Few hospitals have a perfect lighting system, but whether building from scratch or renovating and expanding an old building, one of the hospital owner’s priorities is energy savings. However, a growing number of studies finds that lighting influences the safe and healthy environment within a hospital, and those studies are expected to prompt major changes in the way lighting systems are selected, installed and managed in the coming years. In some cases, the kind of lighting technology being recommended for good health has not yet been manufactured. But, as vendors begin following the cues from health and lighting researchers, hospital owners are working on making their facilities flexible enough to respond to changing technology while appearing homey and comfortable.
The foremost effort is to humanize the hospital experience and make it a restful place for recuperating patients. But facilities’ owners face challenges in lighting these major 24/7 operations. For one thing, although both health research and energy-savings efforts point to dimming lighting for nighttime sleeping, staff members must stay alert for safety.
Studies of circadian rhythms—the biological cycles that repeat approximately every 24 hours—and the solar day have found that lighting can have a profound effect on the health of those in its glare, said Mariana Figueiro, Lighting Research Center (LRC) program director and assistant professor at Rensselaer Polytechnic Institute, Troy, N.Y. Inadequate or irregular light exposure can cause disruptions that are believed to manifest in a variety of health ailments. A study by LRC researchers provides further framework for examining the effects of circadian disruption on breast cancer, obesity, sleep disorders and other health problems. Architecture at nursing homes and hospitals is trending toward increased natural lighting during the day, with automated lights that supplement that daylighting.
Research into a certain photoreceptor in the eye that is associated with regulating circadian rhythms has discovered that lights with blue wavelengths tend to direct the body into wakefulness, and red and amber lighting have a less stimulating wavelength, said Leslie North, principal at Aurora Lighting Design Inc., Grayslake, Ill.
Figueiro’s team found that the kind of lighting and shifts in those lights from day to night can affect the recovery of neonatal infants as well as ICU patients, including those in comas.
Robert White, neonatalogist at Memorial Hospital, South Bend, Ind., and chairman of the Committee to Establish Recommended Standards for Newborn ICU Design, has headed several studies in the past two decades that found infants, adult patients and nurses are affected by the lighting around them.
“Lighting is important for patients and their health. People are just now beginning to recognize that,” White said.
White said that in air traffic control towers and nuclear facilities, where employees work night shifts in highly responsible positions, the focus on lighting began years ago.
“Those industries are working on the lighting that keeps staff alert now,” he said.
Despite the evidence found in recent studies, Figueiro said, a large percentage of facilities’ managers, engineers and architects have reservations about lighting technology used this way. Facility directors often look at the short-term cost rather than the long-term solution.
“Hospital administrators are more concerned about the initial cost and not enough on the long range and on heath focus,” White said. “The lighting industry has to help them understand their options.”
He pointed to light-emitting diodes (LEDs), which offer long-term savings, as an alternative to cheap fluorescents. LEDs are low-energy, have a long life and offer enough color discrimination to navigate. LEDs come in a range of temperatures, so installing them may help regulate those circadian rhythms.
“We try to maintain a normal day/night lighting pattern for the patients,” Aurora’s North said. “Bringing blue daylight colors to hospital staff who work at night can often be the best option when hospitals have to weigh a balance between allowing patients to maintain a normal day/night cycle and keeping the nursing staff alert.”
At the same time, LED nightlights have become popular in patient rooms.
“Amber LEDs are a safe bet,” North said.
Amber is perceived as a comforting color whereas red gives a negative warning impression.
At a hospital, the lighting demands are complex, and the need is for unique solutions that benefit both staff and patients. To provide flexibility in hospitals, there must be more individual controls for regulating the lighting spectrum and intensity spectrum, White said. White sees LEDs as a likely solution because they provide energy conservation and a variety of colors from blues to reds, which allow for color mixing to generate a wide spectrum of individual colors.
Lighting can be healthier psychologically if it can be used to calm the patients. By providing diversionary lighting in stress-inducing locations, such as MRI and CT scan rooms, the patient’s attention can be drawn away from large machinery or medical instrumentation that can increase anxiety in an already highly stressed patient. Everbrite Lighting Techonologies, Greenfield, Wis., makes such custom MRI-safe fixtures, which can be viewed at www.e-l-t.com.
Hospitals create a lot of wasted energy, North said. However, she added that simply cutting energy without a specific plan can be detrimental to the patients and staff members. The International Energy Conservation Code allotment for hospitals is 1.2 watts per square foot, but that does not account for multiple lighting functions, occurring within the same space using separate manual controls. Only in rare occasions, such as patient emergencies, are all of the lights on in those spaces.
“We’re concentrating so much on connected watts that we tend to forget functionality,” she said.
Lighting controlled through switches or dimmers usually can be adjusted by the occupants so that typical consumption is lower than the calculated connected load.
Several immediate technologies are especially applicable to hospitals not ready for major changes to their lighting systems. These include higher output fluorescent lamps, longer lasting fluorescent lamps and metal halide lamps that offer good color-rendering capabilities.
Lighting that cleans
Infection control also is an ongoing issue in hospitals, especially with the recent outbreak of the H1N1 influenza. For fixture manufacturers, this means providing infection control in products. Hospitals today seek fixtures that are easy to wipe down and that don’t have nooks and crannies for bacteria growth.
“The idea is to ensure a clean environment, and we are seeing that as an increasing concern,” North said.
In addition to disinfecting lighting fixtures, healthcare facilities use the lighting itself for that purpose. Use of ultraviolet lamps and lamp systems to disinfect room air and air streams in hospitals, known as ultraviolet germicidal irradiation (UVGI), dates to the early 1900s. Lighting manufacturers have been offering UVGI lamp fixtures for decades, but recently, the interest in this tool has increased.
Lumalier Corp., a lighting company in Memphis, Tenn., provides UVGI upper-air fixtures to control airborne infectious disease in targeted, high-risk areas such as exam rooms, nurses stations, waiting areas, corridors and patient rooms. The company also makes UVGI in duct heating, ventilating and air conditioning systems; portable UVGI surface-disinfection units; and clean-room or controlled-environment UVGI units for use after hours in hospitals’ unoccupied spaces to disinfect air and surfaces.
UVGI installation has been driven primarily by outbreaks of tuberculosis, said David Skelton, marketing manager for Lumalier Corp. In the United States, there is a growing awareness and concern caused by the increase in hospital-acquired infection. Because UV germicidal energy attacks airborne pathogens in the environment, rather than in the patient, renewed use of cleansing UVGI energy has been a recent trend within hospitals. This allows for the proactive prevention of infection and disease, rather than the historical reactive treatment of the infected patients.
Upper-air UVGI fixtures have improved, and designs have expanded over the years to include several specific-use designs, Skelton said, including corner-mount units for use in wall-space-limited patient rooms, hallways or corridors. Hospitals and nursing homes also use 360-degree ceiling pendant units for large areas and units designed for both low- and high-ceiling installations.
UV lamp and ballast technology also have changed over the years. Modern, twin-tube lamps are smaller but more powerful and contain 5 mg or less of mercury. Electronic ballasts are manufactured specifically for UVGI applications.
With all the changing options, many in the industry just aren’t prepared to provide hospital owners with the choices that will be most useful. Architects and lighting engineers need a better understanding of lighting options and trends, White said.
“It’s a little ironic that other areas (such as commercial buildings) understand the health benefits of lighting better than those in the healthcare industry. Because the healthcare industry is in a building boom right now, now is the time for them to consider the options,” White said.
And that building boom should continue with the influx of federal funds made available through the American Recovery and Reinvestment Act.
As the technology changes, the importance of what that technology will provide should not be lost on any of the participants, North said. She recalled hearing a general contractor speaking to his subcontractors before beginning a hospital project.
“He said, ‘This is not your average job. This is the place where your parents and your kids will come to heal’. Hospital work, he suggested, requires just that much more diligence. ‘Do your work here with pride.’”
SWEDBERG is a freelance writer based in western Washington. She can be reached at firstname.lastname@example.org.