(navigation image)
Home American Libraries | Canadian Libraries | Universal Library | Community Texts | Project Gutenberg | Children's Library | Biodiversity Heritage Library | Additional Collections
Search: Advanced Search
Anonymous User (login or join us)
Upload
See other formats

Full text of "LIGHTING FOR HOSPITAL PATIENT ROOMS"

.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 

LraoYj. BOTTOM Washington, D.C. 

Consulting Engineer RUSSELL C, PUTNAM 

CliSside Park, N.J. Professor of Electrical Engineering 

HOWARD M. SHARP Case Institute , of Technology 

Consulting Electrical Engineer Cleveland, Ohio 

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 



1 Typical 2-bed arrangement of patient room ;> 

2 Typical 4-bed arrangement of patient room () 

3 Ceiling-mounted luminaire: Public Health Service experimental imil . . It 

4 Ceiling -mounted luminaire (may bo recess-mounted) 12 

5 Ceiling-suspended concentric-ring luminaire, indirect lighting 13 

6 Ceiling-suspended luminaire with plastic diffusing louvers, indirect 

lighting 1'* 

7 Ceiling-suspended luminaire with opaque shade 15 

8 Ceiling-mounted floodlights; experimental lighting unit 16 

9 Wall-mounted bracket light with translucent shade, indirect lighting . . 17 

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 Lighting levels recommended for patient rooms ft 

2 Reflectance and brightness values 27 



SUMMARY 

This report of lighting studies undertaken by the Public Health Service with the 
assistance of special consultants provides data and guidelines to aid hospital planners 
in determining the optimum lighting needs for a patient's room in a general hospital. 
Recommendations are also made as to how these requirements might best be met. 

Most lighting studies in patient rooms heretofore have been chiefly confined to 
the problems relating to the patient's use of light during reading and resting. These 
studies, therefore, were designed to be more extensive in scope. In addition to setting 
forth ways to meet the various types of lighting required by patients, attention was 
given other essential considerations such as: 

(1) Optimum lighting conditions in the patient's room for hospital personnel 
{i.e., physician, nurse, and housekeeper) performing specific functions requiring dif- 
ferent levels of illumination. 

(2) The effect of certain factors, such as the shape and positioning of lighting 
units and reflectances resulting from the color and type of walls, ceilings, bedclothes, 
and furnishings. 

The team of investigators conducted its studies in specially designed mock-up 
patient rooms and in several multibed patient rooms in hospitals. All persons con- 
cerned, including not only the patient but also members of the hospital staff performing 
various tasks in the room, were consulted as to their lighting needs and preferences. 
In the mock-up rooms, many types of commercially available luminaires and experi- 
mental units were installed. Detailed studies were made by varying illumination levels 
and brightnesses as well as colors and reflectances of interior finishes. Photometer 
readings were taken and each situation was assessed to determine optimum lighting 

levels. 

The importance of a close working relationship between the architect, interior 
decorator, and lighting engineer is borne out by tests and studies made to determine 
the extent to which lighting conditions are affected by color. Their joint efforts are 
essential since good lighting design must take into account not only the placement, 
shape, and type of luminaires to be used but also the brightness and reflectance values 
of the surface finishes and the color of ceilings, walls, floors, and furnishings. 

The reflectance factors of any color selected by the architect or interior decorator 
should be shown on the architectural plans or in the specifications. By indicating 
the color and reflectance values of room interiors, an effective lighting system can 
be developed that takes into account the control of brightness and glare to provide 
visual comfort and to lessen ocular fatigue. During subsequent redecoration of room 
interiors, room finishes should be selected which will provide optimum lighting levels. 

An important outgrowth of these studies has been the development of a tentative 
code of lighting levels and brightnesses. Criteria for the use of these data, presented in 
the advisory recommendations, are briefly stated as follows: 

General lighting should be indirect or designed so that the bright- 
ness of a luminaire or interior finish, when viewed from any normal in-betl 
position, does not disturb patients. The luminaire should be installed m 
such a manner that excessive stoottinese of the lighting in the *> e 
minimized. The brightness tnus produced should not exceed 90 'foot- 
lamberts. Control equipment for dimming the lights may ft." 1 advan- 
lageously. Fluorescent lamps, if used in patient rooms, should be the deluxe 
(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 lend 
themselves to dual use as examination lights and reading lights, but in most 
instances, it is impractical to combine these lighting features in a single 
luminaire. 

Nightlights should provide a low level of illumination with a low 
brightness-contrast value to minimize discomfort to patients but sufficient 
for the nurse to enter the room. A control switch mounted at the door may 
be provided for the nurse to switch the nightlight to a higher lighting level, 
if needed. 



Definitions 



Brightness Photometric brightness (luminance), (B) 

The luminous flux per unit of projected area per unit solid 
angle either leaving a surface at a given point in a given 
direction or arriving at a given point from a given direc- 
tion; the luminous intensity of a surface in a given 
direction per unit of projected area of the surface as 
viewed from that direction. (Note: Measured in foot- 
lamberts, as denned helow.) 

Color temperature of alight source 

The temperature at which a black-body radiator must be 
operated to have a chromaticity equal to that of the light 
source. (Note: Measured in degrees Kelvin.) 

Footlambert (fL) 

Unit of photometric brightness (luminance) equal to 
I/TT (pi) candle per square foot. A theoretical perfectly 
diffusing surface emitting or reflecting flux at the rate of 
one lumen per square foot would have a photometric 
brightness of one footlambert \\ all directions. No 
actual surface completely fulfills this condition. 

Footcandle (/c) 

The unit of illumination when the fool is the unit of length; 
the illumination on a surface one square foot in area on 
which a flux of one lumen is uniformly distributed. It 
equals one lumen per square foot. 

Fluorescent lamp 

An electric discharge lamp in which a fluorescing coating 
("phosphor") transforms some of the ultraviolet energy 
generated by the discharge into light. 

Glare 

The effect of brightness or brightness differences within 
the visual field sufficiently high to cause annoyance, dis- 
comfort, or loss in visual performance. 



Incandescent filament lamp 

A lamp in which light is produced by a filament heated 
to incandescence by the flow of an electric current 
through it. 

Lamp 

An artificial source of light; by extension the terra is also 
used for artificial sources radiating in regions of the 
spectrum adjacent to the visible. (A portable lighting 
unit consisting of a lamp or lamps with housing, shade, 
reflector, or other accessories is also commonly called a 
"lamp." To distinguish between such a complete lumi- 
naire and the light source within it, the latter is sometimes 
called a "bulb.") 

Luminaire 

Complete lighting unit consisting of a lamp or lamps to- 
gether with the parts designed to distribute the light, to 
position and protect the lamps, and to connect the lamps 
to the power supply. 

Lux (fa) 

The unit of illumination when the meter is the unit of 
length; equal to 1 meter-candle or 1 lumen per square 
meter. (Note: Ifcequalsl0.761ux.) 

Reflectance 

The ratio of the flux reflected by a surface or medium to the 
incident flux. (Note; Usually measured in percent.) 



Note: These definitions nppear in IBS Lighting Handbook, Third 
Edition, 1959, published by the Illuminating Engineering Society, 
New York, N.Y. 



04S948 062 -2 



The scope of this project is confined to studies of 
lighting needs in multibed rooms in a general hospital. 
Although these studies are directed to patient rooms hav- 
ing two or more beds, the basic data apply equally for 
single-bed rooms except that glare from patients' reading 
lights would not present the same problem for this type 
of room. These data may also be applicable to health 
facilities other than general hospitals. However, no spe- 
cific study was made for other classes of patient facilities, 
such as outpatient or diagnostic and treatment areas, or 
other types of hospitals. 

The investigators for the first part of this project 
consisted of a team of special consultants an electrical 
engineer specializing in lighting problems, a doctor of 
science experienced in applications of light and radiation 
in health facilities, and ail ex-president of the Illuminat- 
ing Engineering Society with broad experience in il- 
lumination problems and the technical staff of the 
Division of Hospital and Medical Facilities. For the 
second part of the studies, a new team of consultants 
was selected, utilizing skills similar to those of the pre- 
vious group, and including two architects. 



Facilities and Equipment Used in 
Determining Lighting Values 

Most of the studies were conducted in experimental 
2-bed or 4-bed mock-up patient rooms, where the Public 
Health Service staff of architects, engineers, doctors, and 
lurses worked with the special consultants in determining 
he lighting needs in such rooms, These mock-up rooms 
[figs, 1 and 2) were equipped with hospital beds and 
furniture; windows were covered to exclude daylight; 
and interior surfaces were aesthetically finished in vari- 
ous hues to provide specific colors and reflectance values. 
Wall and ceiling luminaires with dimmers to permit ad- 
justments of light levels over wide ranges were installed, 
with provision for varying the light sources to produce 



contrast conditions on the ceiling, walls, bedclothes, and 
surface of interest, such as a book page or chart. 

In the first part of this project, studies also were 
done in four 2-bed patient rooms at the Clinical Center, 
National Institutes of Health, Bethesda, Md, Here the 
patients, attending nurses, and doctors wore consulted 
on their lighting needs. These rooms wore equipped with 
typical commercial lighting units: a ceiling-suspended 
concentric-ring unit; a ceiling-mounted square-box unit; 
a ceiling-mounted spotlight unit; and a wall-mounted rec- 
tangular unit containing fluorescent lamps, The three 
ceiling units had dimmers to raise or lower the lighting 
intensities. 

Throughout the studies, lighting levels were con- 
trolled or modified by dimmers and rectifier-type 
switches. 1 Measurements were made with light meters 
and brightness meters. Colors and reflectances were 
judged according to Munsell value scales. 3 In addition, 
the reflectance values were verified by measurements with 
meters. 

The Lighting Problem 

Lighting installations in hospital multibed patient 
rooms involve many aspects that must be considered 
simultaneously, The patient, the nurse, and the doctor 
require different illumination levels to accommodate vari- 
ous functions and services. The lighting levels required 
in the rooms range from a fraction of a footcandle for 
nightlighting and rest periods up to 100 footcandles or 
more for critical examination or treatment. Several 
steps of lighting levels within this range are needed for 
patients' use and for routine nursing service. 

1 Light levels controlled by; Dimmers of the autotratiaformer 
types, switches of the rectifier type providing 100 percent and 
30 percent of incandescent lamp intensity, ordinary "on-off" 
switches, and specially made silver-bowl lamps with two elements 
which were controlled by a switch in each element circuit. 

'Munsoll value scales for judging color and reflectance; 19-stop 
neutral scale. 



Figure 1, Typical 2-bed arrangement of patient room. 



INTERIOR FINISHES 

Wall color Reflectances (%) 



Red- 
Gray. 
Gray. 
Gray. 



26 
60 
50 
50 



White ceiling 70 

Tan floor 25 



TV- 



A' 



-w 7 



Figure 2. Typical 4-bed arrangement of patient room. 



INTERIOR FINISHES 
Wall color Reflectances (%) 



Red- 
Gray. 
Blue. 
Gray. 



26 
60 
40 
50 



^W 



J\ 



White ceiling __ 80 

Tan floor _ 25 



NOTE: Ceiling height: 8 feet 6 inches. 



"V 



Although lighting for the comfort and personal needs 
of the patient is important, the specific lighting needs of 
the nurse and the doctor also must be considered. Glare 
from the brightness of luminaires, interior finishes, and 
other reflecting surfaces is a common complaint, Hence, 
where practicable, such brightness should be kept low 
enough so that seeing conditions will be comfortable for 
any person in the room, particularly patients, since they 
occupy the room continuously. 

The lowest lighting level satisfactory for any par- 
ticular seeing task in a multibed patient room is pieferable 
because of the disturbing effect a higher level may have on 
those patients wishing to rest. 

The degree of discomfort caused by glare is related 
to a person's physical well being. Nurses and doctors, 
presumably well and healthy, are not discomforted by 
brightnesses to the same degree as most patients. Their 
main problem is getting enough light at the right location 
to perform their tasks efficiently without subjecting the 
patients to high, uncomfortable brightness. 

Glare is frequently caused by excessive brightnesses 
of room interior finishes. Both color and reflectance of 
interior finishes must be a part of the planning of lighting 



systems in order to select lighting equipment and designs 
that will keep brightnesses within the limits recommended 
(see "Tentative code of lighting levels and brightnesses," 
page 9) . Gloss finishes should be avoided. 

If only minimum levels of lighting were to he sup- 
plied for all the functions performed in patient rooms (see 
appendix A), the lighting equipment would be too com- 
plex and costly. Fortunately, several functions and see- 
ing tasks may be satisfied by one lighting level. Hence, 
relatively few steps of lighting levels will suffice for the 
entire range of lighting needs, permitting them to be met 
in a practicable and simple manner and at reasonable 
cost. 

The use of color in patient rooms also is related to 
lighting. Customary environment becomes very im- 
portant, not only for the patient, who wishes to appear as 
healthy to himself and friends as he would under general 
environmental conditions, but for those rendering care. 
A basic illumination requirement in the hospital is that the 
appearance of the patient be viewed under "normal" 
lighting conditions so that the doctors and nurses can 
detect at a glance any clinical changes of the skin, mucous 
membranes, or eyes. 



Lighting Practices and 
Requirements Surveyed 



To determine the lighting practices of hospitals and 
the purpose for which illumination is needed, the con- 
sultants surveyed a number of hospitals, conducted inter- 
views with personnel and patients, and studied the 
literature on hospital lighting. Visits were made to old 
and new hospitals in New York and New Jersey and to 
recently constructed facilities in the southeastern part of 
the Nation. In addition, an analysis of the activities, and 
procedures involved in medical and nursing care for 
which electric lighting is required in a patient room 
was made by a physician and nurse of the Professional 
Services Branch, Division of Hospital and Medical Fa- 
cilities, Public Health Service. This phase of the study, 
reported by Dr, Bruce Underwood, is summarized in 
appendix A, 

For the more complicated medical and nursing pro- 
cedures suggested by Dr. Underwood, an intensive study 
of the lighting needs for treatment and nursing care was 
done at the Clinical Center of the National Institutes of 
Health. Staff members, representing the medical and 
nursing fields, made observations on brightness, glare, and 
comfort. Nurses, doctors, and auxiliary personnel were 
asked to state their preferences as to minimum and opti- 
mum lighting levels for their various functions in the 
rooms. Each situation was assessed by adjusting the 
illumination repeatedly, by means of a dimmer, to higher 
and lower lighting levels. Photometer readings for each 
specific situation were averaged. 

Comfortable lighting conditions for patients' reading 
also were investigated by varying the illumination on the 
reading matter and the brightness on the ceiling. 

From the observations mentioned, it is evident that 
a multiple problem is encountered in providing electric 
lighting in hospital patient rooms containing two or more 



occupied beds. To provide a comfoi table seeing e 
ment for patient use during the usual waking hou 
eral lighting of a low level, about 10 footcandles, 
be provided. Substantially higher levels of 
illumination may produce an undesirable condi 
direct or reflected glare within direct view of p 
The maximum, general lighting suitable for patien 
usually adequate for routine nursing care, but insi 
for detailed reading of tliermo meters, charts, instn 
and other data. Although the patient's reading lig 
he used for this purpose, such practice is not desirt 
cause it usually requires placing the data in the p 
visual field. 

For more critical examination at the patient's 3b 
a higher level of illumination will be needed by the 
or nurse. A separate unit should be installed or fui 
for this purpose, as the patient's reading light is 
considered inadequate for medical examination, 
the examination light is used for relatively short ] 
of time, the higher level of illumination and the ass 
brightnesses could be tolerated by patients in th( 
without undue discomfort. 

When patients sleep or rest, a nightlight is ne< 
provide only a low level of illumination to ona] 
nurse to enter and move freely around the room; to 
patients to orient themselves and to attend to their 
self care if awakened at night; and to enable am 
patients to find their way to lavatories. This SOT 
light should be suitably placed ao as not to disturb p 
who may be awake. 

Common Deficiencies in 
Patient Room Lighting 

The common deficiencies noted in patient 
lighting are : insufficient amount of light at locations 



needed; excessive amount of light causing uncomfortable 
glare in some places; and no examination light installed 
in the room. 

The usual causes for complaint from patients are: 
glare from brightness of light sources and reflecting sur- 
faces; spotty appearance of general lighting caused by 
abrupt or excessive variations in brightnesses of adjacent 
surfaces; lieat that radiates from reading light; reading 
light that is hot to the touch; insufficient light for reading; 
reading light in wrong location; excessive illumination 
and/or glare from nightlight; and annoyance or disturb- 
ance due to location of the nightlight. 

The usual causes of complaint from the hospital staff 
are: insufficient general illumination for routine nursing 
care or for cleaning the room; insufficient or incorrect 
type of light for examinations, giving intravenous injec- 
tions, changing dressings; and other critical seeing tasks 
pertinent to patients' care, 

Recommended Lighting Levels 

Because of the many functions performed in a single 
room, the problem is not the academic one of the best 
illumination for each procedure but the practical one of 
providing illumination satisfactory for the most difficult 
visual task. Since the illumination for the most difficult 
task will only be needed periodically, the installation 
should be controlled so as to provide a selection of lower 
steps of illumination reasonably satisfactory for other 
tasks, 



From these studies and the review of the literature, 
the lighting levels shown in table I are recommended. 



Table 1. Lighting levels recommended for patient 
rooms 



Lighting needs in patient rooms 



Minimum 
lighting levels 
(Footcandles) 



1. For patient comfort: 

a. Head of bed for reading. 

b. Foot of bed 



2, Lighting for nursing service: 

a. General, for nurse to observe patient 

b. Reading thermometers, charts, 
directions 

3. General illumination for cleaning 

and routine nursing service 



4. Local lighting for critical examination 
by doctor or nurse 



20-30 
5-10 



2 
10-15 

10 
50-100 



Note: Recommendations on brightness limitations which were de- 
veloped during Part II of these studies are presented on the follow- 
ing page. 



DEVELOPMENT OF LIGHTING RECOMMENDATIONS 



The findings of the first part of the studies point to 
the incompatibility and difficulty in providing lighting 
levels for (1) patient-use illumination localized and 
minimized to be acceptable to another patient in the same 
room; (2) general illumination sufficient for routine 
nursing care; and (3) higher lighting level over the whole 
bed for critical examinations when glare for a few minutes 
may be the least of the patient's discomfort. To what 
extent it may be practical to provide these three types of 
illumination by less than three separate lighting fixtures 
was explored in the second part of the project. 

In Part II an evaluation was made of lighting char- 
acteristics of various types of luminaires, both commer- 
cially available units and experimental units. Details of 
these case studies are shown in figures 3-18. From the 
combined studies, the following tentative code of lighting 
levels and brightnesses was developed. Guidance in the 
use of this information is given under "Advisory Recom- 
mendations" (page 28), 

Tentative Code of Lighting 
Levels and Brightnesses 

The levels of lighting needed for particular seeing 
tasks and the brightnesses which can be tolerated com- 
fortably are not definite values and may vary greatly, de- 
pending upon the user's needs and the patient's physical 
or mental condition. However, for code purposes, defi- 
nite lighting values are specified below. The practicality 
of these lighting levels and brightnesses was checked when 
the lighting characteristics of various types of luminaires 
(figs, 3-18) were evaluated. 

Lighting Levels: 
Footcandles (fc) 

Nightlighting; 0.5 fc, maximum, on floor, at a dis- 
tance of 3 feet from the luminaire. It is desirable to pro- 
vide 1% fcfor momentary use. 



Observation lighting: 2 fc, maximum, 3 feet above 
floor, for nurse to see the patient's apparent condition, 
fluid drainage, oxygen therapy equipment, and to make 
similar observations without the need for additional 
lighting. 

General lighting: 10 fc, for cleaning, routine nurs- 
ing service, patient's self-care, visitors, dining, and as 
background lighting for use with reading light. 

Reading lighting; 20-30 fc, 3 feet 9 inches above 
floor, on reading material of patient in bed or in chair. 

Examination lighting: 50-100 fc, for use of doctor 
and nurse to make critical examinations, to administer 
treatments such as intravenous injections, to change 
dressings, and to give other medication necessary for the 
care of patients. 

Tolerable Brightness Limits: 
Footlamberts (fL) 

General light and reading light: 90 fL, maximum 
brightness of any luminaire, light source, or room interior 
surface as normally seen from any normal reading or 
patient's bed position, 

Nightlight; 20 fL, maximum brightness normally 
produced on or by the nightlight as observed from any 
normal bed position. The maximum brightness for 
momentary use should not exceed 50 f L. 

Examination light; 250 fL, maximum brightness 
of a fixed nonadjustable luminaire as seen from adjacent 
beds or from beds across the room* from a normal bed 
position. 

Luminaire Types and 
Service Features 

Luminaires, which consist of complete lighting units 
or components of lighting units, are commonly used in 
patient rooms for one or more of the following services: 



patient's reading light, general lighting, examination light, 
and nightlighting. Several variations in the combination 
of service features have been incorporated into commercial 
units presently available. For example, a patient's read- 
ing light is usually combined with some type of general 
lighting component and frequently with a nightlight. 
Characteristics of these lighting service featuies are as 
follows: 

Reading lights are supplied in adjustable and non- 
adjustable types, arranged for mounting on wall, bed, or 
ceiling, 01 they may be portable types such as table lamps 
and floorlamps. Adjustable and poi table units require 
more maintenance than nonadjustable types because of 
movable parts and breakage by patients who may misuse 
them when attempting to raise themselves in bed. Ex- 
tension cords connecting portable lamps are dust-catchers 
and dust-distributors and may constitute a tripping hazaid. 

General lighting for the room is usually provided by 
ceiling-mounted units, wall brackets, table lamps, or floor- 
lamps. The ceiling-mounted luminaires permit a more 
even distribution of lighting throughout the room than the 
wall-bracket luminaires and are relatively economical. 
The conventional types of wall-bracket units, table lamps, 
and floorlamps that are commonly used to provide general 
lighting are either deficient in lighting levels or distribu- 
tion, high in brightness, or unsatisfactory for proper 
maintenance. 

Examination, lights used as local lighting by the 
doctor or nurse to examine or treat patients are often 
provided by ceiling-mounted nonadjustable units, wall 
brackets with adjustable arms, or portable spotlights of 
the floorstand and the hand-held types. Installed units 



do not interfere with the use of both hands or free move- 
ment of the doctor or the nurse while examining or 
ti eating patients. 

Nightlighting of low level is needed in patient rooms 
for the nurse to see as she enters and as she moves wilhin 
the loom, for patients to oiient themselves if awakened at 
night, and if necessary, for their immediate self-care. 
A i eduction in this low level is desirable when the patient 
rests or sleeps. Nightlights are not intended lo supply 
enough light for the nurse to observe the patient's face 
or to render nursing seivice, but rather to detect whether 
additional light may be needed for the patient's care. The 
preferred location for the nightlight is near the floor 
adjacent to the room entrance to permit a minimum, but 
sufficient, amount of lighting for the nurse to enter the 
room and to piovide a subdued environment for the 
patient. 



Luminaire Case Studies 

Many different types of commercial luminairea com- 
monly used in patient rooms, as well as experimental 
lighting units, were installed in the mock-up rooms where 
illumination characteristics, brightnesses, glare, mainten- 
ance featuies, and control were studied. These case stu- 
dies, as shown in figures 3-18, are not intended to identify, 
praise, or censuie any luminaire, but to determine the 
typical characteristics of the component parts of each 
type. All lighting units were installed in accordance with 
the recommendations of the manufacturers. 



Figure 3. Ceiling-mounted luminaire: Public Health Service experimental unit. 



Service: 

Combination unit: reading, examination, 

and general lighting. 

Lamps : 

Two 40-watt fluorescent lamps (deluxe 

warm) 

One 150-watt reflector flood 

One 150-watt projector flood 

Brightness: 

Footlamberts measured at intervals across 

wall and ceiling indicated by encircled 

numerals. 

Illumination: 

Lighting levels in footcandles indicated by 

numerals on beds and reading matter. 

Interior finishes: 

Colors and reflectances: Head walls red, 

26 percent; ceiling 'gray, 70 percent. 

Remarks: 

The two fluorescent lamps, switched sep- 
arately, provide two sources of indirect 
general illumination, arranged so that 
either one or both sources may be used as 
desired. The reflector floodlight is for 
reading. Both the reflector flood and the 
projector floodlights constitute the exami- 
nation light. All of these components pro- 
vide the lighting levels and low brightnesses 
recommended, However, the reading and 
examination lights are nonadjustable and 
thereby are limited to lighting a predeter- 
mined area. 








Viewing Position 
Q Footlamberts 




64B948 002 8 



11 



Figure 4. Ceiling-mounted luminaire (may be recess-mounted)* 




X 



Viewing Position 
Footlamberts 
Excessive Foollamberts 




Service: 

Combination unit; reading, nightlight, ex- 
amination light, and general lighting. 

Lamps: 

Four 20-watt fluorescent 
Three 40-watt fluorescent 
One 6-watt incandescent 

Brigiit?iess : 

Footlamberts measured at intervals across 
ceiling, walls, and face of luminaire indi- 
cated by numerals in circles and squares. 
The numerals in squares indicate excessive 
brightnesses. 

Illumination: 

Lighting levels in footcandles indicated by 

numerals on bed and reading matter. 

Interior finishes: 

Colors and reflectances: Head walls red, 

26 percent; ceiling gray, 70 percent, 

Remarks: 

The fluorescent lamps are switched to pro- 
vide the following combinations of lamps 
for general, reading, and examination 
lights: two 20-watt general, four 20-watt 
reading, four 20-watt, and three 40-watt 
examination. The lighting provided by 
these lamp combinations for the services 
stated produces the lighting levels recom- 
mended, but the brightnesses are excessive. 
The large lighted area provided by the read- 
ing light allows the patient considerable 
freedom of movement within the area 
lighted for reading. However, the night- 
light, located at the foot end of the lumi- 
naire, exceeds the brightness recommended. 
Its brightness and location are objection- 
able to most observers. 



12 



Figure 5. Ceiling-suspended concentric-ring luminaire, indirect lighting. 



Service; 
General lighting 

Lamps: 

One 150-watt incandescent, silver bowl, con- 
trolled by high-low switch. 

Brightness: 

Footlamberts measured at intervals across 
ceiling and wall indicated by numerals in 
circles and square. The numeral in square 
indicates excessive brightness, 

Illumination: 

Lighting intensities in footcandles indi- 
cated by numerals on beds and reading 
matter. 

Inferior Finishes: 

Colors and reflectances: Head wall blue, 

40 percent; ceiling white, 80 percent, 

Remarks : 

This light controlled by a high-low switch, 
provides two lighting levels. In the sketch 
are shown lighting levels and brightnesses 
as produced with a high-low switch in 
"high" position. When the switch is in 
"low" position these levels and bright- 
nesses are reduced about 70 percent, 




Viewing Position 
CJ Footlamberls 

Excessive Footlamberts 




Figure 6, Ceiling-suspended luminatre with plastic diffusing louvers, indirect lighting. 




Viewing Position 
Footlamberts 
Excessive Foot lam berls 







Service; 
General lighting 



One 500-watt incandescent, silver bowl, 
dimmer controlled, 

Brightness: 

Footlamberts measured at intervals across 
ceiling and wall indicated by numerals in 
circles and square. The numeral in the 
square indicates excessive brightness. 

Illumination: 

Lighting levels in footcandles indicated by 

numerals on beds and reading matter. 

Interior Finishes: 

Colors and reflectances: Head wall blue, 

40 percent; ceiling white, 80 percent. 

Remarks : 

The lighting levels produced by this lum- 
inaire are controlled by a dimmer which 
permits adjustments over a range from 
to 50 footcandles at bed level, 30 inches 
above the floor. When the dimmer is ad- 
justed to provide 12^ footcandles at bed 
level, the brightnesses are as shown above, 
When the light is adjusted by the dimmer 
to provide the lighting levels recommended 
for reading or for examinations, bright- 
nesses on ceiling and walls exceed the limit 
recommended. 



14 



Figure 7. Ceiling-suspended luminaire with opaque shade. 



Service; 
General lighting 

Lamp : 

One ISO-watt incandescent, controlled by 

high-low switch, general lighting. 

Brightness: 

Footlamberts indicated by encircled nu- 
merals for high and low positions of switch, 

Illumination; 

Lighting levels in footcandles shown at 

points indicated. 

Interior Finishes : 

Colors and reflectances; Head wallred, 
26 percent; side wall gray, 60 percent; 
ceiling white, 80 percent. 

Remarks : 

This luminaire is suspended from the cen- 
ter of the ceiling of a 4-bed ward and is 
controlled by a high-low switch. When the 
switch is in "high" position, this unit pro- 
vides 10 footcandles 30 inches above the 
floor over a large area and has a cutoff of 
direct view of the lamp at about knee posi- 
tion' on the beds. When the switch is in 
"low" position, 3 footcandles are provided. 
The usefulness of this type of luminaire is 
limited by low ceiling height. However, 
the indirect lighting reflected from the ceil- 
ing, plus the direct lighting confined to a 
wide control area, produce a restful and 
pleasant environment. 



85) fL-SwItch High 
25) fL-Switch Low 




Viewing Position 
(___) Footlamberts 




15 



Figure 8. Ceiling-mounted floodlights: experimental lighting unit. 




*70fL inside edge of shade 
,30 fc Reading 




Service : 

Combination reading and examination 
lights: Study assembly of two swivel-type 
adjustable hooded downlights. 



Lamps: 

One ISO-watt reflector flood. 

watt projector flood. 



One 150- 



lllumination: 

Footlamberts measured at inside bottom 
edge of shade. Lighting levels in foot- 
candles are indicated by numerals on bed 
and reading matter. 

Interior Finishes: 

Colors and reflectances: Head wall blue, 

40 percent; ceiling white, 80 percent. 

Remarks: 

This experimental unit, consisting of flood- 
lights attached to a bus mounted on the 
ceiling, permits adjustment of the spacing 
between the downlights and the direction 
of the light beam. The purpose of this 
lighting unit was to determine the charac- 
teristics and usefulness of similar ceiling- 
mounted units when used for reading and 
examination lights. When the reading 
unit is adjusted to angle the beam forward, 
as shown, additional shielding is necessary 
to protect patients on the opposite side of 
the room from excessive brightness. This 
type of reading light with no background 
illumination produces an unpleasant light- 
ing environment. 



16 



Figure 9. Wall-mounted bracket light with translucent shade, indirect lighting. 



Service; 

Combination reading light, nightlight, and 

indirect light for general illumination. 

Lamps: 

One 75-watt incandescent, for general light- 
ing. One 100-watt incandescent, for read- 
ing. One 6-watt incandescent nightlight. 

Brightness: 

Footlamberts measured at intervals across 
ceiling and wall indicated by numerals in 
circles and squares. The numerals in the 
squares indicate excessive brightnesses. 

Illumination: 

Lighting levels in footcandles indicated by 

numerals on beds and reading matter. 

Interior Finishes: 

Colors and reflectances; Head wall- blue, 

40 percent; ceiling white, 80 percent. 

Remarks: 

The adjustable rending light provides ade- 
quate illumination, but the luminaire may 
be maladjusted and thus shine in another 
patient's eyes* The brightness of the trans- 
lucent shade of the general lighting com- 
ponent exceeds the limit recommended. 
The night lighting component of units of 
this type provides inadequate illumination 
for nurses to see furniture or other objects 
on the floor. 



Viewing Position 
Footlamberts 
Excessive Rrotlamberts 




17 



Figure 10. Watt-mounted bracket light with opaque shade, indirect lighting 



Viewing Position 
Q FootlambGrts 




Service; 

Combination reading light, nightlight, and 

indirect light for general illumination. 

Lamps: 

One 75-\vatt incandescent, for general 

lighting 

One 60-watt incandescent, for reading 

One 6-watt incandescent nightlight 

Brightness; 

Footlamberts measured at intervals across 

wall and ceiling indicated by encircled 

numerals. 

Illumination: 

Lighting levels in footcandles indicated by 

numerals on beds and reading matter. 

Interior Finishes; 

Colors and reflectances: Head wall red, 

26 percent; ceiling white, 80 percent. 

Remarks: 

The adjustable reading light, which is not 
fixed to the wall bracket provides adequate 
illumination and is essentially a portable 
unit provided with a bayonet-type fitting 
that may be inserted into any available 
socket, such as in a wall bracket, clamp-on 
bracket, intravenous rod receptacles on the 
corner of beds, or on a heavy base placed 
on a bedside table or dresser. Although 
it is possible to maladjust the light to shine 
in another patient's eyes, the unit is con- 
structed to minimize this probability. The 
general lighting component does not pro- 
vide the recommended illumination. Ob- 
servation pertaining to the nightlight is 
similar to that stated for figure 9, 



18 



Figure 11. Wall-mounted himinaire, fluorescent and 
incandescent, including examination light. 



Service; 

Combination reading, examination, and 

semi-indirect light for general illumination 

Lamps ; 

Two 40-watt fluorescent (deluxe warm), 

for general lighting 

One 20-watt, 28-volt incandescent, for 

reading 

Two 20-watt, 28-volt incandescent, for 

examination 

Brightness: 

Footlamberts measured at intervals across 

wall and ceiling indicated by encircled 

numerals, 

Illumination: 

Lighting levels in footcandles indicated by 

numerals on beds and reading matter. 

Interior Finishes; 

Colors and reflectances: Head wall blue, 

40 percent; ceiling white, 80 percent. 

Remarks ; 

The level of general lighting, provided by 
the two fluorescent lamps, is within the 
limit recommended. This light is well dif- 
fused and distributed over a large area of 
wall and ceiling. The reading light, pro- 
vided by one 20-watt lamp mounted on an 
adjustable arm, permits the patient to ad- 
just the light to suit the reading position 
selected. However, the light may be mal- 
adjusted to shine in another patient's eyes. 
The examination light, provided by two 
20-watt lamps on another adjustable arm, 
permits positioning of the light as needed 
by the nurse or the doctor. This light also 
is subject to maladjustment, as pointed out 
for the reading light. Both reading and 
examination lights provide the recom- 
mended lighting levels. 



Examining Light 

(75 fc at 14-Inch distance) 




Viewing Position 
Footlamberts 




19 



Figure 12. Wall-mounted luminaire, incandescent. 




Service: 

Combination reading light, nightlight, and 

indirect light for general illumination. 

Lamps: 

One 100-watt incandescent, for general 

lighting 

One 100-watt incandescent, for reading 

One 6-watt nightlight 

Brightness: 

Footlamberts measured at intervals across 

ceiling and wall indicated by encircled 

numerals. 

Illumination: 

Lighting levels in footcandles indicated by 

numerals on beds and reading matter. 

Interior Finishes: 

Colors and reflectances; Head wall blue, 

40 percent; ceiling white, 80 percent, 

Remarks: 

The nonadjustable reading light provides 
adequate illumination; however, it is lim- 
ited to a predetermined area. The gen- 
eral lighting level is less than that rec- 
ommended when using a 100-watt lamp. 
If a 150-watt lamp is used, the illumina- 
tion is sufficient but the brightnesses of the 
ceiling and wall are excessive. The night- 
light features are the same as described for 
figure 9, 



Figure 13. Wall-mounted luminaire^ fluorescent. 



Service: 

Combination reading and indirect light for 

general room illumination 

Lamps: 

One 40-watt fluorescent, for general light- 
ing 
One 40-watt fluorescent, for reading 

Brightness: 

Footlamberts, measured at intervals across 
ceiling and walls, indicated by encircled 
numerals. The numeral in the square in- 
dicates excessive brightness. 

I Humiliation: 

Lighting levels in footcandles indicated by 

numerals on beds and reading matter. 

Interior Finishes: 

Colors and reflectances: Head wall blue, 

40 percent; ceiling white, 80 percent. 

Remarks: 

This type of luminaire provides the light- 
ing level recommended for reading, and 
spreads the light over a relatively large 
area, as is desirable for this purpose. How- 
ever, the brightness, as viewed from an ad- 
jacent bed or the bed on the opposite side 
of the room, greatly exceeds the recom- 
mended limit. The level of the general 
lighting provided by one fluorescent lamp 
is below that recommended; however, with 
both fluorescent lamps on, the general light- 
ing level is within the limit recommended. 




. ._ Viewing Position 

O Footlamberls 

PI Excessive Footlaniberts 




21 



Figure 14. Wall-mounted bracket louvered reading light. 



Viewing Position 
Footl amber ts 
Excessive Foottamberts 




Service: 

Reading light with indirect general lighting 

component 

Lamps: 

Two 20-watt fluorescent 

Brightness: 

Footlamberts measured at intervals across 
ceiling and wall indicated by numerals in 
circles and square. The numeral in the 
square indicates excessive brightness. 

Illumination; 

Lighting levels in footcandles indicated by 

numerals on beds and reading matter. 

Interior Finishes: 

Colors and reflectances: Head wall red, 

26 percent; ceiling white, 80 percent. 

Remarks: 

This type of luminaire provides the lighting 
level recommended for reading and spreads 
the light over a relatively large area, as is 
desirable for reading. However, the 
brightness, as viewed from on adjacent bed 
or the bed on the opposite side of the room, 
greatly exceeds the recommended limit. 



22 



Figure 15. Floorlamp portable-type luminaire. 



Service: 

Heading, general illumination, examina- 

lion, nnd nightlighl 



incandescent, for general 
for general 



One 100-wntt 

lighting 

One 6-wntl incandescent, 

lighting 



ttrightness: 

I'Wlamborts measured on coiling and in- 
side bottom edgo of shade are indictiLcd by 
numerals in circle nnd square. The nu- 
meral in the square indicates excessive 
brightness. 

Illumination; 

Lighting level in footeandles indicated by 

numeral for reading matter. 

Interior Finishes; 

Colors and reflectances: Head wall blue, 

40 percent; coiling white, BO percent. 

Remarks; 

This Unninairo is provided with a reflector 
unit that may bo adjusted for reading, ex- 
amination, or general lighting. When the 
shade is properly adjusted for reading, this 
fixture provides the recommended illumi- 
nation, but if maladjusted, can cause dis- 
comfort glare to other patients. When the 
shade is Adjusted for cither examination or 
general lighting, the lighting levels are be- 
low the values recommended for these 
services. The nightlight in the base of the 
lamp reflcclB light parallel to the floor, but 
is limited to a small area. The connecting 
cord for this type of light is an undesirable 
dust catcher and tripping hazard, 




Viewing Position 
Footlamberls 
Excessive Footlamberls 




23 



Figure 1 6. Wall-mounted nightlight ivith crystal glass prismatic lens. 




Service; 
Nightlight 

Lamps: 

One 10-watt incandescent, controlled by a 

high-low switch 

Brightness; 

Footlamberts taken one foot from edge of 
luminaire are indicated by numerals on 
wall; footlamberts taken on face of lumi- 
naire from positions A, B, G at 3 feet 6 
inches from floor are shown in table below. 



FOOTLAMBERTS on FACE of 
LUMINAIRE 


Viewing 
position 


A 


B 


G 


Switch on 
high 
position 


80 


50 


30 


Switch on 
low 
position 


25 


15 


10 



Illumination: 

Lighting levels in footcandle readings on 
floor as indicated. The maximum illumi- 
nation with switch in "high" position is 
2.5 fc. 

Interior Finishes: 

Colors and reflectances: Floor tan, 25 
percent; wall on which nightlight is 
mounted gray, 50 percent; wall opposite 
nightlight gray, 60 percent, 

Remarks: 

To provide enough light for the nurse en- 
tering the room from a lighted corridor, 
but to minimize interference with the pa- 
tients' sleep or rest, two levels of night- 
lighting are recommended. The nightlight 
illustrated is controlled by a high-low 
switch. When the switch is in "high" po- 
sition, lighting levels at the floor are as 
shown ; and when the switch is in the "low" 
position, these levels and brightnesses are 
considerably reduced, 



Figure 17, Wall-mounted nightlight, lo u v ered , wit h stain l ess stee l f 



ace finish. 



Service; 
Nigbtlighl 

Lamp: 

One 15-wntl incandescent, controlled by a 

high-low switch 

ftrightness: 

Foollamberts tnken one foot from edge of 
luimimiro arc indicated by nunicrnls on 
wall; foollnmburls token on face of lumi- 
nniro from positions A, II, C at 3 feet 6 
inches from floor tiro shown in inblo holow. 



FOOTLAMJJKKTS on FACK of 
LUMINA1HK 


Viewing 
position 


A 


JB 

10 


C 


Switch on 
high 
position 


15 


10 


Switch on 
low 
position 


5 


2.5 


2.5 



Illumination: 

Lighting levels in foolcondlc readings on 
floor aa indicated. Tho maximum illumi- 
nation with Rwito.li in "high" position is 
3 fc. 

Interior Finishes ; 

Colors and reflectances: Floor tan, 25 per- 
cent; wull on which nightlighl is mounted 
gray, 50 percent; wall opposite nightlight 
gray, 60 percent. 

Remarks; 

To provide enough light for the nurse en- 
tering the room from a lighted corridor, hut 
to minimize interference witli the patients' 
rest or sleep, two levels of nighllighting arc 
recommended. Tho nightlight illustrated 
is controlled by a high-low switch. When 
the switch is in "high" position, lighting 
levels at the floor are as shown; and when 
the switch is in the "low" position, these 
levels and brightnesses are considerably 
reduced. 



Viewing Positions 
O Footlamborls 



WUIS fc I'll 1 !>*<?.' M- V> i" ll" 1 '." :r!,'*! . ' nd 

!?$| 

fcyri'jj'^' :tfn 




25 



Figure 18. Wall-mounted nightlight, louvered with matte black face finish. 




Service: 
Nightlight 

Lamp: 

One 15-watt incandescent, controlled by a 

high-low switch 

Brightness; 

Footlamberts taken one foot from edge of 
luminaire are indicated by numerals on 
wall; footlamberts taken on face of lumin- 
aire from positions A, B, C at 3 feet 6 
inches from floor are shown in table below. 



FOOTLAMBERTS on FACE of 
LUMINAIRE 


Viewing 
position 


A 


B 


C 


Switch on 
high t 
position 


2 


1.5 


1.5 


Switch on 
low 
position 


0.6 


0.4 


0.4 



Illumination: 

Lighting levels in footcandle readings on 
floor as indicated. The maximum illumi- 
nation with switch in "high" position is 
3 fc. 

Interior Finishes: 

Colors and reflectances: Floor tan, 25 
percent ; wall on which nightlight is 
mounted gray, 50 percent; wall opposite 
nightlight gray, 60 percent. 

Remarks: 

To provide enough light for the nurse en- 
tering the room from a lighted corridor, 
but to minimize interference with patients' 
rest or sleep, two levels of nightlighting are 
recommended. The nightlight illustrated 
is controlled by ft high-low switch. When 
the switch is in "high" position, lighting 
levels at the floor are as shown; and when 
the switch is in the "low" position, these 
levels and brightnesses are considerably 
reduced. 



26 



Lighting Affected by Surface Finishes 

The effects on brightnesses of wall 01 ceiling finishes 
that may result from redecorating, or even from fading of 
colois of original finishes, also should be considered in the 
design of lighting systems. As an example, a blue wall 
in one of the mock-up rooms had an original brightness 



of 85 footlamberts when lighted with a particular lurni- 
naire. After four months this wall had faded enough so 
that its brightness had increased to 100 footlambeits when 
lighted with the same luminaire, The data in table 2 give 
the differences of values for reflectances and brightnesses 
of ceiling and wall color finishes, as produced by the same 
light source. 



Table 2. Reflect mute and brightness values (determined for various luminaire types) 



Table 2a. Reflectance and biightness values of a specific 
area on the ceiling, lighted as in figure 5, with 150-watL 
silver-bowl lamp in ceiling-suspended concentric ring-type 
luminaire. 



Ueflerlimt'c 
Ceiling color (percent) 


Brightness 
(footlunihcrla) 


Blue, dark 


20 
65 
50 
60 
17 
37 
6 
83 
70 


4-5 
130 
75 
110 
60 
100 
20 
170 
140 


Blue, light 


Green, medium 




Red, dark-.. 


Yellow-red, medium dark 


White, light 


Grav. Heli 1 _. -, 





Table, 2c. Reflectance and brightness values of a specific 
area on the wall one foot above luminairo, lighted as in 
figure 11, with two 40-watl fluorescent (deluxe wurm) 
lamps in a wall bracket with diffusing plastic covers. 



Reflectance 
Wall color (percent) 


Brightness 
(foolltmiberls) 




20 
40 
50 
65 
50 
60 
17 
37 
6 
83 


40 

85 
100 
. 120 
70 

no 

35 
60 
7 
200 






Blue, light 








Yellor-red, medium dark 


White, light __. 



Table 2b. Reflectance and brightness values of a specific 
area on the wall one foot above luminaire, lighted as in 
figure 9, with 100-watt incandescent lamp in a wall- 
bracket uptight with translucent plastic shade. 



Reflectance 
Wull color (percent) 


Brightness 
(foollnmberts) 


Blue, dark 


20 
40 
50 
65 
50 
60 
17 

28 
37 
6 
83 
60 
50 


75 
110 
160 
220 
140 
180 
90 

130 
130 
20 
320 
210 
200 


Blue, medium dark 




Blue, light __ 


Green, medium 






Watermelon, medium 
dark red 


Yellow-red, medium dark 
Black, dark 


White, light 









Table 2d, Reflectance and brightness values of a specific 
area on the wall one foot above luminaire, lighted as in 
figure ]2, with 100-watt incandescent lamp in a wall- 
bracket uptight, totally indirect. 



Reflectance 
Wall color (percent) 


Brightness 
(foollnmlierls) 




20 
40 
50 
65 
50 
60 
17 
37 
6 
83 


60 
100 

150 
200 
120 
170 
55 
95 
10 
300 






Blue, light 








Yellow-red, medium dork 


White, licht 



27 



ADVISORY RECOMMENDATIONS 



Discomfort glare produced by excessive brightness 
a common and primary source of complaint in patient 
ioms. Designers should be cognizant of the effects of 
)lor and reflectances of interior finishes which contribute 
i the degree of brightness produced by lighting. Glossy 
nishes should be avoided. 

If fluorescent lamps are used in patient rooms, they 
lould be of the deluxe (warm or cool white) type, 
'eluxe-type fluorescent lamps are considered satisfactory 
>r use in patient rooms. However, in relamping, the 
imps may mistakenly be replaced by any one of a number 
E color tones other than those for which the system was 
ssigned. 



reneral Lighting 

General lighting should be indirect or so designed 
lat the brightness of any luminaire or interior finish does 
Dt exceed 90 footlamberts when viewed from any normal 
i-bed position. 

The general illumination should be produced by one 
more luminaires having the capacity to provide a mini- 
um of 10 footcandles 30 inches above the floor, hut 
Lould not greatly exceed 10 footcandles for normal use, 
ontrol equipment is recommended for dimming the il- 
mination to create a soft light for the patient's rest and 
taxation. 

To prevent excessive spottiness of general lighting 

the room, the installation should provide a lighting 

vel ratio of less than. 1 to 5 on a horizontal plane 30 

ches above the floor within a radial distance of 8 feet 

om the maximum lighting level on that plane. 



eading Light 

The reading tight should be capable of providing 
>out 30 footcandles but not less than 20 footcandles at 
e normal reading position, assumed to be 3 feet 9 inches 
>ove the floor. To allow the patient some freedom to 
rn in bed without moving out of the reading light zone, 
e area of the reading plane lighted by an adjustable- 
pe unit should be approximately 3 square feet, and for a 
madjustable-type unit the area should be approximately 
square feet. To provide a reasonable degree of uni- 
rmity oi lighting over these recommended areas, the 

J 



lighting level at the outer edge of each area should be not 
less than two-thirds of the lighting level at the center of 
the area. 

To provide comfortable lighting conditions for read- 
ing, the brightness in footlamberts on the ceiling, provided 
by some means of general lighting, should be at least equal 
to the illumination in footcandlea on the reading matter. 



Observation Light 

An observation light should be installed or provided, 
when needed, for the nurse who must make relatively fre- 
quent observations of a patient or of treatment equipment. 
This luminaire should be positioned to light the bed area 
and the equipment to about 2 footcandles but not less than 
1 footcandle. As this light may be left on all night, if 
necessary, screens or other means should be provided to 
shield the light from other patients. 



Examination Light 

The examination light should provide not less than 
50 footcandles, preferably 100 footcandlea or more, and 
be of a type or so arranged to minimize shadows at the 
area of interest. To reduce glare and to minimize "spill 
light" that may affect others in the room, this light should 
be shielded or adjusted to confine it to the bed area of the 
patient being examined or treated, 

Nonadj ustable examination lights should light the 
bed area to a degree of evenness so that the lighting level 
does not vary more than 2 to 1 over the entire bed area. 

Adjustable examination lights should be capable of 
producing the recommended lighting levels in the center of 
a circular area 2 feet in diameter, at a distance of not 
less than 2 feet from the light source enclosure, and at 
least half the level at the outer edge. 

Portable examination lights should be capable of light- 
ing performance similar to that described above for ad- 
justable units. 

Because the illumination requirements for examina- 
tions and nursing service vary over a wide range, ar- 
rangements for dimming the lights might be considered. 
However, since an examination light is ordinarily used 
infrequently and for relatively short periods, the added 



cost of providing dimming controls is generally not 
justifiable. 

The light level and effective color of the examination 
light should be adequate to permit rapid and correct 
evaluation of the patient's condition as judged from color 
or condition of the patient's skin or tissue. It is gen- 
erally agreed that the color and quality of daylight, under 
specific conditions, are superior to that of electric light 
for most color classification tasks. Daylight itself is vari- 
able, often not available, and electric lighting of this 
color and quality (the order of 6500 K) appears quite 
blue unless the viewer's eyes are adapted to this light alone 
after individually variable periods of work under it. Con- 
sequently, daylight color and quality of electric lighting 
(6500 K) is not a justifiable requirement for patient 
rooms. In most cases, satisfactory lighting can be pro- 
vided for examination of patients in bedrooms by use 
of commercially available incandescent filament lamps 
and deluxe-type fluorescent lamps that are within the color 
temperature range of 2950 K to 4500 K. Daylight in- 
candescent filament lamps (approximately 4000 K) and 
deluxe cool-white fluorescent lamps (approximately 4200 
K) fall within this range. Also, the recommended color 
may be obtained by use of fixed examination lights aided 
by other lamps and commercially available filters. 



Nightlight 

Nightlights are needed to provide only a low level 
of illumination; therefore, the brightness of the luminaire 
and its immediate surroundings should be low enough in 
brightness-contrast to minimize discomfort to the pa- 
tients. Accordingly, it was found that the brightness of 
the nightlight luminaire should not exceed 20 footlam- 
berts. However, if this brightness provides insufficient 
illumination for the nurse, a brightness up to 60 foot- 
lamberts and correspondingly higher footcandles may be 
tolerated by the patient for momentary use. Brightnesses 
in this lange may be provided by a suitable control switch, 
such as a rectifier -type dimming switch mounted at the 
door, convenient for the nurse to switch to the higher 
lighting level as she enters the room and back to the 
lower level as she leaves the room. 

Nightlights that utilize louvers through which the 
light is emitted should be so constructed or so installed 
that there will be no direct view of the light source from. 
a normal in-bed position. The surface finish of the 
nightlight should be such as to have a very low brightness 
value at all times. 



Appendix A. Medical and Related Needs for Lighting in a Patient 
Room in a General Hospital 

Appendix B. Selected Bibliography 



Appendix A 



MEDICAL AND RELATED NEEDS FOR LIGHTING 
IN A PATIENT ROOM IN A GENERAL HOSPITAL 

by 

BRUCE UNDERWOOD, M.D., Senior Surgeon (R) 
Professional Services Branch, Public Health Service 



This study emphasizea lighting requisites primarily 
from the viewpoint of the clinical needs and care of the 
patient and includes the activities of those persons in- 
volved in rendering service to or for the patient in the 
patient's room. The following analysis is a summary of 
the various conditions for which light is needed in the 
patient's room, It includes a comprehensive listing of 
the activities frequently or occasionally performed in a 
patient room, including those of patient, physician, nurse, 
technicians, maintenance people, and visitors. 

The information is summarized under four categories, 
as follows ; 



Section- No. 
I 

II 
III 
IV 



Category 
General factors 
Kinds of light needed 
People needing light 
Activities for which light 
is needed 



SECTION I. GENERAL FACTORS 

Of all the lighting systems used in a general hospital, 
probably those provided in the patient rooms have created 
the most concern. As far as we can determine, no known 
lighting systems are entirely satisfactory for these areas. 
Systems designed to triple or quadruple lighting levels 
often defeat their basic purpose, introduce glare, lead to 
complaints, and may lower human efficiency. 

Formerly, light selection and design apparently were 
based on such notions as good taste, personal feelings, or 
the application of rules to establish definite levels of foot- 
candles. For present and future needs, the designing and 
selection of light for ideal light balance should be con- 
sidered for brightness and color control in the environ- 
ment, as well as for other specific factors. 



The many current developments in clinical and ad- 
ministrative practices, summarized below, are significant, 
and indicate the quantity and quality of lighting needed. 

A. Changes in clinical practices 

1. Early ambulation: More patients are up and moving 
about in their rooms during the major period of their 
hospitalization, whereas formerly most patients were kept 
in bed until a day or two prior to their discharge from the 
hospital. 

2. Patient self-care: Combined with the practice of 
early ambulation, patients are encouraged to be active 
during their hospitalization. As a result, patients now 
attend to more aspects of personal care. 

3. Implementation of new diagnostic procedures and 
the availability of mobile equipment: Many services and 
procedures, such as blood chemistry, basal metabolism, 
electrocardiography, and X-rays, now are being performed 
in patient rooms instead of transporting the patient to the 
laboratory or other diagnostic areas. 

4. Use of new drugs; The administration of many new 
drugs requires frequent dosage and the use of hypodermic 
needles, thus increasing the need for light in order to find 
the site of injection and to observe patient reaction. 

B. Changes in administrative practices 

1, Varied personnel: Employment of many kinds of 
personnel such as aides and special therapists and greater 
use of part-time workers and volunteers for various tasks. 

2. Visitors and patients: More lenient visiting hours 
and less restriction of visitors for patients have increased 
significantly the general flow of numerous persons to 



32 



patient rooms. Also, as a result of the practice of early 
ambulntion, more patients visit each other's rooms or con- 
tinue their business functions either with visiting associ- 
ates or via telephone. 

3, Safety precaution; As a corollary to public educa- 
tion regarding accident prevention, hospitals have imple- 
mented safety programs, including increased use of light, 
which help to avoid litigation. 



C. Other factors 

1. Aging population and increased age of retirement 
indicate an increase in the percentage of older patients, 
nurses, and other personnel rendering service; the de- 
crease in their visual acuity must be considered. 

2. Availability of greater quantities of reading matter 
for patients. 

3. Trend for hospitals to use more printed materials to 
inform and instruct patients. 

4. Use of color in lighting to enhance the appearance 
of the area and to create a psychologically pleasing 
environment. 



SECTION II. LIGHTING SERVICES 



SECTION III. 
LIGHT 



PEOPLE NEEDING 



In addition to the patient, there are a variety of 
individuals needing light in the patient's room. The fol- 
lowing list indicates the range of persons who visit this 



area: 



Physicians (includ- 
ing surgeons, an- 
esthesiologists, 

dentists) 

Nurses 
Dietitians 
Therapists 
Social workers 



Technicians (X-ray 
laboratory) 

Housekeeping 
personnel 

Maintenance 
personnel 

Administrative 
personnel 

Visitors 



SECTION IV. 
ING LIGHT 



ACTIVITIES REQUIR- 



The diversity of the people who have reason to be in 
the patient's room makes it pertinent to examine some of 
their specific activities in order to analyze the extent of 
lighting that may be required. The activities of the pa- 
tient, the physician, and the nurse are enumerated below; 
within each group a few examples ate given to illustrate 
some of the details involved. 



The lighting services needed generally are classified A. Patients 



as: 



General illumination 
Reading light 



Examination light 
Nightlight 



Special lighting features occasionally are needed for 
patients. For example, for patients following ocular 
surgery, provision should be made to attain a low lighting 
level, devoid of high brightness or glare. Some patients 
require special reading devices, such aa projector light for 
patients on Stryker frames, Reading lights should be 
provided for bedpatients and for patients in chairs. 

Local lighting or special-use lighting may be needed 
for certain types of equipment or for observation. 



1, Sel/'care; 

Getting out of bed; attending to personal hygiene and 
grooming; obtaining and using articles on bedside 
table; locating and selecting clothing which involves 
looking for items in dresser drawers or closets; dressing. 

2. Use of equipment: 

Reading projectors, telephone, radio, television. 

3, Visitors; 

Personal, business, stenographic, clerical. 

4. Social activities: 

Playing cards'; visiting and conversing with other 
patients. 

33 



Location: 

Signal lights, doorways, toilet rooms, lavatories, bedside 

table. 

Disposal of contaminated articles; 
Handkerchiefs, 

Walking in room: 

Avoiding possibility of stumbling over objects such as 
rugs, chairs, and other furnishings, 

Other activities ; 

Eating, smoking, reading, writing, needlework. 

. Physicians 

1. Medical rounds: 

a. General observation or examination of patient 

b. Specific physical examination of patient 

c. Write or read medical orders 

d. Instruct nurae or patient 

e. Gown and wash hands prior to treating patient, 
performing procedure, or to care for isolated 
patient 

f. Treat specific body parts 

2. Medical history: 

a. Read identification materials (name tag on bed, 
admission data on chart, history of former hos- 
pitalized periods, reports or data from referral 
agency or physician) 

h. Interview, converse with, and observe patient 
behavior, reactions, and physical appearance 

c. Write notations on medical record 

3. Consultation: 

a. Read patient's identification and medical rec- 
ord data 

b. Observe patient, examine, or treat specific body 
parts 

c. Converse with other physicians and with patient 

d. Position or arrange patient for examination or 
treatment 

e. Arrange and use instruments and medicinal 
agents (involves reading fine graduations on 
syringes or closely observing amount of agent 
drawn) 

f. Observe patient's response to medication or 
treatment 



g. Check drainage and adjust treatment apparatus 
h. Look at X-iays 
i. Write notations on medical record 

4. Procedures; 

a. Measurement of blood pressure (read and record 
measurement, remove and return equipment to 
container) 

b. Obtain specimens for diagnostic tests 

c. Perform gavage, lavage, paracentesis 

d. Apply, remove, or adjust casts, splints, and other 
orthopedic appliances or dressings 

C. Nurses 

1. General care; 

a. Admit and receive new patient 

b. Prepare patient bed unit 

c. Prepare patient (undress, dress, arrange for 
safekeeping of personal belongings) 

d. Assist or administer personal care (bathe, sham- 
poo, comb hair, direct oral hygiene) 

e. Help patient into or out of bed or chair 
i. Give or remove bedpan or urinal 

g. Prepare patient for meals and nourishments; 
assist, serve, or feed patient 

h. Visit and/or observe patient for needs 

i. Inspect patient rooms (tiny bedside tables, 
dressers, other furnishings j remove soiled 
linen and articles to be discarded) 

j. Check equipment and apparatus 
2 Administration of medicine: 

a. Read patient's identification 

b. Select right medication from carts or trays for 
administration to patient 

c. Give or assist patient receiving medication 
(orally, hypodermically, application) 

d. Record notes {medication given, patient's re- 
sponse) 

3. Observations and data recording: 

&. Note progress of patient (skin color, restless- 
ness, respiratory functioning, reaction to medi- 
cations and treatments; if obstetrical patient, 
note contractions and other symptoms) 



b. Observe fluid intake, col'or and quantity of urine, 
vomitus, or feces 

4. Assist physician(s) during examinations, proce- 
dures, or treatments: 

a. General or specific examination (eyes, ears, vag- 
inal, proctoscopic) 

b. Procedures such as aspiration, gavage, lavage, 
vena puncture, lumbar puncture, abdominal 
paracentesis 

c. Apply, remove, or adjust appliances and equip- 
ment (casts, splints, and other orthopedic appli- 
ances; bandages, restraints) 

5. Other phases of nursing care, specific treatment, 
procedures, or assistance: 

a. Take temperature (oral, axilla, rectal), pulse, 
and respiration: 

1) Identify patient; inspect thermometer to de- 
tect imperfections or broken tips 

2) Insert or place thermometer; observe pa- 
tient's condition ; observe watch and patient 
to obtain accurate pulse and respiration 
rates ; read fine graduations on thermometer 

3) Clean thermometer; record observations on 
chart 

b. Prepare patient for catheterization and/or blad- 
der irrigation: 

1) Identify patient; arrange tray and other ar- 
ticles; prepare and drape patient; cleanse 
and prepare specific site area 

2) Manipulate catheter and equipment for with- 
drawal of urine ; introduce solution ; observe 
flow of urine for collecting in receptacle; 
check amount of solution introduced and 
return flow 

3) Handle and manage safely the removal of 
receptacle and equipment from bed; reas- 
semble equipment on tray 

4) Care of patient and bed after treatment 

5) Prepare specimen for laboratory (transfer 
urine to container, label specimen) 

6) Record treatment and data on medical chart 
or forma 



7) Transport (carry or by other means) equip- 
ment tray and articles from patient's room, 
avoiding stumbling or tripping over 
furniture 

c. Care during specific situations: 

1) Prepare bed unit for return of patient from 
operating room, recovery room, delivery 
room, treatment areas, X-ray 

2) Presurgery; post-anesthesia; shock recov- 
ery; tracheotomy; if obstetrical patient, pre- 
pare for delivery and after delivery 

3) Observe equipment and apparatus (heat 
cradles, oxygen tent or respirator, orthopedic 
appliances) 

4) Apply compresses, surgical dressings, bind- 
ers, ice collars, electric pads 

5 ) Assist or instruct patient in walking with or 
without orthopedic appliances 

6) Care during transfer from bed to stretcher 
or during early ambulation 

7) Bathe, dresa, feed infants or children 

8) Orient and instruct patient prior to treatment 

9) Instruct others of specific nursing procedures 
or general care 

10) Arrange for removal' of deceased patients 

d. Assist, start, check, or terminate procedures and 
treatment: 

1) Postural drainage; tidal drainage 

2) Hypodermoclysis; intravenous solutions 

3) Wangensteen suction ; Levine tube 

4) Aerosol therapy; oxygen or steam inhala- 
tion 

5) Diathermy; light treatment 

6) Therapeutic bed baths; immersion of body, 
or arm or foot soaks 

7) Enemas; perineal care 

8) Installations and irrigations of ear, eye, 
throat, colostomy 



35 



Appendix B 

SELECTED BIBLIOGRAPHY 



Banbury, J., "Lighting in Operating Theatres; Impor- 
tance of Fluorescent Fixtures," Hospital and Health 
Management London, 13:158-9, May 1950 

Beny, R. C., "Modernized Lighting for Surgery," 
Hospital Management, 78:50-4, July 1954 

Birren, Faber, "Functional Color in Hospitals," Archi- 
tectural Record, 105:145-6, May 1949 

Birren, Fafaer and Logan, H. L., "Agreeable Environ- 
ment," Progressive Architecture, 41:174-7, August 1960 

Blumenauer, G., and Campbell, Coyne H., M.D., "Color 
has Important Place in Hospital Care of Patients," Hos- 
pital Management, 61:122-6, April 1946 

Bond, Richard, "Good Lighting is Part of Good House- 
keeping," Modern Hospital, 83:124, September 1954 

Clay, C. L., and Allphin, W., "Putting Patients' Rooms 
in the Best Light," Modern Hospital, 73:108-110, July 
1949; 73:108, August 1949; 73:120-2, September 1949 

Crouch, C. L., and Kaufman, J, E., "Solving the Prob- 
lem of Surgical Lighting," Hospitals, 34:55-8, Mar. 16, 
1960 

Davidson, J. M., "This Hospital Designed Its Own Pa- 
tient Bed Light," Hospitals, 34: 33-5, Mar. 1, 1960 

Elliott, F. E., "Bedside Lighting for Ward Patients," 
Nursing Times London, 46:1238, Dec. 2, 1950 

Frisby, John, "Fluorescent Lighting, A New Technique 
in Ward Lighting," The Hospital-London, 5:609-614, 
October 1949 

Gifford, A. Campbell, "Influence of Color in Hospitals; 
Its Effect on Patients and Staff," Hospital and Health 
Management London, 12:415-8, October 1949 

Graham, Felix B,, "Basic Elements in the Planning of 
Electrical Systems: Hospitals," Architectural Record, 
116:217-220, October 1954 

Griffin, Noyce L., "Recommended Lighting Practices 
Put the Hospital in Its Best Light," Modern Hospital, 
84:84, March 1955 

Haynes, Howard, and Staley, K. A., "Reflections on 



Hospital Lighting, Part 4, Patients' Rooms and Wards," 
Modern Hospital, 88: 126-130, April 1957 

Heywood, D. W., "A Light for the Patient," Cana- 
dian Hospital, 22:50, October 1945 

Hyman, H,, "Color Schemes for the Comfort of the 
Convalescent," Modern Hospital, 66:86-7, April 1946 

James, L, V., "Axiom: Let There Be Planned Light," 
Institutions, 33:67-9, August 1953 

Jones, E. W., "What Kind of Lighting Do You Want?" 
Modern Hospital, 68: 110-2, May 1947 

Kalff, L. C., "Environment in Seeing," Illuminating 
Engineering, L-7: 319-330, July 1955 

Maclnnes, J. W,, and Palmer, G., "Engineering in Hos- 
pitals Lighting," Hospital and Health Management 
London, 10:455-9, November 1947 

Martin, D., " 'Enough Light' Isn't Enough in a Hos- 
pital Room," Hospital Administration and Construction, 
1 : 40-3, 1959 

"Materials for Light Control," Illuminating Engineer- 
ing, 1-2:98-9, February 1955 

Meeker, Phelps, "Discomfort Glare and Glare Factor 
Calculations," Illuminating Engineering, L-2: 82-5, Feb- 
ruary 1955 

Ministry of Works, Great Britain, "Artificial Lighting 
and Hospital Wards," The Hospital London, 52: 472-5, 
July 1956 

Musgrove, J., "Hospital Lighting," Proceedings, Inter' 
national Commission on Illumination, C, 1957 

"New Ideas in Lighting and Finishing," Architectural 
Forum, 100: 135-9, April 1954 

Parker, A. H,, "Chief Engineer Grapples with Problems 
and Nuggets of Wisdom Result," Hospital Management, 
61:128-9, June 1946 

Podolsky, E., M.D., "Color in Hospitals, an American 
Point of View," Hospital and Health Management Lon- 
don, 12:113-5, April 1949 

Putnam, Russel C, and Faucett, Robert E., "The Thresh- 
old of Discomfort Glare at Low Adaptation Levels," Il- 
luminating Engineering, XLVI-10, October 1951 



36 



Reichel, S. M., M.D., "Color Therapy for Environmen- 
tal Monotony in Chronic Disease Hospitals," Hospitals, 
30: 54-5, June 1, 1956 

"Rewiring a Hospital; Wide Use of Multichannel 
Trunking," Electric Journal, 151 : 654, Aug. 28, 1953 

Roop, D. M., P.E., "Experiment in Patient Room Light- 
ing," Hospital Management, 87: 88-90, May 22, 1959 

Rosenfield, I., Architect, "Daylighting for Hospitals," 
Pencil Points, 26: 92-6, December 1945; 27: 89-91, Feb- 
ruary 1946 

Rosenfield, I., Architect, "Advances in Hospital Light- 
ing Design," Pencil Points, 26: 84-9, July 1945 



Schroeder, G. C., Jr., "Hospital Design with a Future," 
Illuminating Engineering, 5: 521-3, November 1955 

Smalley, H. E,, "The Variable Height Bed," Hospital 
Management, 82: 42, July 1956 

"Specialized and General Lighting in Hospitals," Hos- 
pital and Health Management London, 12:500-1, De- 
cember 1949 

Tate, R. L. C., "Ward Lighting Problems," Hospital 
and Health Management, 19: 37-9, February 1956 

White, H. Mayhew, "Applications of Lighting in the 
Hospitals," Hospitals, 27: 129-130, December 1953; 28: 
127-9, January 1954 



NOTE; Inquiries relating to the above publications sbould be directed to the sources indicated. 



37 



U S. GOVERNMENT PRINTING OFFICE : 1902 O 845348 



The categories of publications include! 1 in the Hospital and Medical 
Facilities Series* under the Hill-Burton Program follow; 

A- Keg ulntiona 

B- Community Planning 

G - -Organization and Administration 

5)- Design and Equipment 

E Research and Demonstration 

Jj\ Reports and Analyses 

G Jiibliography 

An annotated bil)Hography of these publicatioiiH will be provided 
upon request. Inquiries should be addressed to : 

Division of Hospital and Medical Facilities 
Public Health Service 

U.S. Department of Health, Education, and 
Washington 25, D.C.