ARCHITECTURE & DESIGN
Daylight and infection control An unusual, and often forgotten, benefit of daylight is its great capacity to disinfect. While we elect new ‘infection control tsars’, set up new ‘deep clean’ regimes, develop ‘bio’ coats and gels, introduce copper, silver, and gold into our ironmongery, furniture and fittings, and fabric finishes to combat escalating infection issues, we would do well to start by opening windows, to allow daylight to effortlessly and cost- effectively contribute to this ongoing battle against a formidable adversary. Compelling evidence clearly shows that patients recovering in sunlit hospital wards are less likely to catch infections. Sunlight is known to kill bacteria and viruses, such as MRSA, Listeria, norovirus, Legionella, Staphylococcus, Salmonella, and the very common microorganism, Clostridium difficile. Nosocomial infections, otherwise known as healthcare-associated infections (‘HCAIs’) occur worldwide, affecting approximately 10% of hospitalised patients, which in turn prolongs hospitals stays, increases morbidity and mortality, and means ever-increasing costs for healthcare services.
Daylight interventions neglected Typical infection prevention and control assurance operating procedures are usually vigorous in multiple modes of attack and prevention. However, they never include daylight interventions as a benefit to the overall cleansing regime. Acute medical/surgical ward disinfection regimes could usefully allow for the temporary opening of windows, which are traditionally controlled by restrictors. This would allow for additional, unobstructed daylight to usefully penetrate deep into these bedded spaces. This modus operandi could be controlled by the Matron and ward domestics, to coincide with cleaning rotas, and at times when patients were washing, toileting, dining, exercising, resting, or meeting up with family and friends in adjacent day/dining spaces. An article published in Infection and Drug Resistance, ‘Healthcare Associated Infections – An overview’, states that ‘HCAIs remain one of the biggest causes of death in most countries’.3
It is common knowledge that there are seasonal variations in bactericidal effectiveness and sunlight. Patients are more vulnerable to influenza, measles, pneumonia, and other respiratory infections, during the winter months. This is also consistent with the observation that there are seasonal variations in cancer and cardiac events and other apparently non-infection related conditions. Unfortunately, many new healthcare buildings are not always
82 Health Estate Journal October 2019
Irish playwright, George Bernard Shaw, reportedly wrote his best works in a revolving back garden room designed by him to track the sun throughout the day.
designed to prevent the spreading virulent infections that incapacitate our hospitals, especially during the winter months. Despite considerable provenance related to solar-focused, therapeutic healing architecture, recently designed healthcare environments appear to unfortunately reduce opportunities for introducing natural fresh air, ventilation, and daylight. Optimistically this may change with a greater adoption of Biophilic design, where natural daylight is a major protagonist in this developing design tool.
The ‘elephant in the room’ Climate change has been identified as the biggest global health threat of the 21st century. How will healthcare architecture adapt and evolve to the increased frequency and magnitude of extreme weather conditions? More frequent extremes of air temperatures will contribute directly to deaths from cardiovascular and respiratory diseases, which will be most common among the elderly population and sensitive patient groups. We will have to deal with not only the more familiar hypothermia conditions of abnormally low body temperatures, but also hyperthermia delivering diametrically opposite conditions. Clearly the Government will have to reassess and recalibrate ‘Winter fuel allowances’ to include AC cooling. New design tools will need to be developed to assess the resilience of the hospital building envelopes, and their impact on varied patient profiles. Our building skins will have to adapt to much greater fluctuations in ambient diurnal and seasonal temperatures.
Architectural sunblock armoury Through the ages, across global latitudes, and across architectural styles, solar control, on and within the external envelopes of buildings, has varied considerably. – from Roman/Persian shutters, to fine Edwardian net curtains, to the heavy, lead-weighted, Victorian floor-to-ceiling, velvet-lined curtains. Think also of of hoods and canopies over alpine/seaside homes and pergolas in Mediterranean villas, and of everything from awnings, horizontal and vertical blinds, window films, and roller shutters, to Brise Soleil, ultimately culminating in more sophisticated, extremely sensitive, sensor technology-driven solar attenuators. Today, with the advent of accelerating climate change, these devices have to develop further and work most effectively to combat solar heat gain. Window glass alone – a simple singular building component – has evolved into varied forms of ‘smart glass’ specification to combat the ingress of sunlight. The varied types of it now include switchable glass, intelligent glass, electrochromatic glass, liquid crystal glass, dynamic and electronic glass, smart and dimmable glass, PDLC, and self- tinting glass, fritted glass, and beyond. This effectively forms our ‘sunblock,’ which prevents many of the beneficial components of ‘full spectrum’ daylight entering our patient environments. Architects and designers have to develop new ways of delivering optimal solar control, as well as allowing real opportunity for the ingress of the healing qualities of daylight. A fine calibration of the two is needed.
Richard’s Mazuch’s take on the Papworth Tuberculosis Shelters used from around the mid-1920s onwards.
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