.A. repiort of a joint project Toy Hea.lt3a Service staff oons-u.lt struts U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Division of Hospital and Medical Facilities Architectural and Engineering Branch Washington 25, D.C. PUBLIC HEALTH SERVICE PUBLICATION NO. 930-D-3 October 1962 For salt! by the Superintendent of Documents, U.S. Government Printing Office Washington 25, D.C. Price 35 cents. The provision of optimum lighting conditions in patient rooms is an important element in the design of hospital and related medical facilities. In determining lighting requirements, consideration should be given not only to the patient's personal needs and comfort but also to activities which take place in the patient's room, such as nursing care, medical examinations, test procedures, and housekeeping. When this Hill-Burton Program activity was undertaken in 1956, the primary aims were to determine lighting requirements and to develop light- ing levels that might serve as criteria for illumination of patient rooms. As the study progressed, the need was recognized for enlarging the scope of the project to include a study on how the lighting requisites might be met most economically and satisfactorily for both the patient and the hospital staff. Consequently, continuation of the project was authorized on this basis; the studies are referred to as Part I and Part II. The recommendations in this report are based on an evaluation of the many problems concerning artificial illumination in patient rooms in general hospitals. The many factors which increase or lessen the reflectance or brightness of light such as wall color and luminaire design are discussed in some detail, It is hoped that the findings of these studies will he useful as guidelines for architects, engineers, and others concerned with the design of lighting systems for hospital patient rooms. (/ JACK C. HALDEMAN, M.D. Assistant Surgeon General Chief, Division of Hospital and Medical Facilities STUDY GROUP The following persons were responsible for developing the lighting studies and preparing this publication: SPECIAL CONSULTANTS L. RALPH BUSH ERIC PAWLEY Consulting Electrical Engineer Research Secretary Atlanta, Georgia American Institute of Architecture D.C. LraoYj. BOTTOM Washington, Consulting Engineer RUSSELL C, PUTNAM CliSside Park, N.J. Professor of Electrical Engineering Case Institute, of HOWARD M. SHARP Technology Cleveland, Ohio Consulting Electrical Engineer Past-President of Illuminating PAUL NELSON Engineering Society Consulting A rchitect Washington, D.C, Paris, France PUBLIC HEALTH SERVICE Division of Hospital and Medical Facilities Architectural and Engineering Branch AUGUST F, HOENACK, Chief) Architect GEORGE IVANICK, Assistant Chief, Architect NOYCE L. GRIFFIN, Electrical Engineer JAMES J. PARGOE, Electrical Engineer Professional Services Branch BRUCE UNDERWOOD, M.D., Chief CECILIA M.KNox,R.N. CONTENTS Page FOREWORD iii STUDY GROUP iv SUMMARY 1 DEFINITIONS 3 SCOPE OF STUDIES 4 Facilities and Equipment Used in Determining Lighting Values 4 The Lighting Problem 4 PART I LIGHTING NEEDS 7 Lighting Practices and Requirements Surveyed 7 Common Deficiencies in Patient Room Lighting 7 Recommended Lighting Levels 8 PART II DEVELOPMENT OF LIGHTING RECOMMENDATIONS . 9 Tentative Code of Lighting Levels and Brightnesses 9 Lighting Levels: Footcandles (fc) 9 Tolerable Brightness Limits: Footlamberts (fL) 9 Luminaire Types and Service Features 9 Luminaire Case Studies 10 Lighting Affected by Surface Finishes 27 ADVISORY RECOMMENDATIONS 28 General Lighting 28 Reading Light 28 Observation Light 28 Examination Light 28 Nightlight -. 29 APPENDIXES A. Medical and Related Needs for Lighting in a Patient Room in a General Hospital 32 B. Selected Bibliography 36 ILLUSTRATIONS room ;> 1 Typical 2-bed arrangement of patient room () 2 Typical 4-bed arrangement of patient Health Service imil . It 3 Ceiling-mounted luminaire: Public experimental bo 12 4 Ceiling -mounted luminaire (may recess-mounted) indirect 13 5 Ceiling-suspended concentric-ring luminaire, lighting indirect 6 Ceiling-suspended luminaire with plastic diffusing louvers, 1'* lighting 15 7 Ceiling-suspended luminaire with opaque shade unit 16 8 Ceiling-mounted floodlights; experimental lighting . 17 9 Wall-mounted bracket light with translucent shade, indirect lighting 10 "Wall-mounted bracket light, opaque shade, indirect lighting lit 11 Wall-mounted luminaire, fluorescent and incandescent, including examination light , 10 12 Wall-mounted luminaire, incandescent 20 13 Wall-mounted lurainairo, fluorescent 21 14 Wall-mounted bracket louvered reading light 22 15 Floorlamp portable-type luminaire 23 16 Wall-mounted nightlight with crystal glass prismatic Ions 24 17 Wall-mounted nightlight, louvered, with stainless steel face finish 25 18 Wall-mounted nightlight, louvered, matte black face finish 26 TABLES Number p^ 1 levels recommended for Lighting patient rooms ft 2 Reflectance and brightness values 27 SUMMARY Health with the This report of lighting studies undertaken by the Public Service assistance of special consultants provides data and guidelines to aid hospital planners in a in determining the optimum lighting needs for a patient's room general hospital. Recommendations are also made as to how these requirements might best be met. confined to Most lighting studies in patient rooms heretofore have been chiefly and These the problems relating to the patient's use of light during reading resting. In addition to studies, therefore, were designed to be more extensive in scope. setting forth ways to meet the various types of lighting required by patients, attention was given other essential considerations such as: the room for (1) Optimum lighting conditions in patient's hospital personnel functions dif- {i.e., physician, nurse, and housekeeper) performing specific requiring ferent levels of illumination. of (2) The effect of certain factors, such as the shape and positioning lighting of units and reflectances resulting from the color and type walls, ceilings, bedclothes, and furnishings. in The team of investigators conducted its studies specially designed mock-up rooms in All con- patient rooms and in several multibed patient hospitals. persons of the staff cerned, including not only the patient but also members hospital performing various tasks in the room, were consulted as to their lighting needs and preferences. luminaires and In the mock-up rooms, many types of commercially available experi- mental units were installed. Detailed studies were made by varying illumination levels reflectances of interior finishes. Photometer and brightnesses as well as colors and to determine readings were taken and each situation was assessed optimum lighting levels. between the interior The importance of a close working relationship architect, out tests and studies made to determine decorator, and lighting engineer is borne by color. Their efforts are the extent to which lighting conditions are affected by joint must take into account not the placement, essential since good lighting design only luminaires to be used but also the and reflectance values shape, and type of brightness and of the surface finishes and the color of ceilings, walls, floors, furnishings. or interior decorator The reflectance factors of any color selected by the architect should be shown on the architectural plans or in the specifications. By indicating can the color and reflectance values of room interiors, an effective lighting system control of and to provide be developed that takes into account the brightness glare redecoration of room visual comfort and to lessen ocular fatigue. During subsequent selected which will lighting levels. interiors, room finishes should be provide optimum has been the of a tentative An important outgrowth of these studies development in Criteria for the use of these data, presented code of lighting levels and brightnesses. stated as follows: the advisory recommendations, are briefly or so that the bright- General lighting should be indirect designed from normal in-betl ness of a luminaire or interior finish, when viewed any The luminaire should be installed m position, does not disturb patients. the *> e such a manner that excessive stoottinese of the lighting in not exceed 90'foot- minimized. The brightness tnus produced should 1 advan- lamberts. Control for dimming the lights may equipment ft."the deluxe if used in rooms, should be lageously. Fluorescent lamps, patient (warm or cool white) type. Reading lights should provide a reasonable degree of uniformity of lighting over a reading plane of approximately 3 square feet for an adjustable-type unit and approximately 6 square feet for a nonadjustable- type unit. ' Local lighting should be provided or installed where needed for observation of specific conditions and should be positioned to light the bed area and equipment as necessary. As this light may remain on all night, a screen or some other provision should be made to shield the light from other patients. Examination lights should be of a type or so arranged to minimize shadows at the area of interest. Such lights should be shielded or adjusted to confine the illumination to the bed area of the patient being examined or treated, thus minimizing glare for others in the room. Illumination requirements for examinations and nursing service vary. For flexibility, controls may be provided for dimming the lights as necessary, depending on the frequency of use of these lights. Some types of luminaircs