When Fresh Air Went Out of Fashion at Hospitals!

How the hospital went from luxury resort to windowless box.

Vacant beds

(uchar / iStock)

SMITHSONIAN.COM

In the March 1942 issue of the journal Modern Hospital, Charles F. Neergaard, a prominent New York City hospital design consultant, published a layout for a hospital inpatient department that was so innovative he copyrighted it. The plan held two nursing units—groups of patient rooms overseen by a single nursing staff—in a single building wing. For each unit, a corridor provided access to a row of small patient rooms along a long exterior wall and to a shared service area between the two corridors.

The feature that made his plan so innovative—and therefore risky? It included rooms that had no windows.

A windowless room hardly seems daringly innovative nowadays, but in the 1940s it was a shocking proposal for a patient wing. It violated a long-lived understanding of what, exactly, the role of the hospital building should be in terms of promoting health.

For nearly two centuries, hospital designers had based their layouts on a fundamental assumption: In order to remain disease-free and health-giving, hospital spaces required direct access to sunlight and fresh air. This rule was the product of a centuries-old belief that disease could be spread by, or perhaps even directly caused by, dark, stagnant spaces where bad air—smelly, vitiated, stagnant, particulate-laden air—accumulated.

In the late 18th century, this correlation was statistically certain. Epidemics always hit the tenants of crowded, impoverished urban districts harder than the inhabitants of airier, wealthier neighborhoods. Patients in large urban hospitals suffered cross-infections and secondary infections far more frequently than patients in rural or small-town hospitals. It was common knowledge that if windowless rooms didn’t directly breed disease, they bred the conditions that led to disease.

Given this correlation, before the 20th century, every single room within a hospital typically had access to the outdoors. Corridors had windows. Linen closets had windows. In some hospitals even the ventilation ducts and enclosures for plumbing pipes and risers had windows. Windows in patient rooms and operating rooms were so large that the glare caused problems—keeping patients awake and causing momentary blindness in surgeons during operations.

Late 19th-century and early 20th-century advances in medical theories and practices altered, but did not erase, a faith in windows. With the development of germ theory, sunlight and fresh air had new purposes. Experiments proved that ultraviolet light was germicidal. So windows of clear glass, or even of special “vita-glass” that did not block the UV rays, were a means of surface decontamination.

Similarly, tuberculosis sanatoria records proved that simple exposure to fresh air could be curative. The hospital building itself was a form of therapy. In a 1940 issue of the architectural journal Pencil Points, Talbot F. Hamlin confidently noted that “the quality of the surroundings of the sick person may be as important in the cure as the specific therapeutic measures themselves.”

But surroundings were important, partly, because of who went to hospitals in the first place. Indeed, until the late 19th century, medical treatment was not the reason to go to a hospital—poverty was. The vast majority of 19th-century hospital patients were charity cases—sick people who could not afford a doctor’s house call, had no family to care for them, and had no place else to go. A patient would occupy the same bed in a hospital ward—which housed anywhere from half a dozen to 30 patients—for weeks, sometimes even months. The doctor made rounds once a day. Nurses provided food, changed bandages, cleaned, and changed linens—but provided very little in terms of hands-on treatment. The hospital’s scrupulously clean, bright, airy rooms were an environmental antidote to the tenement surroundings from which impoverished patients came.

But the population of hospitals changed in the first decades of the 20th century. Medical advances, urban growth, and philanthropic transformations turned hospitals into a new kind of institution—where persons of all classes went to get cutting-edge treatment. Anesthesia and asepsis made hospital surgeries not only safer but also more bearable. New equipment like x-ray machines, ophthalmoscopes, and cardiographs improved diagnostic and therapeutic options. Bacteriological lab technicians could identify pathogens with a certainty undreamed of during the preceding era of symptomatic diagnosis. By the early 20th century, what happened in hospitals was increasingly about medical procedures and efficient workflow, not the ostensible healthiness of the environment in itself.

These changes made the limitations of the earlier “therapeutic” hospital designs glaringly apparent. In order to provide a window in every room, buildings could not be wider than two rooms deep; this inevitably required multiple long narrow wings. Such rambling structures were expensive to build, prohibitively expensive to heat, light, and supply with water, and inefficient and labor-intensive to operate. Food reached the patients cold after being trucked from a distant central kitchen; patients requiring operations were wheeled through numerous buildings to the surgical suite.

Hospital designers thus began to arrange practitioners, spaces, and equipment into a more effective layout. Catchwords changed from “light” and “air” to “efficiency” and “flexibility.” An emphasis on efficiency rapidly took over the utilitarian areas of the hospital; time and motion studies determined layouts and locations of kitchens, laundry, and central sterile supplies. Diagnostic and treatment spaces were re-designed to establish efficient, but aseptically safe, paths for the movement of patients, nurses, technicians, and supplies.

But, initially, it left the design of inpatient departments unaltered.

Hospital designers and practitioners worried that patient areas designed for efficiency, not healthiness, would prolong treatment, impede recovery, or even cause deaths. In a 1942 issue of Modern Hospital, Lt. Wilber C. McLin considered it “unthinkable even to consider the possibilities of applying time and motion studies to the methods of direct patient care.” Inpatient departments remained sacrosanct temples of light and air.

By the 1940s, therefore, most hospital buildings were odd mixtures of efficiently arranged medical treatment spaces and inefficiently arranged nursing units. Nurses trudged up and down long, open wards that held 20 or more patients, or long, double-loaded corridors that connected smaller (six-, four- or two-bed) wards and private rooms. Service areas were at the far end of that walk; getting even basic supplies was a long hike. Pedometers proved that the daily distance was best counted in miles; some nurses averaged 8-10 per shift. In 1939, prominent Philadelphia doctor Joseph C. Doane drily observed that “some hospitals are apparently planned on the erroneous theory that nurses wing their way from distant service rooms to far off beds without incurring fatigue.”

This was the design dilemma that confronted Neergaard, an iconoclastic rising star in the brand-new profession of “hospital consultant” (doctors who advised building committees and architects on best practices). He proposed streamlining nursing unit design, keeping windows in the inviolable patient rooms, but prioritizing efficiency over direct access to sunlight and fresh air in the adjacent service rooms. His plan allowed two different nursing units (groups of patients overseen by one head nurse) to share the same windowless central service rooms, reducing spatial redundancy.

Neergaard calculated that this “double pavilion plan” required only two-thirds of the floor area of a traditional nursing unit layout. It also moved the service rooms closer to the patient rooms, drastically reducing a nurse’s daily travels. His design was a first foray into treating the hospital as if it were any other building. The structure was a tool, facilitating the delivery of medical care, not a therapy in itself.

Neergaard knew his ideas would be contentious. In 1937, his presentation at an American Hospital Association convention prompted the prominent hospital architects Carl A. Erickson and Edward F. Stevens to resign from a committee rather than be seen as supporting Neergaard’s proposals. One prominent hospital architect called the double pavilion plan “essentially a slum.”

Neergaard’s ideas, however, won out. Rising costs and decreasing revenue sources made reduction of hospital construction and operational budgets a fiscal imperative. Centralized design reduced the amount of expensive exterior wall construction, facilitated centralization of services, and minimized nurse staffing requirements by reducing travel distances. By the 1950s, with the advent of antibiotics and improved aseptic practices, the medical establishment also believed that patient healthiness could be maintained regardless of room design. Some doctors even preferred the total environmental control offered by air conditioning, central heating, and electric lighting.  Windows were no longer necessary to healthy hospitals, and by the 1960s and 1970s even windowless patient rooms appeared.

The efficient, inhuman, and monotonous buildings of the second half of the 20th century bear witness to the extent to which hospital design became a tool to facilitate medicine rather than a therapy in itself. Today, a stay in a hospital room is endured, not enjoyed.

The pendulum, however, is still swinging. In 1984, hospital architect Roger Ulrich published an article that had one clear and influential finding: Patients in hospital rooms with windows improved at a faster rate and in greater percentage than did patients in windowless rooms.

https://www.smithsonianmag.com/history/when-fresh-air-went-out-fashion-hospitals-180963710/

12 Maintenance Tips to Get Your Home Ready for Spring

Maintaining a healthy home goes beyond dusting and vacuuming. When is the last time you checked your smoke alarms? How about the last time you cleaned out your dryer vent? Follow the tips below to make sure your family and home are ready for a happy, clean spring season.

Clean Gutters

Grab a ladder, and check your gutters for debris. Remove as much as you can with your hands (Don’t forget to wear gloves!). Remove any leftover gunk with a garden hose. Take off any nozzle and have a helper turn on the water when you’re ready. Shove the hose into the downspout to power out of gooseneck bends. Make sure your downspouts channel water at least five feet from foundation walls.

Scrub Walls, Baseboards and Outlets

Scrub all the walls — in the bathroom, kitchen, bedrooms and living areas — with a sponge or brush and mild soap and water. This includes baseboards and outlets. Make sure to completely dry outlet covers before replacing.

Replace Filters

Tom DiPace/AP Images

Replace all filters including water, range hood and air vent filters. You should replace these filters every 3-6 months depending on the type of filter you have.

Clean Faucets and Showerheads

Unscrew the faucet aerators, sink sprayers and showerheads, and soak them in equal parts vinegar and water solution. Let them soak for an hour, then rinse with warm water.

Clean Out the Dryer Vent

Sarah Wilson / Getty Images

A clogged dryer vent can be a fire hazard. To clean it, disconnect the vent from the back of the machine and use a dryer vent brush to remove lint. Outside your house, remove the dryer vent cover and use the brush to remove lint from the other end of the vent line. Make sure the vent cover flap moves freely.

Wash Exterior Windows

Hire a window-cleaning service to clean all exterior windows.

Keep Allergens Away

Photos: Christopher Shane/Styling: Elizabeth Demos

Keep dust, mold and pollen at bay by decluttering your home, checking pipes for leaks and keeping the air clean. Follow these 5 steps to an allergy-free home>>

Check Foundation Vents

A house with a crawl space has vents along the foundation walls. The vents provide air circulation that helps prevent excess moisture and mold growth, and they prevent critters from taking up residence underneath your home. The screens collect leaves and other debris from fall and winter. Spring is a great time to clean them out and check for damage. Clean the vents by hand or use a shop vacuum. Repair any damaged screens — critters can get through even the smallest holes.

Clean the Grill

Frank Murray

Your grill has most likely collected dust during fall and winter. Help your grill live a long life with these maintenance tips, whether you have a charcoal or gas grill.

Prep Your Garden

Julie Forney

You can’t have a successful garden without good soil. Follow these tips on how to prepare your soil to help you grow a lush garden.

Test Smoke Alarms

Test smoke alarms and CO detectors, and change out batteries as needed. It’s cheap, only takes a few minutes and can save your family’s lives.

Clean Outdoor Furniture

Emilee Ramsier

Outdoor entertaining season is just around the corner. Learn the best ways to clean all outdoor furniture (recipes included), from plastic to canvas.

https://www.diynetwork.com/made-and-remade/fix-it/12-maintenance-tips-to-get-your-home-ready-for-spring

Messy Offices Expose Workers To Harmful Bacteria

Messy and cluttered office desk

A new survey has found office workers who don’t clean up their workspace put everyone’s health at risk, according to an article on the TechTimes website.

Printerland, a reseller of printers in the UK, surveyed more than 1,000 office workers and found two-thirds of them didn’t clean up their workspace regularly. One in 10 workers said they cleaned their desk once a month, while another 9 percent said they never cleaned their space.

By not cleaning, office workers in messy environments are at risk from harmful bacteria, including Helicobacter pylori, Staphylococcus aureus, E-coli, and Pseudomonas aeruginosa.

The messy office showed that bugs are present on office chairs (21,000 germs per square inch) and desks, desktops (20,961 germs per square inch), keyboards (3,295 germs per square inch), computer mice (1,676 germs per square inch), and office phones (25,127 germs per square inch), according to the article.

Plus, at least 90 percent of office mugs contain harmful germs on their surface, which 20 percent of them carry fecal bacteria. Charles Gerba, a professor of environmental microbiology at the University of Arizona, recommended employees take their coffee mugs and dishes home every night to clean.

Proper cleaning and disinfecting commonly touched objects and areas reduces the spread of viruses by 80 to 90 percent. Gerba suggests cleaning office items, such as phones and desks with antibacterial spray at least once a week. In addition, office chairs should be vacuumed.

To reduce cross-contamination, cleaning personnel should make sure restroom are stocked with soap and towels. However, since restrooms may be taxed, hand sanitizer should also be made available. Setting up hand sanitizer stations in common areas, such as lobbies and breakrooms, as well as frequently used collaborative spaces, will encourage use, especially by occupants who feel they are too busy to visit the restrooms to wash hands when needed.

 

https://www.cleanlink.com/news/article/Messy-Offices-Expose-Workers-To-Harmful-Bacteria–22112

National Healthy Schools Day Focuses on Lead in the Indoor Environment

In its 16th year now, National Healthy Schools Day seeks to inform the public of health risks that can affect children in educational and child care settings

Dirty Drinking Fountain - National Healthy Schools Day

April 3, 2018, Clearwater FL — The US Environmental Protection Agency (EPA) has reported that 50% of all schools have problems with indoor air quality (IAQ). IAQ issues can be comprised of a complex mix of sources including aging facility infrastructure, deferred maintenance, fouled HVAC systems, dirty ducts, and the use of toxic products for cleaning, among other contributing factors. Every year since 2002, National Healthy Schools Day mission is to inform the administrators and public on these vital issues in an effort to bring awareness and change to the maintenance and safety of educational institutions across the country. The EPA urges schools to “Use the day to take the necessary steps to effectively manage the indoor air quality in your schools, ensuring you are providing your students and staff with a healthy learning environment.”

National Healthy Schools Day 2018 LogoThe focus of National Healthy Schools Day 2018is lead. According to the EPA, Centers for Disease Control (CDC), and the American Academy of Pediatrics there is no safe level of lead for any child. Like many other indoor environmental hazards common to schools, lead has long been ignored. However, more schools and child care facilities are becoming more proactive on lead, especially in drinking water. But the fact remains that lead is ubiquitous throughout an educational environment such as in building and instructional materials, as well as other products and even the soil on the property’s grounds.

“It is time to put children first and end lead and other risks to all children in school and child care,” said Claire Barnett, Executive Director of Healthy Schools Network, the national not-for-profit that co-founded and hosts Healthy Schools Day. She added, “For the 16th annual Day, we thank all the education and health leaders and staff in the states who have recognized the high cost of lead and other toxics to the future of children and are taking action to find and to reduce risks in school and child care settings.”

The good news is more and more people are becoming aware of the importance of optimal IAQ in the learning environment. This year a record number of 59 NGOs nationwide are engaged in the event.

Who is most affected?

Across the U.S. over 55 million children and 7 million adults occupy 130,000 public and private schools. Add to that another 11 million children in child care facilities. All totaled, over 1/5 of the U.S. population is in one of these institutions on a daily basis. Today there are fewer public schools than in year’s past, but more children in them and with less federal and state funding. Schools in disadvantaged communities are often in the worst condition from an architectural and infrastructure standpoint. This can likely correlate to these facilities having the most lead in their buildings’ paint and water systems.

What can be done to improve IAQ?

The first step to finding and fixing IAQ issues is to have a proactive administrative and facilities team willing to invest in the building health of their education institutions. This means having their facilities regularly tested, not just for lead but for the myriad of factors that can deteriorate the health of the indoor environment.

“One of our main focuses has been creating healthy learning environments so students can achieve higher academic learning in healthy buildings,” says Alan Wozniak, President of Pure Air Control Services, Inc., “Our Building Sciences team is constantly working with both k-12 and higher education institutions to proactively test and report on the IAQ in their facilities. If issues are found, the detailed reports provided are integral in the remediation process to get the building back to an optimal state of operations and a healthy learning environment.”

IAQ testing can encompass the entire building envelope or concentrate on a specific area on interest in a forensic level investigation of an issue. In the case of lead, water, surface and air samples can be taken from the indoor environment and sent to a laboratory for in-depth analysis. The lab can then qualify and quantify what is in the samples to help determine the severity of the issue in the specific locations where the samples were collected. Of course if concentrations are found and report the proper corrective remediation actions must be taken.

IAQ testing can also be conducted for other issues that can affect the health of a building and its occupants. Things like bacteria, dust mites, fungi (mold) and volatile organic compounds (VOCs) can all proliferate in the indoor environment. They often act as allergy and asthma triggers which can affect student performance and attendance. Dust and debris built up inside of the HVAC system not only contributes to these allergen triggers, but also can decrease the performance of the equipment which can lead higher humidity and CO2 levels within a building. Not to mention higher energy costs.

National Healthy Schools Day is an important advocacy event that helps bring awareness to the importance of good IAQ for educational institutions throughout the U.S. With this in mind, more schools should be encouraged to take a proactive approach to their indoor environment to ensure healthy facilities for their students and staff all year long.

 

http://pureaircontrols.com/healthy-schools-day-2018-lead-risks/

Indoor Environments’ Impact On Wellness To Be Studied

Well Living Lab will undertake a three-year scientific research plan to identify how indoor environments affect five facets of people’s lives.

How indoor environments affect five significant facets of people’s lives—health, performance, stress and resiliency, sleep, and comfort—will be the focus of an extensive three-year scientific research plan conducted by the Well Living Lab. Studies will examine the five factors for homes, workplaces, and independent living communities. A critical component of the research is the interplay of elements such as sound, lighting, temperature, and air quality, all of which can be altered in various combinations to uncover positive, neutral, and negative effects on people.

indoor environments
Photo: The Well Living Lab

“Our responsibility is to advance the science by conducting human-centered research that can be used in practical ways,” said Brent Bauer, M.D., medical director of the Well Living Lab and director of medicine for Mayo Clinic’s Complementary and Integrative Medicine Program. “It’s our belief that favorable outcomes can be realized, which will have long term benefits for people’s lives.”

A variety of experiments will be reviewed, approved, and monitored by the Institutional Review Board of Mayo Clinic. Questions to be explored include:

  • How office workers respond to artificial lighting that simulates natural light, not just at work, but also how it may change their ability to get sufficient sleep at home.
  • How changes in environmental conditions affect sleep and stress.
  • What types interventions can increase cognitive performance and improve job satisfaction.

The research will further build on the results of the Well Living Lab’s latest study findings, published in Building and Environment. The study found that temperature, noise, and lighting in open office environments affect employees’ ability to get work done. This was a proof-of concept study that demonstrated the strength of living lab methodology in measuring realistic occupant responses to select environmental changes in an open office. Specifically, it indicated that employees are most sensitive to thermal conditions, followed by work-related noise such as conversations and lack of natural light from windows when working in open office environments.  These factors affected work environment satisfaction, productivity, and even carried over into the mood of employees and their sleep.

The study consisted of eight working age participants who spent 18 weeks in a simulated work environment in which acoustics, lighting, and temperature were manipulated in numerous combinations, and the findings were based on occupant responses to surveys and in-depth interviews.

“We want to understand the effect of environmental conditions and combinations of conditions to improve health and well-being, including performance, comfort, stress and resilience, and sleep,” said Dr. Bauer. “This study is just the beginning. We will continue to explore the relationship of environmental factors in the workplace and at home.”

The direction for this scientific exploration was solidified by Mayo Clinic and Delos, as well as the lab’s scientific advisory board with members from academia and governmental institutions including Brigham and Women’s Hospital; Carnegie Mellon University; National Institute of Diabetes, Digestive & Kidney Diseases; Stanford University; University of California; UC Berkley; US General Services Administration and University Medical Center Groningen in the Netherlands.

“We know that passive design elements in our homes, offices, and buildings can contribute to our health and well-being,” said Peter Scialla, COO of Delos and co-chair of the Well Living Lab’s Joint Steering Committee. “This research will further advance change for the building industry and result in innovative design, products, materials, and technologies.”

facilityexecutive.com

Harvey could financially hurt struggling Houston hospitals

Structural improvements over the last decade to Houston hospitals have helped them so far to avoid devastation like Hurricane Katrina in New Orleans in 2005, but the pounding it is receiving from Tropical Storm Harvey is expected to financially hobble many already strained Texas medical centers.

The storm has forced hospitals to cancel surgeries, evacuate patients and contend with food and supply shortages. Even bigger challenges are expected in coming months when people who have lost homes and jobs avoid medical treatment or seek charitable care.

“A lot of hospitals already were burdened by uncompensated care…they were already struggling, and this will make things much harder,” said Vivian Ho, a healthcare economist at Rice University.

Rice has been temporarily closed because of the slow-moving storm that has killed at least 11 people since Friday and paralyzed Houston, the fourth most-populous city in the United States with a U.S.-census estimated 2.3 million.

Houston’s healthcare industry includes some of the most prestigious institutions in the country and has grown to accommodate a rising population in recent years.

But uncertainty about changes to U.S. health insurance policy, the region’s shrinking energy sector and Texas’ high percentage of uninsured have forced several Houston hospitals to cut thousands of jobs this year and post millions of dollars in losses, even before the storm.

Investment bank Jefferies warned in an Aug. 28 note that Harvey could have a significant impact on Texas healthcare providers, especially HCA Healthcare Inc, which has “11 percent of its beds in the areas impacted by severe weather.”

Texas Hospital Association spokesman Lance Lunsford said medical centers made significant improvements after buildings were damaged by Tropical Storm Allison in 2001.

Harvey broke rainfall records for the continental United States, with one site south of Houston recording 49.2 inches (1.25 meters) of precipitation.

Flooding prompted MD Anderson on Monday to cancel appointments and surgeries until Wednesday at the earliest, St. Luke’s Hospital closed one of its branches, and flooding at Ben Taub Hospital shut its food service.

MD Anderson on Monday told employees not part of its storm “ride out” team to stay home.

Roads around the cancer center’s main hospital were impassible, and a doctor posted photos of flooding that reached into the hospital lobby.

MD Anderson’s economic impact to the area is about $35 billion, according to its web site. Its 21 hospitals and affiliated institutions employ more than 106,000 people.