtures should have antimicrobial films to provide bacteria eliminating settings for wavelengths of 254nm, 365nm, or white light. In shared spaces, like corridors, the illuminance level should be 100lx so circadian rhythms in both patients and employees aren’t disrupted or triggered.

Hospitals are spaces where people’s lives rely on the performance and quality of the employees.

As designers, it is our job to create the most effective healthcare spaces where nurses can thrive, and patients can get better faster.

Walton 8 Works Cited Cui, Z., LX Hao, and JL Xu. “A Study on the Emotional and Visual Influence of the CICU Luminous Environment on Patients and Nurses.” Journal of Asian Architecture and Building Engineering, vol. 16, no. 3, 2017, pp. 625-632.

Dianat, I., et al. "Objective and Subjective Assessments of Lighting in a Hospital Setting: Implications for Health, Safety and Performance." Ergonomics, vol. 56, no. 10, 2013, pp.

1535-1545 Dunnill, CW, et al. "Nanoparticulate Silver Coated-Titania Thin Films-Photo-Oxidative Destruction of Stearic Acid Under Different Light Sources and Antimicrobial Effects Under Hospital Lighting Conditions." Journal of Photochemistry and Photobiology aChemistry, vol. 220, no. 2-3, 2011, pp. 113-123.

IES Lighting Handbook: The Standard Lighting Guide. (2011). New York, Print.

Joarder, AR and SDF Price. “Impact of Daylight Illumination on Reducing Patient Length of Stay in Hospital After Coronary Artery Bypass Graft Surgery.” Lighting Research & Technology, vol. 45, no. 4, 2013, pp.435-449.

Winter, George. “Throw some Light on the Subject: Health Benefits of Sunlight should be Maximised in Hospital, Argues George Winter.” Nursing Standard, vol. 21, no. 17, 2007, pp. 28-29.