Contract - Designing for Health: Light and Its Role in Patient Safety

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Designing for Health: Light and Its Role in Patient Safety

21 June, 2010

-By By Tama Duffy Day, FIIDA, FASID, LEED AP


"Designing for Health" is a monthly, Web-exclusive series from healthcare interior design leaders at Perkins+Will that focuses on the issues, trends, challenges, and research involved in crafting today's healing environments.

I have always been fascinated with sunlight. As a child growing up in rural North Dakota, I would sit in the sunlight as it came streaming into our home during the long cold winters, amazed that the sun’s rays could be so warm and comforting when the temperature outside was frigid.

And everywhere I travel, the spaces I visit connect me to new ways of thinking about light. A short distance from Dublin is Newgrange, Ireland, a megalithic passage tomb built in 3,200 B.C. Covering approximately an acre of land, the tomb’s inner passageway of more than 60 ft. carries you to a cruciform-shaped inner chamber. As the sun rises on the winter solstice, this inner chamber is illuminated for 17 minutes. As noted in the many writings about Newgrange, the passageway and chamber were both oriented and constructed to maximize the accuracy and length of the light that enters the chamber during the solstice. To be admitted into Newgrange for this winter solstice experience one needs to win their ticket lottery. I was not fortunate to win the lottery, but even in August the visit was spectacular. Scholars believe these passage tombs had ceremonial, spiritual, and astrological importance, the marking of a new year—a new beginning.

Fast forward to today and experience the work of Swedish artist Daniel Rybakken. His most recent work, “Surface Daylight 2,” recently was unveiled in Milan. Illustrated below in “Daylight Entrance”, Daniel attempts to recreate the impression of natural light and the positive impacts of natural light through artificial means. In an article written by Cosmina Dinu, Daniel stated, “When daylight in a room is removed, the feeling of space decreases, and the contrast between outdoor and indoor increases. I believe that this can result in a feeling of being enclosed for many of us, to be alone or lonely—a social block.”

The connection between light and the spirit has been recorded throughout all the ancient cultures. Theo Gimbel writes that the Egyptians built temples where color healing occurred. “Sunlight shone through colored gems, such as rubies and sapphires, on to people seeking healing.” In Alvar Alto’s 1929 tuberculosis sanatorium at Paimio, Finland, the building contributed to the healing process. Dry, fresh air and sunlight were employed to fight the disease, as sunning balconies and a sundeck were incorporated into the building.

Recently lighting designer Robert Leiter of HDLC architectural lighting design made a correlation not only between light and health, but between lighting and safety. “In lighting, as in medicine, ‘primum non nocere’ [translating to ‘Do no harm’] is fundamental to the lighting in a healthcare facility—provide a visually comfortable environment, free of glare and other visual deterrents or distractions,” he says. “There are some simple ideas that today’s designs have adopted as part of their vocabulary, such as patients not being subjected to the glare of bare bulbs as they lie on a gurney staring up into the lights recessed in the ceiling. At the very least, lensed fixtures are used. Or, even better, other lighting approaches are used so the views of the ceilings are as important and relaxing as the other views a patient might encounter. ‘Do no harm’ also means providing the right functional light for the doctors and nurses at their work areas, including the ability to control the lights for computer work, and this is where the safety function is critical.”

In the Perkins+Will-designed Adopt A Room project, colored light provide a positive distraction for children with cancer, while giving them control over the amount and color of light in their environment. Leiter shares the goal of providing patients control over their environment. “Control of the architectural light fixtures allows for modulation of the light levels within the patient room and adjacent spaces, which plays into patient comfort and health in the maintenance of natural rest/activity patterns,” he says. “Responsive reduction in the light levels to the patient needs aids not only patient health, but also contributes to the promotion of green buildings”

Leiter notes that lighting research shows strong correlations in circadian rhythms (and sleep disorders) with the hormonal responses triggered by non-visual photoreceptors in the eye. Not “rods” and “cones” as we were taught in biology class, but receptors only now being understood that connect directly to non-visual portions of our neurology and affect our health through hormonal controls. Light treatments long have been used to combat seasonal affective disorder, but now we are seeing newer treatments that are tuned to these new receptors.

How we shape and design healthcare facilities has tremendous implications on health and safety. In a 2001 study by Benedetti, bipolar patients in east facing rooms with direct morning sun had a 3.67-day shorter hospital stay than bipolar patients in west facing rooms. L. M. Wilson noted that delirium and depression in patients in a windowless Intensive Care Unit was twice as high as those patients in an ICU with window.

There is continual growing evidence of the importance of light, not only on our mental state, but also in patient safety. In a Booker and Roseman analysis of hospital medication errors in Alaska, medication errors were 1.95 times more likely in December than in September. (December in Alaska has the shortest number of daylight hours.) In a 1991 study, prescription-dispensing errors were directly associated with the level of illumination (Buchanan et all). An illumination level of 146 foot-candles was associated with a significantly lower error rate than the baseline level of 45 foot-candles.

Too often our healthcare environments are spaces where light quality and quantity is the same everywhere, creating monotonous, unsafe, and confusing places. Developing successful lighting strategies that support both health and safety require the integration of a lighting designer in the earliest phases of a project. Lighting designers balance the request of sustainable energy needs (reducing energy use) with the skills of providing the right amount of light in the right locations. Clients need guidance in making informed decisions on the use and maintenance of the new generation of LED fixtures. Guidance often left to the post occupancy conversations.

Some of our recent lighting strategies align the attributes of health and safety: Medication dispensing areas feature motion detectors that increase light levels when staff approach the medication cart. Adjustable task lights are specifically designed to illuminate decentralized nurse work areas without producing glare. Signage panels illuminated with energy-saving LEDs provide text, color, and light as unified components for wayfinding and direction. And a behavioral health facility is designed to have both east- and west-facing patient rooms, allowing staff to “prescribe” the sunlight orientation to the appropriate patients.

Using light appropriately and innovatively can save energy, inspire health and healing, and also increase patient safety: benefiting from both the art and the science of light. More information about the integration of light and lighting designers can be found at the International Association of Lighting Designers Web site www.iald.org.

As for me and my next light-inspired adventure, it’s James Turrell’s Roden Crater in Arizona. (See “Painting with Light” in the Contract July 2008 issue for a story on Turrell’s Roden Crater.) In 1974 Turrell bought a dormant volcano and ever since has been turning this crater into a symmetrical astronomical instrument. Once a year, at the solstice, the sun enters and illuminates this crater. Not scheduled for visitors until 2011, perhaps this time I’ll win the lottery.

Tama Duffy Day, FIIDA, FASID, LEED AP, has been informally studying the impact of light on healing and safety since 1990. She is a principal at Perkins+Will and is the national interior design healthcare practice leader, formulating research and design initiatives throughout the firm. She can be reached at Tama.DuffyDay@perkinswill.com.


Additional reference material:

Benedetti, F., Colombo, C., Barbini, B., Campori, E., & Smeraldi, E. (2001). Morning sunlight reduces length of hospitalization in bipolar depression. Journal of Affective Disorders, 62(3), 221- 223.

Booker, J. M., & Roseman, C. (1995). A seasonal pattern of hospital medication errors in Alaska. Psychiatry Research, 57(3), 251-257.

Buchanan, T. L., Barker, K. N., Gibson, J. T., Jiang, B. C., & Pearson, R. E. (1991). Illumination and errors in dispensing. American Journal of Hospital Pharmacy, 48(10), 2137-2145.

Currie J. M. (2007). The fourth factor; A historical perspective on architecture and medicine. Washington DC: The American Institute of Architects. (Images and data on Alvar Alto’s sanatorium)

Dinu, C. http://www.designro.net/light-study-by-daniel-rybakken/

Gimbel, T. (1994). Healing with color and light: Improve your mental, physical, and spiritual health. New York: Fireside (Simon & Schuster Inc.), p. 21.

Leiter, Robert. robert@hdlclighting.com http://www.hdlclighting.com

O’Kelly, M. (1995 - paperback). Newgrange: Archaeology, Art and Legend. New York, NY: Thames and Hudson.

Rybakken, D. http://www.danielrybakken.com

Turrell, J. http://www.pbs.org/art21/artists/turrell/clip1.html

Wilson, L. M. (1972). Intensive care delirium: The effect of outside deprivation in a windowless unit. Archives of Internal Medicine, 130(2), 225- 226.

Past installments of "Designing for Health" include (click on title to access the full article):
Research-Based Client Communication
An Urban Clinic—Connecting with the Community
Patient and Staff Safety in Behavioral Health Facilities
A Harmonious Companionship—Rejuvenating State-of-the-Art
Leading by Design – A Place to Flourish
Expanding the Definition of Sustainability to Include Chemical Awareness
10 Strategies to Move Your Client Toward Sustainability




Designing for Health: Light and Its Role in Patient Safety

21 June, 2010


www.knowth.com; Newgrange megalithic passage tomb, Ireland

"Designing for Health" is a monthly, Web-exclusive series from healthcare interior design leaders at Perkins+Will that focuses on the issues, trends, challenges, and research involved in crafting today's healing environments.

I have always been fascinated with sunlight. As a child growing up in rural North Dakota, I would sit in the sunlight as it came streaming into our home during the long cold winters, amazed that the sun’s rays could be so warm and comforting when the temperature outside was frigid.

And everywhere I travel, the spaces I visit connect me to new ways of thinking about light. A short distance from Dublin is Newgrange, Ireland, a megalithic passage tomb built in 3,200 B.C. Covering approximately an acre of land, the tomb’s inner passageway of more than 60 ft. carries you to a cruciform-shaped inner chamber. As the sun rises on the winter solstice, this inner chamber is illuminated for 17 minutes. As noted in the many writings about Newgrange, the passageway and chamber were both oriented and constructed to maximize the accuracy and length of the light that enters the chamber during the solstice. To be admitted into Newgrange for this winter solstice experience one needs to win their ticket lottery. I was not fortunate to win the lottery, but even in August the visit was spectacular. Scholars believe these passage tombs had ceremonial, spiritual, and astrological importance, the marking of a new year—a new beginning.

Fast forward to today and experience the work of Swedish artist Daniel Rybakken. His most recent work, “Surface Daylight 2,” recently was unveiled in Milan. Illustrated below in “Daylight Entrance”, Daniel attempts to recreate the impression of natural light and the positive impacts of natural light through artificial means. In an article written by Cosmina Dinu, Daniel stated, “When daylight in a room is removed, the feeling of space decreases, and the contrast between outdoor and indoor increases. I believe that this can result in a feeling of being enclosed for many of us, to be alone or lonely—a social block.”

The connection between light and the spirit has been recorded throughout all the ancient cultures. Theo Gimbel writes that the Egyptians built temples where color healing occurred. “Sunlight shone through colored gems, such as rubies and sapphires, on to people seeking healing.” In Alvar Alto’s 1929 tuberculosis sanatorium at Paimio, Finland, the building contributed to the healing process. Dry, fresh air and sunlight were employed to fight the disease, as sunning balconies and a sundeck were incorporated into the building.

Recently lighting designer Robert Leiter of HDLC architectural lighting design made a correlation not only between light and health, but between lighting and safety. “In lighting, as in medicine, ‘primum non nocere’ [translating to ‘Do no harm’] is fundamental to the lighting in a healthcare facility—provide a visually comfortable environment, free of glare and other visual deterrents or distractions,” he says. “There are some simple ideas that today’s designs have adopted as part of their vocabulary, such as patients not being subjected to the glare of bare bulbs as they lie on a gurney staring up into the lights recessed in the ceiling. At the very least, lensed fixtures are used. Or, even better, other lighting approaches are used so the views of the ceilings are as important and relaxing as the other views a patient might encounter. ‘Do no harm’ also means providing the right functional light for the doctors and nurses at their work areas, including the ability to control the lights for computer work, and this is where the safety function is critical.”

In the Perkins+Will-designed Adopt A Room project, colored light provide a positive distraction for children with cancer, while giving them control over the amount and color of light in their environment. Leiter shares the goal of providing patients control over their environment. “Control of the architectural light fixtures allows for modulation of the light levels within the patient room and adjacent spaces, which plays into patient comfort and health in the maintenance of natural rest/activity patterns,” he says. “Responsive reduction in the light levels to the patient needs aids not only patient health, but also contributes to the promotion of green buildings”

Leiter notes that lighting research shows strong correlations in circadian rhythms (and sleep disorders) with the hormonal responses triggered by non-visual photoreceptors in the eye. Not “rods” and “cones” as we were taught in biology class, but receptors only now being understood that connect directly to non-visual portions of our neurology and affect our health through hormonal controls. Light treatments long have been used to combat seasonal affective disorder, but now we are seeing newer treatments that are tuned to these new receptors.

How we shape and design healthcare facilities has tremendous implications on health and safety. In a 2001 study by Benedetti, bipolar patients in east facing rooms with direct morning sun had a 3.67-day shorter hospital stay than bipolar patients in west facing rooms. L. M. Wilson noted that delirium and depression in patients in a windowless Intensive Care Unit was twice as high as those patients in an ICU with window.

There is continual growing evidence of the importance of light, not only on our mental state, but also in patient safety. In a Booker and Roseman analysis of hospital medication errors in Alaska, medication errors were 1.95 times more likely in December than in September. (December in Alaska has the shortest number of daylight hours.) In a 1991 study, prescription-dispensing errors were directly associated with the level of illumination (Buchanan et all). An illumination level of 146 foot-candles was associated with a significantly lower error rate than the baseline level of 45 foot-candles.

Too often our healthcare environments are spaces where light quality and quantity is the same everywhere, creating monotonous, unsafe, and confusing places. Developing successful lighting strategies that support both health and safety require the integration of a lighting designer in the earliest phases of a project. Lighting designers balance the request of sustainable energy needs (reducing energy use) with the skills of providing the right amount of light in the right locations. Clients need guidance in making informed decisions on the use and maintenance of the new generation of LED fixtures. Guidance often left to the post occupancy conversations.

Some of our recent lighting strategies align the attributes of health and safety: Medication dispensing areas feature motion detectors that increase light levels when staff approach the medication cart. Adjustable task lights are specifically designed to illuminate decentralized nurse work areas without producing glare. Signage panels illuminated with energy-saving LEDs provide text, color, and light as unified components for wayfinding and direction. And a behavioral health facility is designed to have both east- and west-facing patient rooms, allowing staff to “prescribe” the sunlight orientation to the appropriate patients.

Using light appropriately and innovatively can save energy, inspire health and healing, and also increase patient safety: benefiting from both the art and the science of light. More information about the integration of light and lighting designers can be found at the International Association of Lighting Designers Web site www.iald.org.

As for me and my next light-inspired adventure, it’s James Turrell’s Roden Crater in Arizona. (See “Painting with Light” in the Contract July 2008 issue for a story on Turrell’s Roden Crater.) In 1974 Turrell bought a dormant volcano and ever since has been turning this crater into a symmetrical astronomical instrument. Once a year, at the solstice, the sun enters and illuminates this crater. Not scheduled for visitors until 2011, perhaps this time I’ll win the lottery.

Tama Duffy Day, FIIDA, FASID, LEED AP, has been informally studying the impact of light on healing and safety since 1990. She is a principal at Perkins+Will and is the national interior design healthcare practice leader, formulating research and design initiatives throughout the firm. She can be reached at Tama.DuffyDay@perkinswill.com.


Additional reference material:

Benedetti, F., Colombo, C., Barbini, B., Campori, E., & Smeraldi, E. (2001). Morning sunlight reduces length of hospitalization in bipolar depression. Journal of Affective Disorders, 62(3), 221- 223.

Booker, J. M., & Roseman, C. (1995). A seasonal pattern of hospital medication errors in Alaska. Psychiatry Research, 57(3), 251-257.

Buchanan, T. L., Barker, K. N., Gibson, J. T., Jiang, B. C., & Pearson, R. E. (1991). Illumination and errors in dispensing. American Journal of Hospital Pharmacy, 48(10), 2137-2145.

Currie J. M. (2007). The fourth factor; A historical perspective on architecture and medicine. Washington DC: The American Institute of Architects. (Images and data on Alvar Alto’s sanatorium)

Dinu, C. http://www.designro.net/light-study-by-daniel-rybakken/

Gimbel, T. (1994). Healing with color and light: Improve your mental, physical, and spiritual health. New York: Fireside (Simon & Schuster Inc.), p. 21.

Leiter, Robert. robert@hdlclighting.com http://www.hdlclighting.com

O’Kelly, M. (1995 - paperback). Newgrange: Archaeology, Art and Legend. New York, NY: Thames and Hudson.

Rybakken, D. http://www.danielrybakken.com

Turrell, J. http://www.pbs.org/art21/artists/turrell/clip1.html

Wilson, L. M. (1972). Intensive care delirium: The effect of outside deprivation in a windowless unit. Archives of Internal Medicine, 130(2), 225- 226.

Past installments of "Designing for Health" include (click on title to access the full article):
Research-Based Client Communication
An Urban Clinic—Connecting with the Community
Patient and Staff Safety in Behavioral Health Facilities
A Harmonious Companionship—Rejuvenating State-of-the-Art
Leading by Design – A Place to Flourish
Expanding the Definition of Sustainability to Include Chemical Awareness
10 Strategies to Move Your Client Toward Sustainability

 


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