Lynne Wilson Orr, Principal, Parkin Architects Limited
Paediatric hospitals are well-known for theming their interior design. Everything from trains to space to underwater themes have been developed to add visual interest for hospitalized children. Chicago’s Children’s Memorial Hospital even has a real fire engine in one of its lobbies, and a sculpture of a mother whale and her calf animate the main lobby. Adult facilities are also being themed, with ‘spa’ and nature themes being the most popular. Natural-looking materials, views to gardens, soft colours, artwork and spectacular lighting systems make these spaces warm and welcoming.
Healthcare architects and designers are well aware of research that indicates that people get better faster, need less pain medication and believe they have received a better quality of care, if they are in a well-designed, patient-friendly environment. As a result, healthcare administrators are reallocating capital construction funds to allow designers to: incorporate silk-screened panels to divide large waiting spaces into smaller, more comfortable seating areas; provide soft seating and fireplaces in waiting areas; and make hospital entrances look less like airport waiting rooms and more like hotel lobbies. Over the years, and with input from organizations such as Planetree and the Center for Health Design, healthcare interiors have evolved from cold, sterile places painted an insipid palette of pastels to warm, inviting places with lots of colour and pattern, interesting artwork, and with enough space to make patients and family alike feel cared-for and welcome.
I read an article today about healthcare surfaces and how they are selected that concerns me greatly about the future of healthcare interiors. The author claims that materials and finishes are selected almost solely for their visual appeal with little regard to how easily they can be cleaned and that patients in hospitals are exposed to more viruses and bacteria than they should be. In essence, she suggests that those who make these selections ignore infection and prevention issues and as a result create unsafe environments for patients, families and staff. She advocates treating surfaces as fomites (which are objects or materials that can act as hosts for infectious organisms) and selecting materials solely on the basis of their ability to reduce risk and prevent transmission of diseases. Over the last couple of years we have seen many hospitals refuse to allow any wooden furnishings, window curtains, carpeting and plants to be incorporated into their facilities because of cleaning and infection concerns. If hospitals continue along this path and now follow this lead to further restrict interior materials, it seems that the pendulum could be about to swing back to shiny, glazed walls, polyurethane furniture with no upholstery, and really depressing environments.
I take exception to the idea that healthcare designers don’t think about safety issues when creating interiors. Parkin’s healthcare designers are very, very aware of infection prevention and control issues with materials and finishes, and also with issues that are created by poor detailing and designs that could create conditions for opportunistic bacteria and viruses to make themselves at home. Our designers spend hours researching materials, their propensity for staining, whether they support the growth of bacteria and viruses, what cleaning protocols the client currently has, warranties, durability, and detailing, to ensure that there are no cracks and crevices where bugs can live. We don’t depend on antimicrobial finishes on materials as there is very little evidence as to their durability. We review our specifications continually to ensure that they are up-to-date, and that we are working with the most current information. Manufacturers frequently change products and we need to know that what we are specifying is appropriate. And we work very hard to continually push the boundaries of what healthcare design should be, creating interesting and supportive spaces for patients, staff and visitors.
My concern is that there has to be a balance between the need to protect patients and staff from Hospital Acquired Infections (HAIs) and the intrinsic need that we all have to be cared for in supportive hospital environments when we need healthcare. Let’s not go back to those horrible post-war institutions that made most people feel sicker than they were because the environment was so depressing—but could be sterilized such that no germ dared to invade! Instead, let’s look to continue to develop materials and finishes that are easily cleaned and disinfected (which are not the same thing by the way), but also provide visual interest and create the healing environments that we all need and deserve.