Sunny Disposition

By Nancy E. Berry on July 6, 2012

Natural light and views can brighten the operating room and its staff.

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Co Architects incorporated interior windows at the Palomar Medical Center in Escondido, California. Courtesy of Co Architects.

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WHR Architects designed the operating rooms at the new Jersey Shore University Medical Center with windows to allow natural light into the room. Courtesy of the Jersey Shore University Medical Center

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At the end of the 1800s, operating rooms were often located on the top floor of a hospital so the room could be lit with skylights. Special Collections Photographic Archives and Rare Books University of Louisville

A growing trend in Europe—the idea of incorporating natural light into the operating room (OR)—is cycling back into fashion, not only because it has environmental benefits but also because natural light promotes better work conditions for the staff. Studies have shown that natural light enhances mood, increases staff alertness, decreases fatigue, reduces stress, and improves the staff’s natural body rhythms. Best practices, quality patient care, and more sunlight have been linked to greater job satisfaction.

“Ideas like using natural lighting or incorporating some form of natural light in the OR improve the concept of time and the actual working environment,” notes Kaeleigh Sheehan, Project Manager for Practice Greenhealth focusing on the Greening the OR Initiative. “Working 16 hours in a closed-off, windowless room can be a challenge for anyone, but having some sort of access to natural light gives the perception of time passing or provides sunlight.”

According to Dr. Vincent Cirella, Chairman of the Department of Anesthesiology at Jersey Shore University Medical Center, “A hundred years ago, ORs would be located on the top floor of hospitals with skylights to take advantage of daylight. As the decades passed and artificial light improved, ORs were relegated to windowless caves. You could be working long hours in the OR and walk outside to three feet of snow—you wouldn’t even know it had been snowing all day.” Today Dr. Cirella is thrilled to be working in the new medical center’s OR suites designed with two large windows that allow sunlight to stream into each room, creating a warm glow. “I love to feel the sun while I’m working—I don’t feel isolated from the outside world,” Dr. Cirella explains. Designed by WHR Architects, Inc., the LEED Gold–certified building has six new surgery suites in its new Mildred Rosa Diagnostic and Treatment Pavilion, which is part of the hospital’s expansion project; the new suites provide surgeons and OR staff with a fully integrated high-tech OR environment wrapped in the glow of natural light.

“Providing natural light not only for the patients but also for the staff was one of the project goals,” says Tushar Gupta, Principal at WHR Architects. “Attention to areas such as the OR suite where daylight is typically inaccessible was a priority during the design development.” Gupta notes that the literature strongly substantiates the benefits of natural light in classrooms, in office settings, and particularly in hospitals. “We were committed to soliciting the opinions of the surgeons, anesthesiologists, and surgical nurses regarding the application of natural light in this U.S. application,” she says. “We used a high-performance, low-E glass—the window assembly included integral blinds that allow the surgical team to control access to natural light, glare, and privacy.”

The Center for Health Design’s white paper titled “Impacts of Light on Outcomes in the Healthcare Setting” includes a study of 141 nurses in Turkey who were exposed to daylight for at least three hours a day; the study found that the nurses experienced less stress and were more satisfied at work (Alimoglu & Donmez, 2005). Also highlighted in the same white paper was a survey conducted at a new medical center incorporating many daylight-enhancing features (such as atriums and windows in patient rooms and operating rooms) that examined the impact of natural light on staff satisfaction. The study found that 43 percent of the staff rated the increased natural light in the new facility as having a very positive impact on their work life, and 27 percent rated it as having a positive impact (Mroczek, Mikitarian, Vieira, & Rotarius, 2005).

“Studies show that daylight access improves productivity and reduces fatigue, which contribute to the reduction of possible medical errors and the improvement of patient care,” says Frances T. Moore, AIA, LEED AP Associate Principal, CO Architects. The firm incorporated natural light into the outer surgical corridors at Kaiser Permanente’s Panorama City Medical Center, Panorama City, California. CO Architects also chose to utilize natural light in the OR at Palomar Medical Center West in Escondido, California—a hospital design following the Green Guide for Health Care (based on the LEED system). The ORs use “borrowed” light brought in through internal windows: Some ORs have windows to a corridor that faces exterior windows, whereas others have windows to a corridor that faces internal courtyards. All the OR glass is one-quarter-inch thick and is clear.

“Adding windows is about improving the working environment for clinical staff with the idea that natural light improves well-being,” notes Moore. The biggest consideration when incorporating natural light is light control. “Certain procedures need specific light and temperature levels, so the need for light depends on the preference of the physician or surgeon,” states Moore. Windows have shades to control daylight versus electric light, so if electric lights are not needed by the surgeon, they can be left off and exam lights would be the only artificial light. Another consideration is privacy, which is taken care of with the blinds. Introducing natural light into hospitals—even into the ORs—can be a good way to promote wellness. Natural light incorporated into lighting design not only benefits patients and staff but also is a sustainable light source delivered at no cost and is preferred by most clinicians.