Textiles are woven into the fabric of the healthcare built environment; draperies, privacy curtains, blankets, bedding, furniture and medical furnishings, floor and wall coverings are examples of the many fabric products used in hospitals. The demands of the contract marketplace, including healthcare, for durability and safety have fostered a fabric industry that puts chemicals and materials into the environment that may hurt, rather than protect, human health and the environment. The intense and unique needs of the 24/7 healthcare organization for cleanability, infection control, and fire safety combine to challenge the 21st-century fabric industry as it moves to safer, less toxic chemicals and designs that both safeguard building occupants and promote environmental and community health.

The fabric industry, like many other building product industries in recent decades, has responded to the stringent requirements of healthcare facilities through an increasing reliance on petrochemical-based materials. The previous generation of bio-based fabrics—wool, cotton, rayon—has been superseded by nylons, polyesters, and other synthetic fibers. Performance attributes such as flame retardance (safety), durability (longevity), and cleanliness (patient well-being) have been engineered into man-made fabrics through the increasing use of chemical flame retardants and protective coatings. Unaccounted for, until recently, are the cumulative effects these products and the associated chemicals used in their production might have on the long-term health and well-being of patients, staff, and the broader communities with which they come in contact. Scientific studies of the chemicals used to bring these performance gains to healthcare fabrics are showing alarming links with a wide range of health effects from asthma to cancer.

People do not experience fabrics only in healthcare settings—fabrics are prevalent in automobiles, offices, and homes. Because people in the United States now spend almost 90% of their time indoors, and another 6% in their automobiles, the health implications of the diverse chemical components in the many materials that populate our indoor environments are being more seriously studied. The U.S. Environmental Protection Agency (EPA) estimates that 20% of the population exhibits health issues associated with Sick Building Syndrome and Building Related Illness.

Today, architects and designers, facilities staff, and fabric companies are grappling with the emerging need to balance short-term performance gains with long-term health effects. This “life cycle” lens is a defining characteristic of a new wave of socially responsible business models. Increasingly, major fabric manufacturers, as well as purchasers, are evaluating product offerings through triple-bottom-line methodologies that seek to balance environmental, social, and economic criteria, from manufacture through end-of-life disposal. Adding a chemical to the finish of a chair makes it easier to clean, thus resulting in significant short-term practical advantages for a hospital. When emitted by the 1,000+ chairs throughout the facility, however, those same chemicals may also have serious long-term negative health effects. Likewise, the cubicle curtains that provide privacy to patients are treated with toxic flame retardants and other chemicals to reduce the hazards of accidental fire. In the long-term, however, they may be continually exposing those same patients to different and dangerous long-term health effects.

Within the healthcare sector, the commitment to sustainable building goals is inextricably linked to environmental and human health. The healthcare industry addresses sustainability through the framework of its historic mission, “First do no harm.” In 2002, the American Society for Healthcare Engineering's (ASHE) Green Healthcare Construction Guidance Statement defined the broad goal for green construction as protecting health at three levels: building occupants, the local community, and global. Insofar as the products in buildings, including fabrics and their constituent chemicals, contribute to long-term negative health impacts, the healthcare industry has a tremendous opportunity to use its scale and purchasing power to promote the development of safer alternatives to protect health at all three levels. The fabric and furniture industries have a complex supply chain network to bring along with them on the road to sustainability and health. In doing so, they join with the broader building industry in seeking safer, healthier, more sustainably sourced and recycled building materials.

As the dialogue begins, healthcare organizations are bringing clarity and inquisitiveness to these topics. The potential opportunities for innovation can help lead toward a future for the fabric industry that is both healthy and sustainable.

Concerns and alternatives

An increasing body of science has identified a wide range of deleterious health impacts from the chemicals now widely used throughout the building material industry, ranging from bronchial irritants to endocrine disruption and cancer. Responding to the scientific evidence, the healthcare industry has begun developing criteria to identify chemicals of concern and to prioritize sustainability efforts. The Center for Health Design (CHD) and Health Care Without Harm (HCWH) recently published a priority list of criteria emphasizing avoidance of the international Stockholm Convention's list of persistent organic pollutants (POPs), other persistent bioaccumulative toxic chemicals, carcinogens, mutagens, reproductive or developmental toxicants, neurotoxicants, endocrine disruptors, and volatile organic compounds (VOCs). The list encourages the use of sustainably sourced bio-based materials, or recycled/recyclable materials. The list can be found within the report available at http://www.rwjf.org/files/publications/other/Design21CenturyHospital.pdf.

Today, the primary fibers that meet the performance needs of healthcare institutions are mostly synthetic materials—nylon, polyester, and polyvinyl chloride (PVC or “vinyl”)—some of which release or are made from toxic chemicals. They may contain dyes made with heavy metals and toxic chemical additives to meet stringent fire safety codes and can be treated with finishes and antimicrobials that are not necessarily efficacious and may negatively affect human health and the environment.

Aesthetic demands of healthcare have changed, as well. Fabrics like vinyl, which used to be acceptable in a healthcare environment, are now associated with an “institutional” aesthetic. Designers today want cost-competitive, high-performance fabric choices that connote healing, reflect advances in healthcare and technology, yet evoke a calming environment.

The fabric industries in the United States and Europe face challenges in that they must operate under more stringent and expensive environmental regulations for emissions to air, noise, and water pollution than in other parts of the world. Simultaneously, here in the United States, fabric manufacturers face severe competition from companies overseas that are able to produce fabrics less expensively and according to environmental regulations that are either lax or disregarded.

In order to move to more sustainable fabric choices, manufacturers and consumers must address the health and environmental issues in each of the major aspects of production for the contract market: fibers; finishes or treatments; and coloring and/or dyes. For each of these aspects, innovative companies are developing creative alternatives that are beginning to reshape the market.

For example, healthcare specifiers and purchasers are increasingly concerned that PVC/vinyl products release persistent bioaccumulative toxicants (PBTs) and other chemicals of concern during their manufacture,use, and/or disposal, including dioxin, a known carcinogen, and phthalates, linked to asthma, reproductive damage, and obesity. Likewise healthcare is increasing its concern about polyurethane due to its use of formaldehyde and other toxic chemicals in its manufacture. Fiber manufacturers are responding to these concerns by researching and/or bringing to market fabrics that use greener chemistry including:

  • plastics, such as polyethylene or thermoplastic polyolefins, with less toxic problems in their life cycle;

  • products made from post-consumer recycled content; and

  • bio-based products.

Given the environmental impacts and other problems with extracting more petrochemicals, the future clearly lies in technologies that close the material loop either through recycling petroleum plastics or by growing bioplastics (plastics made from plant materials instead of from fossil fuels) and composting or recycling at the end of life. Challenges lie ahead with each of these paths. Currently there are no policies or guidelines embraced by the market to ensure that bioplastics are grown sustainably. Moreover, there is no system in place to ensure a sufficient infrastructure for end-of-life recycling and composting.

Just like their fellow fabric manufacturers, treatment and finish manufacturers are finding that the chemicals they have relied upon are now being identified as toxicants of concern by scientists. Specifiers and purchasers are responding with requests for greener alternatives. Some of the most significant actions undertaken by the more innovative finish manufacturers to avoid key chemical groups of concern are:

  • replacing perfluorochemicals (PFCs) used for stain resistance with non-halogenated compounds;

  • replacing halogenated flame retardants (HFRs) such as PBDEs (polybrominated diphenyl ethers) with non-halogenated retardants, redesigning the fiber for inherent flame resistance, or redesigning the products so they do not need a flame-resistant fabric;

  • reducing or eliminating volatile organic compounds (VOCs);

  • reformulating dyes to avoid heavy metals;

  • questioning the use of nanotechnology until there is sufficient regulation and publicly available safety testing; and

  • eliminating antimicrobials.

Several efforts are emerging to help guide healthcare specifiers and purchasers and the fabric industry to work together to develop healthier, more sustainable fabrics:

  • Increasingly rigorous standards for limiting VOC emissions, based on the California section 01350 standard, such as Greenguard's Children & Schools and Scientific Certification Systems Indoor Advantage Gold.

  • Green building design assessments that reward use of healthier fabrics, such as the Green Guide for Health Care.

  • Product assessment frameworks and standards that help define green fabrics across a range of attributes, including the Healthy Building Network's Pharos Project, and the Association for Contract Textiles (ACT) Sustainable Textile Standard.

All of these directions, guidelines, and standards are only as good as the market signals that support them. Fabric and finish manufacturers rely on their customers for direction and support in improving their products. The key to market transformation to healthier products that are better for the planet lies in the concerted actions of purchasers large and small. Several major players have shown responsibility and commitment through their actions to research the issues, and engage with manufacturers to guide them to better product designs.

While we cannot expect the fabric industry to change overnight, alternatives already on the market illustrate the potential for greater sustainability and healthier products. In some cases, research and development dollars will have to be devoted to examining the safety and performance characteristics of new technologies and that will take time. In other situations, however, fabric manufacturers can reduce or remove problem chemicals quickly without compromising the performance and aesthetics of the material. Perhaps innovative efforts can bring more sustainable products with even greater performance and aesthetic characteristics than the fabric industry is accustomed to.

With greater awareness of the health issues in relation to fabric, end-users and designers can make more informed decisions and collectively help move the market by their specifications and purchasing power. Fabrics can then continue to be a versatile and economical design element, as they assist in differentiating interior spaces and creating an identity, as well as supporting wayfinding and healing. HD

Julie Silas, JD, is Director of Health Care Projects for the Healthy Building Network and is a lawyer and researcher with more than 15 years experience in health and environmental advocacy. Contact her at

jsilas@healthybuilding.net or 510.594.8270.

Jean Hansen, IIDA, CID, LEED AP, AAHID, is director of Sustainable Interiors for HDR Architecture, Inc., with more than 25 years of experience in interior design, healthcare planning, and sustainable consulting. Contact her at

Jean.Hansen@hdrinc.com or 415.814.6731.

Robin Guenther, FAIA, is principal of Perkins & Will and founder of Guenther 5 Architects. She is a Co-Coordinator of the Green Guide for Health Care, serves on the LEED for Healthcare Committee, and is co-author with Gail Vittori of Sustainable Healthcare Architecture, published by Wiley Press.

Tom Lent is Policy Director for the Healthy Building Network (HBN), with more than 25 years of experience with energy and environmental issues primarily focused on healthy and resource efficient building technologies.

To comment on this article, visit http://www.healthcaredesignmagazine.com.

Sidebar

This article is excerpted from “The Future of Fabric,” a report jointly published by the Healthy Building Network and Health Care Without Harm to alert healthcare practitioners, architects, designers and the fabric industry itself to the potential hazards associated with fabric, as well as to spur the development and use of safer alternatives. The full text is available at: http://www.healthy building.net/healthcare/FutureOfFabric.pdf.