Tag: Healing Environment

What is Meant by Healthy Building?

Published on by Andrew MarshallLeave a comment

Introduction

Healthy building refers to an emerging area of interest that supports the physical, psychological, and social health and well-being of people in buildings and the built environment. Buildings can be key promoters of health and well-being since most people spend a majority of their time indoors. According to the National Human Activity Pattern Survey, Americans spend “an average of 87% of their time in enclosed buildings and about 6% of their time in enclosed vehicles.”

Healthy building can be seen as the next generation of green building that not only includes environmentally responsible and resource-efficient building concepts, but also integrates human well-being and performance. These benefits can include “reducing absenteeism and presenteeism, lowering health care costs, and improving individual and organisational performance.” In 2017, Joseph G. Allen and Ari Bernstein of the Harvard T.H. Chan School of Public Health published The 9 Foundations of a Healthy Building: ventilation, air quality, thermal health, moisture, dusts and pests, safety and security, water quality, noise, and lighting and views.

Refer to Mental Environment and Healing Environments.

Integrated Design

Healthy building involves many different concepts, fields of interest, and disciplines. 9 Foundations describes healthy building as an approach built on building science, health science, and building science. An integrated design team can consist of stakeholders and specialists such as facility managers, architects, building engineers, health and wellness experts, and public health partners. Conducting charrettes with an integrated design team can foster collaboration and help the team develop goals, plans, and solutions.

Buildings and Health Components

There are many different components that can support health and well-being in buildings.

Indoor Air Quality

Spengler considers indoor air quality as an important determinant of healthy design. Buildings with poor indoor air quality can contribute to chronic lung diseases such as asthma, asbestosis and lung cancer. Chemical emissions can be outgassed by building materials, furnishings, and supplies. Air fresheners, cleaning products, paints, printing, flooring, and wax and polish products can also be a source of volatile organic compounds (VOCs) and semi-volatile compound (SVOCs). The LEED v4 Handbook posits that indoor air quality is “one of the most pivotal factors in maintaining building occupants’ safety, productivity, and well-being.”

Ventilation

Higher rates of ventilation affect indoor pollutants, odours, and the perceived freshness of air by diluting contaminants in the air. ASHRAE’s Standard 55-2017 has minimum standards of 8.3 L/s/person. In one study, raising the rate to 15 L/s/person increased performance by 1.1% and decreased sick building symptoms by 18.8%. Whole Building Design Guide recommends separating ventilation from thermal conditioning so as to increase comfort.

Natural ventilation is discouraged in buildings that have strict filtration requirements, contaminant dilution concerns, special pressure relationships, speech privacy concerns, and internal heat load demands. The San Joaquin ASHRAE chapter recommends assessing the outside air quality and configuration of the façade and building before demonstrating compliance and control of natural ventilation. ASHRAE Standard 55-2017 section 6.4 requires the natural ventilation be “manually controlled or controlled through the use of electrical or mechanical actuators under direct occupant control.” Chris Schaffner, CEO of the Green Engineer, describes operable windows as the “HVAC engineer’s ultimate safety factor.” Spengler and Chen recommend natural ventilation being used wherever possible.

Dust and Pests

Dust and dirt can be a source of exposure to VOC and lead as well as pesticides and allergens. High efficiency filter vacuums can remove particles such as dander and allergens that otherwise result in breathing issues. A study of asthmatic children in inner city urban communities suggests they became sensitive to the presence of cockroaches, mice, or rats due to their presence in their homes.

The Use of Disposable Material

The US culture relies heavily on disposable products, especially within healthcare, to minimize on cost and time. In hospitals, for example, healthcare providers cut on costs associated with sterilising equipment between patient cares by using ready-to-use disposable trays. However, this may at a cost to the environment; in one study, disposable cotton towels were suspected to have an adverse environmental impact. It is estimated that cotton production requires 6.6 kg of carbon dioxide equivalents and 0.024 kg of nitrogen emissions, in addition to a substantial amount of water, fertiliser and work. Healthcare managers are urged to request transparency of medical product production (and waste management) lines to provide assurance that products used have zero or minimal impacts on human health and our environment.

Thermal Comfort

Thermal comfort is influenced by factors like air temperature, mean radiant temperature, relative humidity, air speed, metabolic rate, and clothing. Thermal conditions can affect learning, cognitive performance, task completion, disease transmission, and sleep. ASHRAE defines an acceptable thermal environment as one that 80% of occupants find acceptable, though individual occupant thermal control results in higher satisfaction of occupants. Indoor spaces that are not air conditioned can create indoor heat waves if the outside air cools but the thermal mass of the building traps the hotter air inside. Cedeño-Laurent et al. believe these may become worse as climate change increases the “frequency, duration, and intensity of heat waves” and will be harder to adjust to in areas that are designed for colder climates.

Moisture and Humidity

The Whole Building Design Guide recommends the indoor relative humidity to be between 30 and 50% to prevent unwanted moisture and to design for proper drainage and ventilation. Moisture is introduced into the building either by rainwater intrusion, outside humid air infiltration, internally generated moisture, and vapor diffusion through the building envelope. High temperatures, precipitation, and building age enable mould. It contributes to mould and poor indoor air quality. Vapor retarders have traditionally been used to prevent moisture in walls and roofs.

Noise

While noise is not always controllable, it has a high correlation and causation relationship with mental health, stress, and blood pressure. One study suggests that there is a higher correlation of noise irritation and bodily pain or discomfort in women. Effects of excessive noise pollution include hearing impairment, speech intelligibility, sleep disturbance, physiological functions, mental illness, and performance. The World Health Organisation (WHO) recommends creating a “National Plan for a Sustainable Noise Indoor Environment” specific to each country.

Water Quality

Water quality can be contaminated by inorganic chemicals, organic chemicals, and microorganisms. The WHO considers waterborne diseases to be one of the world’s major health concerns, especially for developing countries and children. WHO recommends following water safety plans that include management, maintenance, good design, cleaning, temperature management, and preventing stagnation. Stagnant water is found to deteriorate the microbiological quality of water, and increase corrosion, odours, and taste issues. The bacterial pathogen Legionella may have a higher potential for growth in large buildings due to long water distribution systems and not enough maintenance.

Awareness of these issues is recommended by the WHO in order to maintain water quality:

  • Backflow
  • Cross connections
  • External quality management
  • Independent water supply
  • Material use
  • Minimisation of dead ends and stagnation
  • Seasonal use areas
  • Storage tank integrity
  • Water pressure
  • Water temperature

Safety and Security

Concerns of safety affect the mental and possibly physical health of residents by reducing the amount of physical activity. Fear of crime can result in less physical activity as well as increased social isolation. Atkinson posits that crime is based on motivated offenders, targets, and the absence of guardians. Adjusting these in buildings may increase presumed safety.

Lighting and View

The type and timing of light throughout the day affects circadian rhythms and human physiology. In a study done by Shamsul et al., cool white light and artificial daylight (approximately 450-480 nanometres) was associated with higher levels of alertness. Blue light positively affects mood, performance, fatigue, concentration, and eye comfort and enabled better sleep at night. Bright light during winter has also been shown to improve self-reported health and reduce distress.

Daylighting refers to providing access to natural daylight, which can be aesthetically pleasing and improve sleep duration and quality. The LEED handbook writes that daylighting can save energy while “increasing the quality of the visual environment” and occupant satisfaction.

Views to green landscapes can significantly increase attention and stress recovery. They can also have a positive influence on emotional states. Ko et al. consider views to be “important for the comfort, emotion, and working memory and concentration of occupants.” Providing a view to nature through a glass window may benefit occupants’ well-being and increase employee’s effectiveness.

Site Selection

Creating a walkable environment that connects people to workplaces, green spaces, public transportation, fitness centres, and other basic needs and services can influence daily physical activity as well as diet and type of commute. In particular, proximity to green spaces (e.g., parks, walking trails, gardens) or therapeutic landscapes can reduce absenteeism and improve well-being.

Building Design

There are many aspects of a building that can be designed to support positive health and well-being. For example, creating well-placed collaboration and social areas (e.g. break rooms, open collaboration areas, café spaces, courtyard gardens) can encourage social interaction and well-being. Quiet and wellness rooms can provide quiet zones or rooms that help improve well-being and mindfulness. Specifically, a designated lactation room can support nursing mothers by providing privacy and helping them return to work more easily.

Biophilic design has been linked to health outcomes such as stress reduction, improved mood, cognitive performance, social engagement, and sleep. Ergonomics can also minimize stress and strain on the body by providing ergonomically designed workstations.

Occupant Engagement

While some components of healthy buildings are inherently designed into the built environment, other components rely on the behavioural change of occupants, users, or organisations residing within the building. Well-lit and accessible stairwells can provide building occupants the opportunity to increase regular physical activity. Fitness centres or an exercise room can encourage exercise during the work day, which can improve mood and performance, leading to improved focus and better work-based relationships. Exercise can also be promoted by encouraging alternative means of transportation (e.g. cycling, walking, running) to and from the building. Providing facilities such as bicycle storage and locker/changing rooms can increase the appeal of cycling, walking, or running. Active workstations, such as of sit/stand desks, treadmill desks, or cycle desks, can encourage increased movement and exercise as well. “Behavioural measures” can be taken to “encourage better public health outcomes: e.g. reducing sedentary behaviours by increasing access to stairways, using more active transportation options, and working at sit-to-stand desks.” Other examples that can promote health and well-being include establishing workplace wellness programmes, health promotion campaigns, and encouraging activity and collaboration.

Infectious Disease

ASHRAE states that “Transmission of SARS-CoV-2 through the air is sufficiently likely that airborne exposure to the virus should be controlled. Changes to building operations, including the operation of heating, ventilating, and air-conditioning systems, can reduce airborne exposures.” Current recommendations include increasing air supply and exhaust ventilation, using operable windows, limiting air recirculation, increasing hours of ventilation system operation and upgraded filtration. Joseph Allen of the Healthy Buildings Programme at Harvard suggests 4-6 air changes per hour in classrooms, especially when masks are off.

Proper ventilation of areas has been found to have the same effect as vaccinating 50-60% of the population for influenza. Enhanced filtration using a MERV 13 filter would be adequate to protect against transmission of viruses. Allen mentions three ways humidity can affect transmission: respiratory health, decaying, and virus evaporation. Drier air also dries out the respiratory cilia that catch particles. Viruses decay faster between 40 and 60% humidity. Respiratory droplets that become aerosols are less likely to do so at higher humidity. After 60%, mould growth begins to be encouraged.

Sustainable design of patient rooms, intensive care units, and courtyards could offer opportunities to not only maximise on human safety and wellbeing, but also environmental energy efficiency, waste management recycling, and performance optimization – all of which constitute the core of sustainability. However, this may come at an unexpected cost of enabling growth and spread of opportunistic microbes.

Health and Well-being in Standards and Rating Systems

There are several international and governmental standards, guidelines, and building rating systems that incorporate health and well-being concepts:

  • AirRated
  • ANSI/ASHRAE/USGBC/IES Standard 189.1-2014, Standard for the Design of High-Performance Green Buildings
  • BAIOTEQ
  • Fitwel
  • General Services Administration Facilities Standards for the Public Buildings Service (P-100)
  • Green Building Initiative Green Globes
  • Leadership in Energy and Environmental Design
  • United States Department of Defence Unified Facilities Criteria Programme
  • WELL Building Standard

GreenSeal Standards for Healthy Buildings and Schools

Founded in 1989, GreenSeal is a leading global ecolabeling organization (that is part of The Global Ecolabelling Network) that has set strict criteria for occupant health, sustainability, and product performance. The Healthy Green Schools & Colleges initiative assists facility managers in locating low- or no-cost actions that have a significant impact on indoor air quality and health. The curriculum covers the full spectrum of facilities management methods and was created in collaboration with renowned school facility management professionals:

  • Indoor Air Quality Testing and Monitoring
  • Cleaning and Disinfecting
  • Integrated Pest control
  • Sustainable Purchasing
  • HVAC and Electric management
  • Training and intercommunications

WELL Building Standard Certification

The WELL Building Standard Certification was first launched in 2014 (WELL v1), and it focuses on the well-being and health of occupants in buildings. It was developed by Delos Living LLC and is currently administered by the International WELL Building Institute (IWBI) who released the second version (WELL v2) in 2020. Generally speaking, WELL v2 has updated requirements for investigating the relationship between building design and human health, adds more diversity to spaces and applications of the standard, and features a single rating system that resembles USGBC LEED’s efforts.

More specifically, WELL v1 discussed 100 performance features that can be considered for the certification of a building. Those 100 performance features are classified into 7 “concepts” as follows: Air, Water, Nourishment, Light, Fitness, Comfort, and Mind. Of these 100 features, 41 were required preconditions, and 59 were optional optimisations. In order to achieve a WELL certification, a building has to meet the following:

  • For a WELL silver certification: 41 required preconditions.
  • For a WELL gold certification: all the requirements for silver certification plus 40% optimisations.
  • For a WELL platinum certification: all the requirements for gold certification plus 80% optimisations.

On the other hand, WELL v2 uses a four-certification system that mimics LEED’s scoring system. The required preconditions are decreased to only 23 (vs. 41 in v1), and the optimisations rose to 92 (vs. 59 in v1). WELL v2 also added 3 more “concepts”: Sound, Materials and Community. With these updates, more buildings could qualify for a certification under the new system:

  • For a WELL bronze certification: 40 points are required (this is only available for shell and core buildings)
  • For a WELL silver certification: 50 points are required.
  • For a WELL gold certification: 60 points are required.
  • For a WELL platinum certification: 80 points are required.

There are some caveats with WELL v2, however. For instance, a building has to meet all required 23 preconditions before qualifying a certification. If one precondition is not satisfied, the building may not proceed with WELL standard certification irrespective of how many points achieved. Additionally, a building must earn at least 4 points in the “Thermal Comfort” and “Air” concepts, and 2 points at minimum in the remainder of the concepts. Lastly, a building can attain a maximum of 110 points because of an additional 10 points that could be achieved for innovation and performance.

Based on most recent surveys more than 72M square feet of residential and commercial spaces have been certified around the globe to date.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Healthy_building >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

An Overview of Healing Environments

Published on by Andrew Marshall2 Comments

Introduction

Healing environment, for healthcare buildings describes a physical setting and organisational culture that supports patients and families through the stresses imposed by illness, hospitalisation, medical visits, the process of healing, and sometimes, bereavement. The concept implies that the physical healthcare environment can make a difference in how quickly the patient recovers from or adapts to specific acute and chronic conditions.

Refer to Mental Environment and Healthy Building.

Background

The original concept of the healing environment was developed by Florence Nightingale whose theory of nursing called for nurses to manipulate the environment to be therapeutic (Nightingale, F. 1859). Nightingale outlined in detail the requirements of the “sick room” to minimise suffering and optimise the capacity of a patient to recover, including quiet, warmth, clean air, light, and good diet. Early healthcare design followed her theories outlined in her treatise, “Notes on Hospitals”. Following the discoveries by Louis Pasteur and others which lead to the Germ Theory, plus other technologies, the role of the environment was dominated by infection control and technological advances.

Starting in the 1960s, healing environments have been linked with evidence-based design (EBD), giving the concept a strong scientific base. While in some respects it can be said that the concept of healing environments has evolved into EBD, it’s mainly in the area of reduction of stress that this overlap occurs; as EBD goes beyond the healing environments dimension to consider the effect of the built environment on patient clinical outcomes in the areas of staff stress and fatigue, patient stress, and facility operational efficiency and productivity to improve quality and patient safety. A 1984 study by Roger Ulrich found that surgical patients with a view of nature suffered fewer complications, used less pain medication and were discharged sooner than those who looked out on a brick wall. Since then, many studies have followed, showing impact of several environmental factors on several health outcomes.

Today, the philosophy that guides the concept of the healing environment is rooted in research in the neurosciences, environmental psychology, psychoneuroimmunology, and evolutionary biology. The common thread linking these bodies of research is the physiological effects of stress on the individual and the ability to heal. Psychologically supportive environments enable patients and families to cope with and transcend illness.

Goal

The goal of creating a healing environment is to reduce stress, and thereby reduce associated problems such as medical error, inability to concentrate, and physical symptoms of stress that can affect logical thought process. While use of EBD techniques would not necessarily make an environment a healing one, through EBD we can define environmental factors that can help to ease stress and thereby result in a healing environment. Malkin emphasizes the contribution of research to concepts that can create a healing environment, but just the inclusion do not make setting a ‘healing environment’. The design team needs to translate the EBD into design solutions unique to the individual hospital.

According to “The Business Case for Creating a Healing Environment” written by Jain Malkin, the physical setting has the potential to be therapeutic if it achieves the following:

  • Eliminates environmental stressors such as noise, glare, lack of privacy and poor air quality;
  • Connects patients to nature with views to the outdoors, interior gardens, aquariums, water elements, etc.;
  • Offers options and choices to enhance feelings of being in control – these may include privacy versus socialisation, lighting levels, type of music, seating options, quiet versus ‘active’ waiting areas;
  • Provides opportunities for social support – seating arrangements that provide privacy for family groupings, accommodation for family members or friends in treatment setting; sleep-over accommodation in patient rooms;
  • Provides positive distractions such as interactive art, fireplaces, aquariums, Internet connection, music, access to special video programmes with soothing images of nature accompanied by music developed specifically for the healthcare setting; and
  • Engenders feelings of peace, hope, reflection and spiritual connection and provides opportunities for relaxation, education, humour and whimsy.

Importance of Lighting and Sound

Lighting

80% of what we interpret of our surroundings comes to us from what we see of our environment and that is greatly affected by the light available in that environment. Lighting design in healthcare environments is a major factor in creating healing situations. Since the design of healthcare environments is said to influence patient’s outcomes, yet high costs prevent most hospitals from renovating or rebuilding, changes in lighting becomes a cost-effective way to improve existing environments. It is proven that people who are surrounded by natural light are more productive and live healthier lives. When patients are sick, and surrounded by medical equipment and white walls, the last thing they need is a dark, stuffy room. This is why it is important for every room to have a window for natural light to come into and help create a healing environment for the patient.

The Auditory Environment

While so much of the patient’s experience is based on visual cues, the majority of meaning of their experience is auditory. The many sounds of a hospital are foreign to their experience and their line of sight is limited. Nightingale claimed that sounds that create “anticipation, expectation, waiting, and fear of surprise … damage the patient.” Add to the perception and meaning attribute to any sound the factors of age-related hearing impairment common to older patients, heavy medication, pain, and other conditions, cognition is impacted as is the ability to understand language. Hospital noise, at any volume level, is credited with being the primary cause of sleep deprivation, a contributing factor in delirium, and a risk factor for errors. The current pressure to reduce noise at night has been mistakenly understood to mean undue quiet at night when patients most need cues that people are around them and available if they need help. Just s lighting must be designed to serve both day and night, so much the auditory environment be designed to support activity, cognition, rest, and sleep.

Adding to the above, patients need positive visual and auditory stimulation. Nightingale called for variety, colour, and form as a means of arousing creativity and health in patients. Currently, using appropriate art, nature imagery and music are found to improve the experience of the patient. Technologies have afforded patients infinite options to use media as the choose. The addition of beauty must also be accompanied by an attention to orderliness: removal of clutter, trash, and other distractions.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Healing_environments >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.