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MCDM AG.COM | M AY/ J U N E 2017 | Medical Construction & Design 21 Exposure to blue light during the day can alleviate symptoms. > Shorter, more enjoyable hospital stays: Properly tuned lighting can result in more restful sleep at night and higher mental acuity and physical energy during the day, lead- ing to shorter hospital stays. Moreover, patients typically have little control in healthcare environments, and off ering a tunable light source — paired with automated systems to maintain full benefi ts of tunable light — can increase patient feelings of comfort and ownership in their space. > Younger patients: Research is increasingly revealing the important link between sleep and good health for young patients. Since the diff erence between night and day can eas- ily blur in hospitals, sustained periods of restful sleep can be hard to secure. Tunable lighting can help optimize children's wakeful vs. sleep patterns to hasten recovery. > Day/night shift workers: By increasing blue spectrum lighting during the day, an ef- fect called the "blue boost" can increase staff productivity and increase workplace enjoyment. When properly balanced with other light sources to avoid mis- alignment of circadian phases, tunable lighting can support the peak function of nurses and doctors, helping to reduce er- rors on the job due to decreased alertness, performance and vigilance. Helping to keep the circadian rhythms of night workers properly aligned can also help reduce risk of sleep disorders and physical ailments. Specifi c job function Certain medical functions re- quire variable Color Rendering Index and functionality that tunable lighting can off er. CRI is also important due to the delicate nature of many tasks. For example, R9 (red) color renditions in exam rooms can aff ect whether a practitioner accurately sees the colors of skin, while R13 (tan) aff ects ability to accurately see blood. For this reason, R9 of 60+ is recommended for healthcare, but standard linear fl uorescent lamps only have R9 value of 1. LEDs typically provide superior R9 and R13 values, but must be individually evaluated based on manufacturer data. In operating suites, varying the color temperature of light output in fi ve steps between 3,500K (enhanced red) and 6,500K (reduced red) improves a surgeon's ability to diff erentiate between tissues of similar colors. Increasing green light during endoscopic procedures helps reduce eye fatigue and refl ections of LCD monitors. Adequate lighting is especially important for older staff over age 65, who need up to four times as much light to perform the same task as a 25- year old. Real-world use Tunable lighting can augment locations where access to daylight is limited or unavail- able to make patient and staff experiences more balanced and pleasant. Mahlum recently transformed three ICU rooms into short-stay recovery rooms for Oregon Health & Science University in Portland, Oregon. The existing rooms did not have daylight access and the client wanted to introduce natural light to support recovery and enhance the patient experience. Mahlum worked with PAE to design an LED "skylight" that would mimic the appearance of daylight and provide light in the blue spectrum to maintain circadian lighting eff ects. In use for six months, the lights have helped many patients with recovery by unobtrusively helping to keep circadian rhythms in check. In researching the technology, the project team uncovered a few challenges and best practices to harness the full benefits of the technology: > Balancing needs: When organizing spaces, designers must remember that diff erent patient and staff needs require diff erent types of lighting, which can be deployed in diff erent rooms or altered via controls. > Avoiding harsh contrasts: Transitioning between areas of diff erent color rendition, temperature or intensity can be unpleasant if the shift is too quick or contrasts too sharply. Lighting should be coordinated with architectural fi nishes because color temperature of electric lighting is intended to blend with and comple- ment surface fi nishes. Warmer color temperature is best for a warmer fi nish schedule; cooler temperature for a cooler palette. A holistic lighting ap- proach is essential. > Understanding control options: Overall, tuning is preferably programmed to automatically align with natural circadian rhythms without human intervention. Although signifi cant costs are associated with automation, manual con- trols require staff training and can lead to human error, defeat- ing the purpose of the system. > Cost barriers: Great strides in crafting intelligent lighting design solutions have been enabled by LEDs, which are available in many varieties and at lower costs than just a year ago. Yet, fi rst costs for the pro- gramming components of tun- able lighting systems may be prohibitive for comprehensive use. To overcome this, many facilities are mixing their use or restricting them to particu- lar spaces where the benefi t is the greatest. Other facilities weigh the higher fi rst cost versus the long-term reduced operating and maintenance costs and available incentives. However, an economy of scale appears as tunable lighting is introduced across a healthcare facility. One controller can operate multiple lamps on an entire hospital fl oor or in one department. Tunable lighting technol- ogy off ers designers and facility owners tremendous fl exibility over the color and control of lighting systems. These lighting solutions enhance the healing environment and help main- tain the circadian rhythms of patients and staff . Keeping an open dialog with project stake- holders can lead to successfully designed spaces that keep the user's well-being at the center of designs. Andy Drissell, AIA, LEED AP BD+C, is a licensed architect at Mahlum, specializing in the design of educational and healthcare environments. Spotlight Lighting >> POWER continued from 18 6500K 5000K 4100K 3500K 3000K 2700K ASSOCIATED EFFECTS AND MOODS: Daylight Vibrant Daylight Vibrant Precise Clean $EÅBHDMS Friendly Inviting Calm Warm Ambient Intimate Personal APPROPRIATE APPLICATIONS: Commercial Industrial Institutional Commercial Industrial Institutional Garage Commercial Kitchen/ Bath Light Commercial Living/Family Rooms Commercial/ Hospitality Living/Family Rooms Commercial/ Hospitality MEASURE UP Color temperature, measured in Kelvin, measures the spectral distribution in an electric source. Lower color temperatures are warmer and will feel closer to candlelight; high color temperatures (6,000K+) are bluer and will feel closer to daylight. Chart: Mahlum