Healthcare construction has dramatically changed over the years. Architects, designers, and builders now have myriad considerations with each project such as evidence-based design (EBD), LEED certification and green building, and implementing systems to help control energy costs.

Much research has been conducted linking healthcare facilities' physical structure to improved care. These studies support the theory that improved patient comfort shortens hospital stays, lessens recovery time, and increases the medical team's satisfaction and productivity. But, can this be achieved within projects' budgets?

Not that long ago, building green was dismissed as a method that could send a construction project over budget and past its deadline. There were also misconceptions that style and aesthetics would be sacrificed with the use of sustainable products. But the costs of green designs have dropped dramatically in the last few years and innovative technology is complementing products' designs. And now, technologically advanced products can be used in healthcare applications that have never been thought about before.

Healthcare ranks as the country's second most energy intensive industry and hospitals are the sector's largest energy consumer and producer of greenhouse gases (GHG). The industry's reliance on nonrenewable energy sources contributes to the emission of GHG, driving climate change and impacting public health from air pollution. However, by taking up green practices, whether incrementally or from the ground up, many hospitals are managing to lower energy bills, reduce waste, and achieve healthier indoor air. While there are many products and tactics to confront these issues, energy efficient lighting addresses EBD, sustainability, and reducing energy costs.

Effects of lighting in healthcare

According to a study for The Center for Health Design in August, 2006 by Anjali Joseph, PhD, titled The Impact of Light on Outcomes in Healthcare Settings, “Light impacts human health and performance by enabling performance of visual tasks, controlling the body's circadian system, affecting mood and perception, and by enabling critical chemical reactions in the body … light impacts outcomes in healthcare.”

Based on this study and numerous others, light has dramatic positive affects on patients and staff. New construction designs-especially for patient rooms-should incorporate windows, particularly with pleasant views to nature. Dr. Joseph's study, as well as the highly regarded research by Roger Ulrich and Craig Zimming, finds that patients have shorter recovery times and fewer complications when they can look out a window and see nature. Additionally, employees with access to windows and views of nature experience less stress, better health, and higher job satisfaction.

But what if new construction isn't an option? It isn't always possible to have windows or views of nature in every interior space. But through the use of effective lighting design, healthcare facilities can achieve a calming environment while maintaining light levels for critical visual tasks, energy efficiency, infection control, and ease of maintenance. Windowless interior rooms provide the perfect setting for patient comfort graphics backlit with light-emitting diodes (LEDs). Ceiling and wall graphic panels are soothing and help patients relax, whether in their room, waiting area, or procedure suite. And using low-maintenance, energy-efficient LEDs make sense, especially with today's escalating energy costs.

Lighting and MRI suites

Lighting in MRI suites is challenging because of the short life of incandescent bulbs. Fluorescent lights can't be used either because they generate noise artifacts on patient scans. Some imaging facilities experience weekly light outages, which shuts down the MRI suite for maintenance. However, LED lights are MRI safe because they do not use filaments that are affected by magnetic fields, nor do they emit radio frequencies. Additionally, by not having a filament, LED lighting eliminates the potential for white pixel noise, which can be generated when an incandescent bulb's filament is at the point of failure.

LEDs used in radiology address a number of important issues: reducing accidents in the MRI suite, decreasing maintenance and operational costs, and sustainability. Since more than 10 million MRI scans are performed each year in the United States, there are plenty of opportunities to confront these challenges (figures 1 and 2).

MRI room, Mercy Hospital, Janeville, Wisconsin

CTI room, Wheaton Franciscan Franklin, Franklin, Wisconsin

LED technology: An overview

Typically, LEDs were thought about only for aesthetic uses. But engineering and technological advances have improved LED luminaires' output, making it possible to use high-efficiency LED lighting for commercial applications. Additionally, with their compact size, LEDs can be used in places unreachable with conventional lighting and arranged in a number of different array configurations.

LEDs have been around for a long time. They are small semiconductors that can be used to produce millions of different colors and brightness levels, but use significantly less energy than traditional lighting methods. LEDs create light differently than conventional forms. Other lighting technologies such as halogen and incandescent sources heat up a fragile filament until it radiates light, wasting large amounts of electrical energy through infrared radiation. Conversely, LEDs convert an electrical current directly into light, eliminating that waste of energy. Additionally, LEDs do not burn out like a standard lamp, so individual diodes do not need to be replaced. Instead, diodes gradually produce lower output levels over a long time.

Durability. LEDs are solid state devices containing no moving parts, no filaments, or fragile glass to break, eliminating the risk of damage during transportation, installation, or operation, even in the toughest environments. And, unlike conventional light sources, LEDs are not subject to sudden failure or burnout.

Longer life span. An LED lasts vastly longer than an incandescent source; even after 50,000 hours, an LED is still producing a significant percent of its original output. The following calculations help conceptualize how many years 50,000 hours are when a fixture is illuminated for varying lengths of time eventually at 70% of its original brightness:

  • 24 hours a day = 5.7 years

  • 18 hours a day = 7.6 years

  • 12 hours a day = 11.4 years

  • 8 hours a day = 17 years

LEDs versus incandescents

Incandescent bulbs have a lifespan of only 700-3,000 hours due to the high magnetic field of an MRI. Because incandescent bulbs convert electrical energy to heat energy, temperatures increase in MRI suites, which then have to be cooled. The air conditioner then cycles more often to compensate for the heat thrown off by the bulbs, all of which results in the use of more energy. LED luminaires consume less energy than incandescent while emitting the same amount of light.

Reducing maintenance and operational expenses

Recently, the Department of Energy (DOE) announced that it wants the nation's hospitals to improve energy efficiency by 20% at existing facilities and make new hospitals 30% more efficient than expected. To that end, the DOE recently began an initiative,

EnergySmart Hospitals, to promote improved energy conservation and resources management at the 8,000 U.S. hospitals. LEDs are the perfect solution to meet these mandates.

In 2007, hospitals spent more than $5 billion on energy costs with more than 2.5 times the energy intensity and carbon dioxide emissions of commercial buildings. Of these energy costs, approximately 15% was spent directly on lighting. With dramatically fluctuating oil prices, already cash-strapped hospitals are seeing double-digit increases in energy costs. According to the Environmental Protection Agency (EPA), the healthcare industry could save more than 30% of the $5 billion it spends on energy without sacrificing the quality of care by becoming more efficient. The EPA calculates that every dollar a hospital saves on energy is equivalent to $20 in new revenues and $10 for medical offices. The long life and reliability of LED light sources diminish maintenance costs and help increase profits through reduced labor and relamping expenses.

Looking ahead

Nearly $200 billion of healthcare construction is expected by the year 2015, with dramatic and innovative advances in sustainable products. Unfortunately, of the more than 3,600 currently LEED-registered projects in the United States, only about 2% (74) are healthcare buildings, according to the U.S. Green Building Council.

However, through seamless discussions including architects, engineers, designers, hospital management, and facility executives, innovative, cost-effective energy solutions-such as LED lighting-can be incorporated and implemented into both new construction and renovations. HD

Jeff Gatzow is Everbrite Lighting Technologies' (ELT) product manager. E-mail Jeff at jgatzow@everbrite.com or 414.529.7178.
Healthcare Design 2009 May;9(5):12-14