If you close your eyes and think of an interior where you felt relaxed and at peace, what comes to mind?

Jean Hansen, FIIDA, CID, AAHID, EDAC, LEED AP BD+C, sustainable interiors manager, senior professional associate, HDR Architecture, Inc.; Michelle Halle Stern, AIA, PE, MSPH, LEED Fellow, director, sustainable design services, HDR; and I pondered “healthy interiors” on a January 2012 conference call.

We talked about view; daylight; open space; quiet, pleasant colors; artwork; a calming culture; and a positive energy. We talked about a lack of the “hospital smell,” which we discussed could include food warming, soiled linen, cleaning chemicals, and exhaust. We discussed the patient experience, perception, and the visceral reaction one may have to noise, bright light, or odor.

We can’t always see, smell, or hear the presence of chemicals in building materials, furniture, and finishes. One may associate chemicals with cleaning solutions, disinfectants, mercury, and laboratory chemicals, but carcinogens, reproductive toxins, and asthmagens are frequently found in furniture, casework, fabrics, beds, and medical equipment.

Hospitals are increasingly looking to architects and designers for their expertise in creating healthier interiors free of known chemical hazards. Tools, resources, and experts like the featured “interior intelligence” can guide healthcare leaders towards safer choices in furniture, casework, fabrics, and finishes, so that material choices are in line with the goal of creating a healthy space for workers, patients, and visitors.

Hansen was inspired by sustainability when she heard a talk about green cleaning more than 15 years ago. As a designer and a healthcare planner, she looks through the lens of health to think about design, materials specification, and product and material evaluation.

“Sustainability and health are interconnected,” she says. Halle Stern worked in sustainability before she got her start in healthcare. But with healthcare, it all tied together. The two now work together at HDR, researching and specifying safer materials, and have seen a dramatic increase in requests.

“HDR’s expertise is currently being applied through our work with the U.S. Army for the new William Beaumont Army Medical Center at Fort Bliss. Safer materials and healthier interiors synergize with the military’s new gold standard for medical facilities, world-class design, the use of evidence-based design (EBD), and the USGBC’s LEED for Healthcare.

World class, EBD, and LEED for Healthcare all include strategies and/or objectives to avoid harmful chemicals in building materials and furniture, promote good air quality and create environments that foster healing and healthy work settings,” Hansen says.

Carol Derby’s interest in sustainability took hold in 1994, when Designtex partnered with McDonough Braungart Design Chemistry and the Swiss mill Rohner to develop the world’s first cradle-to-cradle compostable textile. That steep learning curve and successful result introduced new and exciting criteria into the textile development process.

Previously focused on research into innovative materials and technologies for Designtex, Carol found this new challenge of perpetually cycling materials was a new pathway to innovation with a cause—that cause being human and environmental health.


A word on textiles
Today, Derby is director of environmental strategy for Designtex and shares her views on healthier textiles. “There was a time when healthcare textiles were first and foremost about performance, and they were often finished with chemicals that allowed them to shed stains, to deter the growth of microbes, and to resist flames.

"Today those performance characteristics are still very much in demand, but a new design challenge has been articulated: to deliver textiles that offer safety and serviceability without sacrificing human and environmental health. Designing healthy textiles for healthcare is a much more deliberate, forward-thinking activity than designing performance textiles ever was. There is still much work to be done at the chemical level to develop safer alternatives that will deliver the same durable properties to which hospitals have become accustomed. But as alternative chemicals are assessed and deemed preferable, there will be a market ready to receive them as valuable innovations.," she says.


Widespread exposure to chemicals
People are exposed every day to a complex mixture of industrial chemicals. The U.S. Centers for Disease Control and Prevention has measured hundreds of chemicals in urine and blood samples of Americans, finding widespread human exposure to flame retardants, perfluorinated compounds, phthalates and heavy metals, among others.1

Many of these chemicals are linked to diseases and conditions, such as cancers, learning and developmental disabilities, birth defects, and asthma.2

Workers, patients, and their families are exposed to toxic chemicals from building products every day. Building materials and products are significant sources of indoor air pollution, including cleaning compounds, adhesives, paints, carpeting, upholstery, manufactured wood products, and other components of furniture.3

Hazardous chemicals found in these products can be released throughout the lifecycle of the product, from the manufacture through use and disposal.

The materials that cover the floors, walls, and ceilings in buildings release hundreds of different chemicals into hospital air. Furniture, curtains, casework, and office and medical equipment contribute their share.

Volatile organic compounds (VOCs), such as formaldehyde, acetaldehyde, naphthalene, and toluene, are released into the air from particle board, carpets, and other finish materials and are inhaled by patients and staff alike. Semi-volatile compounds, such as phthalates and halogenated flame retardants, latch onto dust and float into breathing spaces.

The potential implications can be subtle but significant, including effects ranging from longer patient recovery times to more sick days for staff. The health effects from building materials reach farther than the occupants of the building, stretching into the broader community.4


The Carmen and John Thain Center for Prenatal Pediatrics
Chris Youssef, NCIDQ, LEED AP BD+C, interior designer for Perkins+Will, described New York City’s Carmen and John Thain Center for Prenatal Pediatrics, Morgan Stanley Children's Hospital as a calming environment for the prenatal care of women with troubled pregnancies.

Where expectant women are accustomed to regular prenatal care, a woman carrying a child with a known medical challenge may have to visit a variety of experts at various locations—adding stress to an already stressful period in her life. The center was designed to bring various experts to one location.

Materials were specified with an avoidance of developmental toxins and use of the precautionary principle—meaning that even in the face of scientific uncertainty, potentially harmful chemicals were avoided, wherever possible. While it was often challenging to figure out how to both meet code and avoid toxic chemicals, using a lens of “material health” enabled Yous
sef to avoid harmful materials without spending more.

Of course, these health issues are considered along with other considerations around cleanability, durability, aesthetics, and cost. Youssef felt at an advantage as both the designer and the architect, because health and design have to work together to create a calming environment.

Youssef conducted research to identify safer materials. He researched products, talked to manufacturers, and requested the disclosure of material ingredients. He explains, “We may understand that PVC is made out of chlorinated plastic, but it also has flame retardants, stabilizers, coloring, plasticizers, and the material science that intrigues you to want to learn more about the other additives. You start digging—why is it bad? And you end up making decisions by which you believe to do less harm.”

Youseff, Hansen, Halle Stern, and Derby use various resources, including Perkins+Will’s Transparency List and the Healthy Building Network’s Pharos Project, to make informed decisions around “material health.” These sites help them identify any red flags that require additional research. With these challenges and research comes the payoff, the moment they find a material or a product that meets their needs—safer materials, aesthetically pleasing, durable, and cleanable.

In healthcare, building projects typically need to meet many requirements. Even though there is no perfect environmentally preferred solution overall, the four experts agree that the products chosen need to meet a  project’s desired aesthetic, provide ergonomic comfort, have acoustic qualities, be durable and stain resistant, support infection control, have inherent antimicrobial properties, and support good indoor air quality—with an approved green maintenance protocol.

An important goal is to avoid the use of chemicals or substances of concern in their composition. HCD


Janet Brown, EDAC, can be reached at jbrown@practicegreenhealth.org.



  1. “Fourth National Report on Human Exposure to Environmental Chemicals,” U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2009, available at http://www.cdc.gov/exposurereport/pdf/Fourth​Report.pdf.
  2. Diamanti‐Kandarakis E et al. 2009 Endocrine‐Disrupting Chemicals: An Endocrine Society Scientific Statement, Endocrine Reviews 30(4):293‐342; P. Grandjean and P. Landrigan, “Developmental neurotoxicity of industrial chemicals,” The Lancet, Volume 369, Issue 9564, Pp. 821‐822.
  3. GGHC 2008. Green Guide for Health Care, Version 2.2 Operations Section, Center for Maximum Potential Building Systems and Practice Greenhealth, December 2008.
  4. Rossi, Mark and Tom Lent, 2006, “Creating Safe and Healthy Spaces: Selecting Materials that Support Healing” in The Center for Health Design, Designing the 21st Century Hospital: Environmental Leadership for Healthier Patients and Facilities. Downloaded on February 3, 2012.