A N S I / I E S N A RP-29-06

An IESNA
Recommended Practico

LigHting

for

Hospitals

and

Health

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Facilities

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 A N S I / I E S N A RP-29-06

L i g h t i n g for H o s p i t a l s

and

Health Care F a c i l i t i e s

Publication of this Recommended

Practice has been approved

by the I E S N A . Suggestions

for revisions s h o u l d be directed

to the I E S N A .

Prepared by:

The I E S N A Committee for Health Care Facilities

A N S I / I E S N A RP-29-06

Copyright 2006 by the 11/uminating Engineering Society of North America

Approved by the IESNA Board of Directors, March 1 1 , 2006, as a Transaction of the 11/uminating Engineering

Society of North America.

Approved as an American National Standard March 27, 2006.

Ali rights reserved. No part of thi s publication may be reproduced in any form, i n any electronic retrieval sys­

tem or otherwise, without prior written perm issio n of the I E S N A .

Published by the llluminating Engineering Soclety of North America, 1 2 0 Wall Street, New York, New York

10005.

I E S N A Standards and Guides are developed through committee consensus and produced by the IESNA

Office i n New York. Careful attention is given to style and accuracy. lf any errors are noted in t h i s document,

please forward them to Rita Harrold, Director Educational and Technical Development, at the above address

for verification and correction. The I E S N A welcomes and urges feedback and comments.

Printed in the United States of America

I S B N - 1 3 : 978-0-87955-213-6

I S B N - 1 O : 0-87995-213-X

DISCLAIMER

IESNA publications are developed through the consensus standards development process approved by the

American National Standards lnstitute. This process brings together volunteers representing varied viewpoints and

interests to achieve consensus on lighting recommendations. While the IESNA administers the process and

establishes policies and procedures to promote fairness in the development of consensus, it makes no guaranty or

warranty as to the accuracy or completeness of any information published herein. The IESNA disclaims liability for

any i n j u ry to persons or property or other damages of any nature whatsoever, whether special, indirect, consequential

or c o m p e n s a t o ry , directly or indirectly resulting from the publication, use of, or reliance on this document.

In issuing and making this document available, the IESNA is not u n d e rt a k i n g to render professional or other

s e rv i c e s for or on behalf of any person or entity. Nor is the IESNA u n d e rt a k i n g to perform any duty owed by any

person or entity to someone else. Anyone using this document should rely on his or her own independent judgment

or, as appropriate, seek the advice of a competent professional in determining the exercise of reasonable care in

any given circumstances.

The IESNA has no power, nor does it u n d e rt a k e , to police or enforce compliance with the contents of this document.

Nor does the IESNA list, certify, test or inspect products, designs, or installations for compliance with this document.

Any c e rt i f i c a t i o n or statement of compliance with the requirements of this document shall not be attributable to the

IESNA and is solely the responsibility of the certifier or maker of the statement.
 A N S I / I E S N A RP-29-06

Prepared by the I E S N A Health Care Facilities Committee

IESNA Health Care Facilities Committee

Richard B. Kurzawa, C h a i r

S . Adams* C . Moser*

K.Baker* P. Mustone

M . Bermant L. M . North*

A. B . Brogden K. Rettich

J . Brownell R . W. R o u s h

R . J . Bucci* M . Rosen

C . M . Burton M . Simeonova

S . K. C o r d o n n i e r R. Smith*

L. K. D e B a u g e - H a r c u m S . Sterkenburg

R . DePrez* D . L. Stymiest

D . Gardberg* P. Trively

J. W . G i l l J. H. Trusk

L. Hayet* G . B. Weinhold

R . Lonsdale

D . MacFadyen* *Advisory

AMERICAN NATIONAL STANDARD

Approval of an American National Standard requires verification by A N S I that the r e q u i r e m e n t s for d u e

process, c o n s e n s u s , and other criteria far approval have been met by the standards developer.

Consensus is established w h e n , i n the j u d g m e n t of the A N S I Board of Standards Review, substantial

agreement has been reached by directly and materially affected interests. Substantial agreement

means much more than a s i m p l e majority, but not necessarily unanimity. Consensus r e q u i r e s that all

views and objections be considered, and that a concerted effort be made toward t h e i r r e s o l u t i o n .

The use of American National Standards is completely voluntary; t h e i r existence does not i n any respect

p r e c l u d e anyone, whether that person has approved the standards or not, from m a n u f a c t u r i n g , market­

i n g , p u r c h a s i n g , or u s i n g products, processes, or procedures not conforming to the standards.

The American National Standards lnstitute does not develop standards and w i l l in no circumstances

give an interpretation to any American National Standard. Moreover, no person shall have the right or

authority to issue an interpretation of an American National Standard in the name of the American

National Standards lnstitute. Requests for interpretations s h o u l d be addressed to the secretariat or

sponsor whose name appears on the title page of this standard.

CAUTION N O T I C E : This American National Standard may be revised at any time. The procedures of the

American National Standards lnstitute require that action be taken to reaffirm, revise, or withdraw this stan­

dard no later than five years from the date of approval. Purchasers of American National Standards may

receive current information on all standards by calling or writing the American National Standards lnstitute.

-•
A N S I / I E S N A RP-29-06

Many of the photographs appearing in this document have been obtained from independent

architects/engineers, l i g h t i n g manufacturers, and professional photographers. These contributors

include:

Figures 1 , 25 M o u n t C l e m e n s General Hospital of M i c h i g a n . S S O E , l n c . , Troy, M I (Designer); Chris

Burkhalter Photography, LLC (Photographer)

Figures 3, 5 The C h i l d r e n s Hospital of Alabama, C h i l d r e n s Health System of Alabama. CRS E n g i n e e r i n g ,

B i r m i n g h a m A L (Designer); John O Hagan (Photographer)

Figure 4 VA Medica! Center of H o u s t o n . S m i t h G r o u p , l n c . , Detroit, M I (Designer); Aker/Burnette, lnc.

( Photographer)

Figures 6, 1 1 H u r o n Valley H o s p i t a l , M i c h i g a n . RTKL, Baltimore, M D and S S O E , l n c . , Troy, M I (Designer);

C h r i s Burkhalter Photography, LLC (Photographer)

Figures 7, 8, 1 6 , 1 7 St. J o h n Macomb Hospital, M i c h i g a n . S S O E , l n c . , Troy, M I (Designer); C h r i s

Burkhalter Photography, LLC (Photographer)

Figure 9 Children s Hospital of M i c h i g a n . S m i t h G r o u p , l n c . , Detroit, M I (Designer); S m i t h G r o u p , lnc.

( Photographer)

Figures 1 O, 20 M i c h i g a n Orthopedic Center, S a i n t Joseph Merey Hospital. Peter Basso Associates, Troy,

M I (Oesigner); A n g e l a R . Wolney (Photographer)

Figures 1 2 , 1 3 M i a m i Valley Hospital of O h i o . H e l m i g Leinesch & Associates, Dayton, OH (Designer);

Michael Houghton, S T U D I O H I O , l n c . (Photographer)

Figure 1 8 O h i o State University Medica! Center. W . E . Monks & Company, C o l u m b u s , OH (Designer);

Michael H o u g h t o n , S T U D I O H I O , l n c . (Photographer)

Figure 1 9 Sutter H e a l t h , C a l i f o r n i a . S m i t h G r o u p , lnc., Detroit, M I (Designer); David Wakely Photography

( Photographer)

Figure 21 Swedish Medical Center, Denver., C O . The Stein-Cox G r o u p , P h o e n i x , AZ (Designer); Ron

J o h n s o n Photography (Photographer)

Figure 22 B e a u m o n t H o s p i t a l , Troy, M I . S S O E , l n c . , Troy, M I (Designer); C h r i s Burkhalter Photography,

LLC ( Photographer)

Figure 23 Genesys H u r l e y Cancer lnstitute, F l i n t , M I . S S O E , l n c . , Troy, M I (Oesigner); C h r i s Burkhalter

Photography, LLC (Photographer)

Figure 24 VA Medica! Center of M i c h i g a n . S m i t h G r o u p , lnc., Detroit, M I (Designer); G l e n Calvin

( Photographer)

Figure 26 Patterson Dental Supply. M i d m a r k Corporation, Versailles, OH (Designer); M i d m a r k Corporation

( Photographer)

Figure 27 Coosa Valley Medical Center, Baptist Health System of Alabama. C R S E n g i n e e r i n g ,

B i r m i n g h a m , AL(Designer); Edward Badham (Photographer)

COVER': Certain contributors are also represented i n the cover c o l l a g e . Top-to-bottom: first image -

see F i g u r e 1 credits, second image - see F i g u r e 22 credits, third image - see F i g u r e 7 credits,

fourth image - see F i g u r e 1 3 credits, and fifth image (bottom) - see F i g u r e 23 credits.
 A N S I / I E S N A RP-29-06

CONTENTS

Preface 1

1 . 0 lntroduction 1

2.0 Types of Facilities 1

2.1 General 1

2.2 The Acute Care Hospital 2

2.3 The C h r o n i c Care Hospital 2

2.4 The Extended Care Facility 2

2.5 Other Facilities 3

3.0 Lighting Objectives · 3

3.1 General 3

3.2 Lighting of the Visual Environment 3

3.3 Task Lighting 5

4.0 Lighting Design Considerations 5

4.1 General 5

4.2 The Hospital Anatomy 5

4.3 Patient Rooms - Adult 6

4.3.1 N u r s i n g Services 6

4 . 3 . 2 Routine Nursing 6

4 . 3 . 3 Observation of Patients 6

4 . 3 . 4 Night Lighting 7

4 . 3 . 5 Examination 7

4 . 3 . 6 Patient Use 7

4 . 3 . 7 Prívate or S i n g l e R o o m s 9

4 . 3 . 8 Multiple-Occupancy Rooms 9

4 . 3 . 9 Windows 9

4 . 3 . 1 O Housekeeping 1 O

4.4 N u r s i n g Stations 1 o
4.5 Critical Care Areas 11

4.6 Pediatric and Adolescent Wards 12

4. 7 Nurseries 13

4.8 Mental Health Facilities 14

4.9 S u r g i c a l H o l d i n g Areas 15

4.1 O Surgical l n d u c t i o n Room or Area 15

4.11 Surgical Suite 15

4.11.1 Operating Room 15

4 . 1 1 . 2 Operating Room S u i t e Corridors 22

4. 1 1 . 3 S c r u b Area 22

4 . 1 1 .4 Special Lighting far Photography and Television 22

4 . 1 1 .5 S u r g e o n H e a d l i g h t s 23

4 . 1 2 Specialized Operating Rooms 24

4.12.1 Eye Surgery 24

4 . 1 2 . 2 Ear, N o s e , and Throat Surgery 24

4 . 1 2 . 3 Neurosurgery 24

4 . 1 2 . 4 Orthopedic Sur ger y 24

4 . 1 2 . 5 Plastic Surgery · 24

4 . 1 3 Postanesthetic Recovery Room 24

4 . 1 4 Cystoscopy Room 25

4 . 1 5 Nonurology Endoscopy Rooms 25

A N S I / I E S N A RP-29-06

4 . 1 6 Obstetric Delivery Suite 26

4.16.1 B i rt h i n g Rooms ( L D R s or L D R P s ) 26

4 . 1 6 . 2 Labor Rooms 26

4 . 1 6 . 3 Delivery Area 27

4 . 1 6 . 4 Post-Delivery Recovery Area 28

4 . 1 7 R a d i o g r a p h i c Suite 28

4.17.1 General 28

4 . 1 7 .2 Diagnostic Section 28

4.17.2.1 Waiting Area 28

4 . 1 7 . 2 . 2 General Radiographic/Fluoroscopic Room 28

4 . 1 7 . 2 . 3 Viewing Rooms 29

4 . 1 7 . 2 . 4 F i l m Sort Area 29

4 . 1 7 . 2 . 5 Barium Kitchen 29

4 . 1 7 . 2 . 6 Dark Room 29

4 . 1 7 . 3 Radiation Therapy Section 29

4 . 1 7 . 4 Diagnostic l m a g i n g Techniques/Equipment 29

4 . 1 8 Dialysis U n i t 30

4 . 1 9 C l i n i c a l Laboratories 31

4.19.1 General 31

4 . 1 9 . 2 Laboratory Types 32

4.19.2.1 Chemistry Laboratory 32

4 . 1 9 . 2 . 2 Hematology/Serology Laboratory 32

4 . 1 9 . 2 . 3 U r i n o l o g y Laboratory 32

4 . 1 9 . 2 . 4 Toxicology Laboratory 32

4 . 1 9 . 2 . 5 Histology/Cytology Laboratory 32

4.20 Laboratory Support Areas 32

4.20.1 S p e c i m e n Collection (Venipuncture) and Donor Areas for the Blood Bank 32

4 . 2 0 . 2 Microscope Reading Room · 32

4 . 2 0 . 3 Blood Bank 32

4 . 2 0 . 4 Central Sterile S u p p l y 32

4.21 Cardiac and Pulmonary Function Laboratories 33

4.21.1 Cardiac Function Laboratory 33

4 . 2 1 . 2 Pulmonary Function Laboratory 33

4 . 2 1 .3 lnhalation Therapy Units 33

4.22 Dental Suites 33

4.23 Examination and Treatment Rooms 34

4.24 Emergency Suite 34

4.25 Fracture Room 34

4.26 Autopsy Suite 35

4.27 Physical Therapy Suites 35

4.28 Pharmacy 35

4.29 Medical lllustration Studio 36

4.30 Geriatric Facilities 36

4.31 Other Service and Business Areas 36

4.32 Emergency L i g h t i n g 36

4.33 L i g h t i n g for Safety 37

4.34 Ambulance Lighting '. . . 37

5.0 Criteria for Health Care Facility Lighting 37

5.1 General 37

5.2 L i g h t i n g Design Procedure 37

5.3 Design lssues 38

5 . 3 . 1 Appearance of Space and L u m i n a i r e s 38

5 . 3 . 2 C o l o r and Color-Rendering Capability of the l l l u rn i n a n c e 39

5 . 3 . 3 Daylighting 40

5 . 3 . 4 Direct Glare and Visual Comfort Probability .40

 - A N S I / I E S N A RP-29-06

5 . 3 . 5 Flicker and Strobe .40

5 . 3 . 6 Light Distrlbution on Surfaces .41

5 . 3 . 7 Light Distribution on the Task Plane (Uniformity) .41

5 . 3 . 8 L u m i n a n c e and L u m i n a n c e Ratios .41

5 . 3 . 9 M o d e l i n g of Faces and Objects .41

5 . 3 . 1 O Points of lnterest .41

5.3.11 Reflected Glare and Veiling Reflections .41

5 . 3 . 1 2 Shadows 42

5 . 3 . 1 3 Source/Task/Eye Geometry .42

5 . 3 . 1 4 Sparkle 42

5 . 3 . 1 5 Surface Characteristics .42

5.3.15.1 Surface Reflectance .42

5 . 3 . 1 5 . 2 Room Surface .42

5 . 3 . 1 5 . 3 Color of Surfaces .43

5 . 3 . 1 5 . 4 Equipment Finishes .43

5 . 3 . 1 6 System Control and Flexibility .43

5.4 l l l u m i n a n c e 43

5.4.1 General 43

5 . 4 . 2 l l l u m i n a n c e Selection for Interior Spaces .43

5 . 4 . 3 l l l u m i n a n c e for Tasks D u r i n g Emergencies .44

5 . 4 . 4 l l l u m i n a n c e for Safety .44

6.0 Lighting System Considerations .44

6.1 Energy Management .44

6.2 Electric Lighting 51

6.2.1 General 51

6 . 2 . 2 Light Sources 51

6.2.2.1 lncandescent Lighting 51

6 . 2 . 2 . 2 Fluorescent Lighting 52

6 . 2 . 2 . 3 H i g h lntensity Discharge ( H I D ) L i g h t i n g 52

6 . 2 . 2 . 4 Light Emitting Diodes ( L E D s ) 52

6 . 2 . 2 . 5 M i s c e l l a n e o u s Light Sources : 53

6 . 2 . 2 . 6 Light Source S u m m a r y 53

6 . 2 . 3 Luminaires 53

6.3 Acoustical and Thermal Factors 54

6.4 Monitoring the Lighting System 54

6.4.1 General 54

6 . 4 . 2 Test lnstrumentation 55

6.4.2.1 l l l u m i n a n c e Measurements 55

6 . 4 . 2 . 2 Operating Room Measurements 55

6 . 4 . 2 . 3 Apparent Color Temperature Measurements 55

6 . 4 . 2 . 4 Total lrradiance Measurements 55

6.5 Special Considerations 55

References 56

Annex A - Designing the L u m i n o u s Environment 58

Annex B - Fundamental Factors of Task Visibility 61

Annex C - Veiling Reflections 62

Annex D - Lighting System Characteristics 65

Annex E - Economics of Lighting Systems 67

Annex F - Lighting System Maintenance 70

Annex G - Fiber-Optic l l l u m i n a t i o n Tests 71

Annex H - Stereo-Surgical Microscope 72

Annex 1 - Glossary of Lighting Terms and Health Care (Hospital) Terms 73

 � A N S I / I E S N A RP-29-06

L i g h t i n g Far H o s p i t a l s and d e s i g n procedures i n c l u d i n g a table of recommend­

ed i l l u m i n a n c e categories for many common hospi­

H e a l t h Care F a c i l i t i e s
tal areas and activities.

S i n c e t h i s Practice may be read and used by n o n ­

PR EFA CE d e s i g n professionals, and by others u n f a m i l i a r with

the terminology or the physics of l i g h t i n g , a detailed

glossary is appended and sorne basic p r i n c i p i e s of

This Recommended Practice revises and replaces light production and control are covered in the

I E S N A RP-29-95, Lighting for Hospitals and Hea/th Annexes. For the lighting designer, there is also

Care Facilities, p u b l i s h e d i n 1 9 9 5 . Additional mater­ included an abbreviated glossary of hospital and

ial on t h i s topic can be found i n Chapter 1 6 of the medical terms.

1
IESNA Lighting Handbook, N i n t h E d i t i o n .

lt is hoped that this latest Practice will provide 2.0 TYPES OF FACILITIES

g u i d e l i n e s for good lighting, s t i m u l a t e the produc­

ers of l i g h t i n g e q u i p m e n t , and i n s p i r e the d e s i g n e r s

of l i g h t i n g systems so that the sick and infirm w i l l 2.1 General

have a more comfortable and enjoyable recovery

environment. Health care facilities usually include acute (and

chronic) care general hospitals, specialized chronic

The IESNA Committee for Health Care Facilities care institutions for the physically and mentally ill,

seeks to c o n t i n u a l l y improve t h i s Practice and wel­ and the extension of services into other facilities

comes suggestions. Previous publications issued w h i c h offer more professional care than is typically

by t h i s C om mit t ee had the benefit of i n p u t from the available at the patient s residence. The latter can

late Dr. W i l l i a m C . Beck. This u n i q u e medical prac­ serve as halfway stations between the hospital and

titioner also appreciated the art and science of light­ the home. Outpatient care delivery is a c o n t i n u i n g

ing. He applied his eftort and imagination to trend because halfway stations can now provide

improve hospital lighting. Much of Dr. Beck s many services once available o n l y i n extended stay

research r e m a i n s i n this edition of the Practice, with facilities.

new information provided by the Committee mem­

bers listed in the roster and by other IESNA In exercising good lighting practice, the designer

Committees. We cannot rest. We must c o n t i n u a l l y s h o u l d take into account the i m m e d i a t e objeotives,

seek ways to introduce new technology develop­ the services that m i g h t eventually be r e q u i r e d , and

ment and trends in a t i m e l y manner. the future trends of the health care arena. For exam­

ple, a facility d e s i g n e d to provide extended care i n

conjunction with an acute care hospital may find its

1 . 0 INTRODUCTION beds recertified for acute care. The reverse is also

true. Furthermore, once outside the institution, a f u l l

nursing oare unit may actas an intermediate oare unit

This Practice p r im a r i l y covers areas that are u n i q u e or even a custodia! u n i t in a residential e n v i r o n m e n t .

to l i g h t i n g health care facilities. The wide variety of

activities w i t h i n these facilities make it necessary to A g i n g eyes must be considered i n all common areas

describe the patient care they encompass, since of medical facilities because older people_ are often

l i g h t i n g needs w i l l vary. Sorne activities w i t h i n health employees, visitors, and volunteers. People over

care facilities are identical (or similar) to those in age 65 oonstitute better than 50 percent of the vol­

other institutions. I n these cases, references w i l l be unteer force h e l p i n g in medical facilities.ª Older peo­
31 32
made to other IESNA p u b u c at í o n s ." : • These ple s needs in specific patient care areas must be

include: the gift shop, library, kitchen, cafetería, considered, since the elderly are the heaviest users

business spaces, classrooms, workshops, parking of health service. On average, people over 65 visit a

facilities, grounds, and other specific functional physician seven times a y e a r , compared to less than

units. There will be sorne locations where recom­ tour visits by the general population. They spend

mendations overlap. For example, the patient room more than tour t i m e s l o n g e r in the hospital than the

may have similar lighting requirements to a hotel · y o u n g e r p o p u l a t i o n and the average stay is 40 per­
9
room when it is used for minimal-care patients. Yet cent longer. The l i g h t i n g d e s i g n e r s h o u l d know the

the l i g h t i n g must be considered differently when the age group served by each medical specialty and

aged, i n f i r m , or acutely sick are i n t h i s same patient address any appropriate age-related lighting require­

room. Refer to Section 5.0 tor criteria and lighting ments as described i n Section 3.2 and Section 4 . 3 0 .

1
A N S I / I E S N A RP-29-06

2.2 The Acute Care Hospital The need for dark fluoroscopic examination rooms

has almost disappeared s i n ce video equipment

Acute care hospital planning needs to consider all has replaced the fluorescent s c r e e n . Most exami­

the diverse l i g h t i n g d e s i g n requirements listed i n t h i s nations are now accomplished with normal room

Practice. The trend towards specialization, for illuminance.

example, means obstetric and pediatric services are

being allocated to certain hospitals and abandoned However, this makes careful luminaire selection

in others based on geographical population shifts. extremely important to control v e i l i n g reflections. An

This in turn w i l l result i n greater d e m a n d upon the individual control to optimize comfortable ambient

support facilities, particularly e n g i n e e r i n g , to provide l i g h t i n g for m u l t i p l e purposes, such as viewing LCDs

the optimum environment within each specialized and/or CRTs i n a common room, is also desired. A

unit. lt will also reduce the need for service f l e x i b i l i ­ fixed lighting system will not suit everyone. Sorne

ty. For instance, it is probable that a s m a l l hospital radiologists will prefer a dimmer room and other

that maintains a delivery room and newborn nursery staff a brighter o n e .

w i l l abandon t h i s u n i t and send patients to a larger

facility nearby. Or the s m a l l hospital m i gh t have a Diagnostic radiography is by no means the only

combination delivery room and operating room. department where radical changes are taking place.

Many deliveries are now taking place in birthing Almost every u n i t from the allergy laboratory to the

rooms, more popularly called Labor/Delivery/ xerography space is b e i n g reoriented visually. Once

Recovery rooms (LDRs) or Labor/Delivery/Recovery/ large multi-bed open wards were quite common.

Postpartum rooms ( L D R P s ) , that also require spe­ Now prívate or semi-prívate rooms are the norm.
1
cial considerations. º lntensive care areas once had multi-bed spaces

compartmentalized by c u rt a i n s . Today, semi-enclo­

However, with the evolving health care market, a sures with glass observation windows or cubicles

d e s i g n e r must take into account that areas o r i g i n a l ­ act as open bed bays from a central hall or work­

ly lighted for one specific task may eventually serve space. By federal/provincial guidelines, intensive

other needs. Building in adaptability can save care areas must afford the patient access to daylight

money i n the l o n g r u n . for orientation. G u i d e l i n e s also require that the head

of each patient bed be visible from the n u r s i n g sta­

Outpatient services are e x p a n d i n g . Thus outpatient tion necessitating the e l i m i n a t i o n of glare i n obser­

procedures often require the same quality and vation windows.

quantity of i l l u m i n a t i o n found in an acute care set­

t i n g . Al s o , many patient operations are now carried 2.3 The C h r o n i c Care Hospital

out in special ambulatory operating rooms with

associated recovery rooms. There are an íncreasing n u m b e r of facilities that pro­

vide long-term care for persons being managed

There is a trend toward relocating facilities, such as and/or weaned from ventilators. Lighting in these

laboratories, to freestanding office b u i l d i n g s designed types of facilities s h o u l d be s i m i l a r to that listed for

for physicians and dentists. These labs have the acute care hospitals. Facilities designed to treat

same special illuminance needs as labs located in patients that require institutionalizing (such as tuber­

hospital b u i l d i n g s . culosis, HIV/AIDS, SARS, and A l z h e i m e r s) s h o u l d

follow requirements similar to nursing homes.

There is also constant change and improvement i n Hospice facilities s h o u l d offer softer, more h o m e - l i k e

medical, surgical, and dental instrumentation. The illumination options.

computer and its application to patient diagnosis

can hardly be overemphasized. C o n s i d e r the impact 2.4 The Extended Care Facility

of magnetic resonance imaging (MRI), ultrasound,

computer assisted tomography (CAT), and the Extended care facilities are ge nera l l y designed to

changing nature of medica! equipment within serve a specific age g r o u p ranging from c h i l d r e n to

today s operating rooms. I n a d d i t i o n , all X-rays and the elderly and present the g r ou p b e i n g served with

m e d i c a l i m a g i n g may be distributed via computer for a home-like environment. Typically, young adults

evaluation/review purposes and shared with other are combined with o l d e r adults in the same extend­

caregivers. There w i l l always be a c o n t i n u u m of new ed care facility. For facilities that serve children,

concepts in medical products and processes. refer to Section 4.6 (pediatrics) and for those that

Expense may limit these new practices to certain serve older adults refer to Section 4.30 (geriatric

hospitals w h i l e other facilities w i l l rely on strategic facilities), and see Recommended Practíce on

alliances and share resources u n ti l usage brings Líghting and the Visual Emiironment for Senior
11
costs d o w n . Living, A N S I / I E S N A R P - 2 8 - 9 8 .

2
 ANSI/ IESNA RP-29-06

2.5 Other Facilities pupil d ilation o r recoverin g from eye surgery w i l l not

b e comfortable in the same i l l u m i n a n c e as a college

Freestanding ambulatory surgical centers, emer­ student with sports in j uries t ry ing to read.

gency centers, medica! office b u i l d i n g s , and c l i n i c s

deserve consideration because they form an appre­ llluminance in m ulti - bed rooms should be unobtru­

c i a b l e , growing part of the health care delivery sys­ sive to one room m ate w h i l e r e m a i n i n g ade q uate for

tem. Here the lighting tasks range from simple the other . L ight that enables a medically - trained

examinations through majar surgery. Every physi­ observer to disco v er color nuances must not pro­

cian s office suite s h o u l d contain l i g h t i n g e q u i p m e n t duce discomforting glare, or overexpose the

(or accommodation far portable e q u i p m e n t ) that w i l l patient s retina. T here i s , therefore, the dichotomy of

provide that physician with the quantity, quality, and trying to provide comfortable h o m e - l i k e atmosphere

directionality needed to perform all functions with right where patients must undergo treatment requir­

ease. General office space, when converted to med­ ing much different l i g h t i n g .

ica! use, often needs i l l u m i n a t i o n adapted both for

patient comfort and for the performance of complex The modern concept of a rn b u l a t l o n keeps many

medical tasks. lllumination of the function of the patients out of bed most of the day. Theretore, it is

space or the task to be performed needs to be con­ probable that o n l y 20 percent of the patients in the

sidered as detailed i n this document (rather than the average hos p ital w i l l be totally b e d r i d d e n . The rest

type of construction the facility is located i n ) . will b e up , and many w i l l avail themselves of the

public lounges. Here television , the universal anti­

dote to boredom, creates o n g o i n g challenges for the

3.0 L I G H T I N G OBJECTIVES l i g h t i n g designer. The general l i g h t i n g must not p ro­

duce glare on the television s screen for patients no

longer viewin g it from bed. L i g h t i n g also s h o u l d be

3.1 General flexi b le e n o u g h for the growing n u m b e r of com p uter

users wanting a comfortable v i ew of t h e i r di s play

Research in lighting concepts has i n c r ea s e d screens w h i l e in the hospital.

k n ow le dge about v i s u a l requirements, resulting in

new solutions to lighting problems. lndustry has S ince lounges and corridors also serve as visiting

provided new equipment for producing light and . areas, good l i g h t i n g i n these areas can create cen­

modifying its quality with continuad concern for ters of visual interest. ( S ee Figure 1.) P ost - occu­

energy conservation. pancy evaluations reveal that subtle colored light

and art displays have great pot e ntial fa r meeting

There are also new medical t e c h n i q u e s that have patient needs by reducing the hospital s institutional

created fresh challenges for the lighting designer; atmosphere.

for example, continuous patient observation in

intensive care unit s containing monitoring equip­ M any patients are apprehensive and vul n er a ble

ment. Visual and auditory s u rv e i l l a n c e must be con­ when hospitali z ed ; therefore, the decor and l i g h t i n g

stant, yet the i l l u m i n a n c e must be both unobtrusive s h o u l d be soothing and relaxing. I n hospital rooms,

and sufficient so the observer w i l l not become v i s u ­ w here patients may lon g be b e d r i d d e n , s i m p l e de c ­

a l l y fatigued. orating patterns, flat c e i l i n g s , and u n c h a n g i n g light­

i n g can become very b o r i n g . P rovide the patient with

The d e s i g n e r must have an appreciation for patient means to m odify or a d j ust t h e i r l i g h t i n g .

needs. I n addition to v i s u a l comfort and ability to see

tasks, other important aspects of l i g h t i n g s h o u l d be L ast, but far from least, energy expenditure must be

considered such as l i g h t i n g for the h u m a n b i o l o g i c a l considered in satisfying lighting ob j ectives . For a di s ­

clock (circadian system) and l i g h t i n g for the special cussion of energy management, see Section 6 . 1 .

needs of the elderly. (See Section 6 . 5 . )

3.2 Lighting of the Visual Environment

Although l i g h t i n g s h o u l d serve the d e m a n d s of the

medica! staff, it should also permit patient/visitor F irst consideration should be given to the ligh t in g

comfort. The patient must feel at ease and involved needed to pe rf orm specific tasks in a given area .

in the healing process prompted through positive Then the general surrounding illuminance can be

• · sensory s t i m u l a t i o n . Patients feel comtortab l e when related to the task ill u m i n a n c e . As a general prin c i ­

they can control the l i g h t i n g in the s pace and partic­ pie , the patient a n d staff should be able to control t h e

ipate i n d e f i n i n g t h e i r own le v el of p ersonal privacy. lighting to provide an environment that soothes the

D ifferent problems or tasks have di ff erent illumi­ patient and provides good visibilit y to the caregi v er .

nance needs . S omeone w i th light sensitivity from I n providing both task and g eneral l i g h t i n g , the l u m i -

3
A N S I / I E S N A RP-29-06

Figure 1 . A relaxing

mix of indirect

l i g h t i n g for glare

control, direct

downlights, and

filtered daylight

provide a pleasant

environment in this

waiting room. A

variety of lighting

controls enables the

room atmosphere to

change with the

time of day. lndirect

lighting i n the

adjacent corridor

also creates a

welcome entry into

this space.

nance of room surfaces should be controlled. For Older eyes exhibit increased sensitivity to glare,

example, luminance differences experienced when adapt much more slowly to changes i n l i g h t (bright­

looking away from the surgical field to the surround ness) levels, lose contrast sensitivity, and require

and back should not impose eye adaptations that higher illuminance levels than young eyes.

affect the surgeon s task performance. Luminance Particular attention s h o u l d be paid to the e l i m i n a t i n g

ratio limitations are discussed in Section 5 . 3 . 8 . 1 . harsh shadows, visual clutter, reflected and direct

g l a r e , and lamp flicker i n a l l facilities used by o l d e r

Techniques of l i g h t i n g the visual environment need adults. Every room or space with h i g h e r l i g h t levels

to be p l a n n e d in concert with the interior designer. for the aged s h o u l d feature ambient or general i l l u ­

The s he e n or gloss of surfaces, the color and minance, preferably u s i n g indirect l i g h t i n g , in addi­

reflectance of interior f i n i s h e s all affect luminance tion to task lighting. Wall and floor areas must be

ratios, light utilization, and space appearance. evenly i l l u m i n a t e d to m a x i m i z e the f u n c t i o n i n g of the

Ceilings, walls, and floors reflect a part of the inci­ o l d e r p e o p l e . Pools of l i g h t on glossy floors or scal­

dent l i g h t , and are an integral part of the l i g h t i n g sys­ loped l i g h t patterns on walls s h o u l d be avoided. For

tem. Som et imes this is forgotten, and a high­ a more in-depth description of proper lighting for
11
reflectance wall is repainted wlth a dark or low­ o l d e r adults see A N S I / I E S N A R P - 2 8 - 9 8 . Contrast

reflectance color. The result is a room that seems within the visual environment; especially on stairs,

m u c h darker and subjects the occupants to uncom­ at level changes, and along wall bases should be

fortably high contrasts. Recommended reflectance provided to compensate for contrast sensitivity loss

v a l u e s are g iv en i n Section 5 . 3 . 1 5 . 1 a n d , for specif­ experienced by older adults. (See Section 4.31 and

ic areas, i n Section 4.0. Section 4 . 3 3 . )

I n recent years there has been a concerted attempt Means for maintaining lighting during utifity power

to avoid clinical antiseptic coldness in hospitals. i n t e r r up t i o n s must also be provided for all areas

Sensory experiences such as art, gardens, and where safety might be compromised by darkness

nature views have been integrated into the architec­ (e.g., surgical/obstetrical, communications, and

ture to add a "quality" atmosphere. Bold color ( h i g h ­ transport). NFPA 70 refers to this l i g h t i n g as b e i n g

chroma) has replaced the bland or neutral only. on the Critica! Branch and differentiates it from the

Sm a ll h i g h - l u m i n a n c e areas can provide brightness Lite Safety Branch which is for the exit l i g h t i n g (sig­

perception and may compensate for less actual i l l u ­ nage and identification of egress paths) to e n s u r e

mi nance. lf surface colors of reduced reflectance are safe and speedy evacuation. Sorne autnorltles now ·

used, then increased i l l u m i n a n c e directed toward the require the submission of egress lighting calcula­

low reflectance surfaces may be r e q u i r e d . tions to confirm adequate i l l u m i n a n c e .

4
 A N S I / I E S N A RP-29-06

3.3 Task Lighting 4.0 L I G H T I N G D E S I G N CONSIDERATIONS

Lighting far task performance depends upan the

importance and delicacy of the particular task. 4.1 General

Where surgical procedures are p e rf o r m e d , the tasks

are the focal point, with less e m p h a s i s on the sur­ Lighting system design for new or renovated health

round. However, consideration of background l i g h t ­ care facilities should give consideration to the occu­

i n g far the peripheral visual field is advisable, and it pants needs, the visual tasks to be performed, the

h e l p s with task performance. Both the t i m e allowed desired appearance of that space (see Annex A),

and the accuracy required must not fatigue the per­ infection control, and energy/economic constraints.

son performing the task. (See Section 5 . 4 . ) The recommendations in this section have been

established based upon the best available e q u i p m e n t

Seeing is a dynamic activity. Eyes do not remain for visual effectiveness. Since e q u i p m e n t constantly

fixed upan a point, but move to all parts of the task changes, there is always a need for further research.

(and beyond). Most tasks do not occupy more than

1 5 percent of the visual field. For this reason, it has The patients treated in diagnostic and therapeutic

been suggested that where task i l l u m i n a n c e levels facilities and the medica! personnel working on them

are high, as in surgery, consideration be given to encompass a wide variety of ages. Consequently

three l i g h t i n g zones - the highest l i g h t level for the the l i g h t i n g s h o u l d be sufficiently f l e x i b l e , such that

operative f i e l d , a second and lower level for the sur­ l i g h t levels and a i m i n g orientations are adequate far

r o u n d i n g table, and a third (peripheral) level grazing all. Good color rendering is an obvious need i n the
10
the w a l l s . However, it is important not to exceed a hospital s task-related areas. Here, various experi­

3:1 luminance ratio between the task area and its ments involving clinical judgment have been con­

immediate s u r r o u n d , and 1 0 : 1 between the task and d u c t e d . " The medical staff may prefer a color tem­

the background, to prevent visual fatigue. Higher perature range that differers from what the patients

luminance ratios cannot be tolerated because dis­ may prefer. (See Section 5 . 3 . 2 . ) lt is recommended

ability g l a r e and increased transient adaptation t i m e that color temperature and color rendering remain

then become distinct p o s s i b i l i t i e s . consistent in all adjacent spaces used to evaluate

the same patient, such as surgical rooms and hold­

Exceptions to the balance of task and general sur­ ing/recovery areas. For a detailed d i s c u s s i o n of the

round l i g h t i n g are called the "spotlight" effect (from i l l u m i n a n c e selection procedure far interior hospital

its theatrical counterpart). This technique is espe­ spaces, (See Section 5 . 4 . 2 . ) Give consideration for

cially useful when endoscopio equipment is used, h i g h color rendering i n d e x ( C R I 85 to 90+) whenev­

such as in a cystoscopic room. This room is u s u a l l y er this characteristic is rated "very important." Also,

kept at a very low level of general i l l u m i n a n c e with a color as part of the work area decor s h o u l d not be

task l i g h t o n l y far the introduction of the endoscope. neglected because reflected light will take on the

This requires d i m m i n g both the general i l l u m i n a n c e h u e of nearby s u r r o u n d i n g surfaces. Task l i g h t s pro­

and the main task lamps, and (usually) the endo­ v i d i n g warm colors used i n lower portions of a room

scopic lamp (typically a fiber optic b u n d l e ) . As more are better far rendering flesh tones; cooler {blue)

endoscopic surgeons view t h e i r task on a video dis­ colors far u p p e r room surfaces, i n c l u d i n g the c e i l i n g ,

play (rather than through an eyepiece), general provide a good color mix with daylight and help

room illuminance may be increased provided the make the space appear livelier.

patient s comfort and privacy are considered and

glare does not appear on the video display. llluminance calculation accuracy is discussed in
1
Chapter 9 of the /ESNA Lighting Handbook. To

The theory that there can never be too m u c h l i g h t is account for uncertainty in both photometric mea­

just not t r u e . Caregiver and patient comfort must be surements and space surface reflections, measured

considered when setting i l l u m i n a n c e levels for task i l l u m i n a n c e s h o u l d be w i t h i n ±1 O percent of the rec­

l i g h t i n g . A l t h o u g h a very h i g h i l l u m i n a n c e capability ommended value. Note, however, that the design

may be needed far sorne tasks, too much l i g h t can illuminance may deviate from these recommended

make the patient, staff, and surgeon very uncom­ values d u e to other l i g h t i n g d e s i g n criteria.

fortable. Adjustable lighting can increase comfort.

Operating microscope manufacturers understand 4.2 The Hospital Anatomy

this problem and will restrict the light source type

and intensity, depending upon the microscope s A hospital is a very c o m p l e x , task-intensive institu­

i n t e n d e d use. (See Annex H ) . tion. The patient is best served by subdued and

unobtrusive l i g h t , w h i l e the medical staff needs varied

i l l u m i n a n c e levels. T h u s l i g h t i n g f l e x i b i l i t y is critical,

5
A N S I / I E S N A RP-29-06

l nv o lv i n g the family in the patient s h e a l i n g process The design of l i g h t i n g for t h i s use s h o u l d emphasize

is important. The functions of the patient, the family, the needs of the patient One or more l u m i n a i r e s i n

and the professional staff must be given proper con­ a s i n g l e - a r multiple-occupancy room may be need­

sideratíon. Sorne of the visual tasks in a patient ed to provide general i l l u m i n a t i o n . A patient lying in

room are s i m i l a r to those at h o m e . Yet the staff must the prone position on the bed is exposed to the lumi­

often accomplish meticulous and complex visual nance of l u m i n a i r e s in the c e i l i n g i n t h e i r direct l i n e

activities far physically and/or emotionally impaired of sight. C o n t i n u o u s exposure to the l u m i n a n c e can

patients. become uncomfartable. Thus, it is suggested that

l u m i n a i r e s for general l i g h t i n g be provided with con­

Fortunately, sorne hospital areas are designated far trols that allow the patient or the staff to modify the

specific activities and, for these, qualitative and l u m i n a n c e of sources in the line of sight. lndirect light­

quantitative definitions of l i g h t i n g requirements can i n g is also often a successful s o l u t i o n to this i s s u e .

be suggested. The relativa size of the various areas

will vary from facility to facility. The American However, it is not suggested that l i m i t i n g l u m i n a n c e

lnstitute of Architects (AIA) and the Facility is the only important objective. Far a pleasant visu­

G u i d e l i n e s lnstitute has introduced its Guidelines for al environment, it is also important to provide for

Design and Construction of Hospital and Health brightness perception. For example, indirect l i g h t i n g
13
Care Facilíties. This publication is considered an may be supplemented by l u m i n a i r e s providing sub­

industry standard by architects, engineers, interior tle brightness to the room. When the patient is relax­

designers, and health care professionals that rec­ i n g , this kind of patterned l i g h t or brightness m o d u ­

o m m e n d program, space, and e q u i p m e n t needs far lation may be satisfying.

clinical s u p p o rt areas.

L i g h t í n g controls s h o u l d be located far the patient as

4.3 Patient Roohls - Adult well as the nursing staff. Dimmers or m u l t i p l e - l i g h t

level switching controls positioned at the door of the

The patient room l i g h t i n g d e s i g n must reconcile rn u l ­ patients rooms are suggested to allow creation of a

tiple lighting needs as s i m p l y and economically as comfortable lighting environment tailored for the

p o s si b le. The patient, the patient s family, doctor, patient. Additional control at the patient bed is rec­

nurse, and housekeeping personnel may each ommended so that calls for nursing assistance

require different illuminance levels. The range of might be reduced. Nurses should never have to

lighting needed far a variety of nursing services search far light to read charts and instruments.

should be provided in a way that is not objectionable Lights used for c h a rt i n g purposes s h o u l d be select­

to other patients i n the same room. Lighting design ed and/or located so that they do not dlsturb the

d e c i sio n s s h o u l d cater particularly to patients whose patient at n i g h t . The use of narrow beam sources is

o n l y field of view may be the c e i l i n g . suggested.

4.3.1 Nursing Services. Lighting far nursing ser­ Perception of color is also important far the visual

vices and critica! examinations is common to nearly comfort of the patient and staff. lf fluorescent la m p s

all hospitals. Patient comfort needs may vary great­ are used for the general l i g h t i n g of the patient room,

ly d u r i n g convalescence d e p e n d i n g u p o n each i n d i ­ they s h o u l d have a h i g h color rendering i n d e x ( C R I ) .

vidual s health and mobility, the type of services

s u p p l i e d by the hospital, whether the room is far sin­ 4.3.3 Observation of Patients. Local low-level i l l u ­

g l e or multiple-occupancy, and whether the hospital minance used during the night is needed. There

is p u b l i c or private. should be l i g h t i n g at each bed and its floor area so

that the nurse may frequently (and unobtrusively)

4.3.2 Routine Nursing. During the course of a observe the patient and any associated e q u i p m e n t .

patient s stay, many routine tasks are performed by This light should be switched at the door or con­

the staff, such as recording the patient s vital s i g n s , trolled by a d i m m e r . The l i g h t i n g s h o u l d have color

administering medications, or providing meals, to quality that properly reveals the patient s appear­

name a few. When the patient is awake, this is the ance. When observation l i g h t i n g must be left on all

most common activity in the room, along with the . n i g h t in shared rooms, or when h i g h e r i l l u m i n a n c e s

patient watching TV or visiting with guests. These are needed, temporary screening between patients

tasks are typically not visually d e m a n d i n g . However, may be necessary.

this state is the one in which the patient spends

most of t h e i r wakeful t i m e , and is important far the There is a potential conflict between the l i g h t n e e d­

impression of comfart far the patient from a visual ed for observation by the nursing staff and the

standpoint. patient s need for darkness at night to accommo-

 A N S I / I E S N A RP-29-06

date s l e e p . Rooms with more than o n e patient are Sorne patient rooms may be e q u i p p e d with exami­

the most problematic. The lighting designer and nation/treatment task l i g h t i n g for use in performing

client should discuss and resolve this conflict minor medical procedures ar examining wounds.

together. This is also an opportunity for the l i g h t i n g Special-use examination/treatment task lights are

d e s i g n a r to educate the client about the biological defined as those l u m i n a i r e s used for m i n a r medical

effects of l i g h t . (See Section 4.3.4.) procedures performed outside the operating room

( e . g . , tissue examination and suture removal).

4.3.4 Night L i g h t i n g . Patient roorns s h o u l d be dark

at n i g h t to provide the o p t i m u m sleep environment. Speciaí-use examination/treatment lighting equip­

Yet hospital staff needs to see objects w h e n enter­ ment varies from floor-mounted "gooseneck" lamps

ing and moving through the patient rooms. to c e i l i n g - m o u n t e d l u m i n a i r e s s i m i l a r to those i n an

Research suggests that the part of the eye respon­ operating room. The following criteria should be

sible for receiving and transmitting information to the considered when selecting these l u m i n a i r e s :

circadian system (keeps a person s sleep/activity

cycle synchronized with the normal night/day cycle) D i s te n c e : l l l u m i n a n c e s h o u l d be adequate at: ( 1 ) a

14
is most sensitive in the blue/green range. This distance of 1 0 7 m m (42 i n . ) or (2) the distance from

i m p l i e s that night-lights should be red-amber. The the l u m i n a i r e to the patient area being e x a m i n e d . I n

common recommended night-light is a flush wall­ treatment rooms, the focal length of the luminaire

mounted low-brightness l u m i n a i r e installed between should be compatible with the task proximity, typi­

305 and 457 mm (12-18 in.) above the floor. cally 60 to 9 1 cm (24 to 36 i n . ) .

l l l u m i n a n c e on the floor is desirable for staff entering

the room from a well-lighted corridor. These features Radíatíon: Far patient safety and comfort, the l u rn i ­

are obtainable from a well-designed l u m i n a i r e . naire should be designed to control radiated heat.
2
No more than O . O S O watts/cm should be produced

Prívate Rooms: Wall-bracket combination lighting at the focal length of the l u m i n a i r e .

units frequently incorporate a n i g h t - l i g h t and w i l l pro­

vide enough l i g h t for the patient to see objects or Color Rendítion: For good rendition of skin and tis­

administer self-care. A dimmer or switch located s u e , a source with adequate spectral power in each

within easy reach of the patient s h o u l d control this of the key portions of the visual spectrum ( corre­

l i g h t . A recent trend permits f u l l control of all room s p o n d i n g to the C I E Standard Observer) s h o u l d be

l i g h t i n g and window treatments from the patient bed u s e d . Sources with a Correlated Color Ternperature

to h e l p l i m i t n u r s i n g calls about room comfort. (CCT) greater than 3000 K and a Color R e n d e r i n g

lndex (CRI) of 80 or higher will generally provide

Shared R o o m s : lt is difficult to provide n i g h t l i g h t i n g satisfactory results.

--....
for an individual patient in a shared room without

awakening other patients. Location, control, and the Mobílíty: The lighting should move freely and be

field of i l l u m i n a n c e s h o u l d be carefully considered i n easily positioned with one h a n d . M o u n t i n g s h o u l d be

these applications. such that once the luminaire is positioned; it will

remain i n place without d r i f ti n g . Adjustments s h o u l d

4.3.5 Examination. Lighting far e x a m i n i n g patients - require no more than five pounds of force by the

in t h ei r rooms s h o u l d be as shadow-free as practi­ u ser.

cable and have a color quality that aids diagnostic

screening so that that careful inspection of a l l tissue Safety: Safety of the user and patient should be

surfaces and cavities may be conducted. Curtains addressed by c o n s i d e r i n g (a) l u m i n a i r e surface tem­

can protect others i n the room from the examination perature, (b) potential tipping-hazard, (e) durability,

light. Whether fixed or portable, the examination and ( d) electrical safety.

l i g h t i n g s h o u l d be confined to the bed area and con­

t r oll ab le by the n u r s i n g staff. Flexíbílity: L u m i n a i r e selection s h o u l d consider that

the function of the space will probably change.

When the patient is b e i n g examined, the uniformity When a new task must be addressed, the l u m i n a i r e

and level of i l l u m i n a n c e are important. For uniformi­ may need to be replaced.

ty of the examination l i g h t i n g , it is recommended that

the ratio of maximum to m í n i m u m i l l u m i n a n c e levels, 4.3.6 Patient Use. The room l i g h t i n g s h o u l d accom­

as measured on a horizontal plane 76 cm (30 in.) modate reading at the normal reading position ( i . e . ,

above the floor, not be greater than 5 : 1 . The míni­ patient sitting u p i n b e d ) , assumed to be about 1 2 0

m u m level is defined as the lowest i l l u m i n a n c e meter cm (47 i n . ) above the floor. Allowing the patient free­

reading i n a circle of 2 . 4 m (8 ft . ) radius centered on dom to turn i n bed without leaving the reading l i g h t

the measured point of maximum i l l u m i n a n c e . zone means the reading plane area should be at

7
 ' A N S I / I E S N A RP-29-06

Figure 3.

Private

patient room

for s i n g l e

occupancy.

patient control and m i n i m u m l i g h t trespass between fewer nuisances with end-to-end bed arrangements.

patient beds, so that annoyance to the other Built-in limitations are needed so patients can t

patient(s) is m i n i m i z e d . move adjustable lamps to positions that offend oth­

ers. Alternatively, louvers, barn doors, or other

lt is recommended that fluorescent luminaires in devices may be used far glare control. (Mechanical

patient areas use h i g h frequency electronic ballasts limitations are more dependable than thoughtful­

to minimize noise and flicker. However, ballast ness.) Bed placement and drawn curtains may

selection must also anticípate possible radio fre­ affect general, night, and observation lighting.

quency interference p r o b l e m s , e s p e c i a l l y those that M u l t i p l e l i g h t sources are u s u a l l y required.

could arise in older facilities where the wiring

i n c l u d e s c o m m o n neutral conductors. 4.3.9 Windows. Windows are an important light

source for patient orientation, for connection to the

4.3. 7 Private or S i n g l e Rooms. The prívate h o s p i ­ natural world, and far relief from boredom. The n e g ­

tal room may have the aura of a h o me or hotel bed­ atives can include loss of privacy, heat gain, and

room, yet it must accommodate a multitude of med­ unwanted g l a r e . Therefore, l i g h t control far windows

ica! tasks. (See Figure 3 . ) Practically any lam p can is e s s e n t i a l . Often an opportunity exists to employ

s i m u l a t e a home e n v i r o n m e n t if the l i g h t level pro­ decorative colored fabrics and to design far visual

vided falls w i t h i n recommended limitations and does relief. One fabric layer should control glare while

not interfere w it h routine nursing services. allowing visibility of the outdoors; another layer

Luminance l i m i t a t i o n s are s i m p l i f i e d when just one might restare privacy from the o utsi d e and protect

patient is in the room. However, if the hospital s against nocturnal l i g h t trespass. Most m edi c al facili­

needs c han ge , prívate rooms may be adapted far ties l i g h t the g r o u n d s at n i g h t . When thi s l i g h t enters

two or more patients. thro ug h a window, the patient s sleep is d i s t u r b e d .

The preferred solution involves blinds controlled

4.3.8 Multiple-Occupancy Rooms. Patient-roorn from the patient s bed.

l i g h t i n g becomes more complex w h e n the n u m b e r of

occupants increases. Each patient s lamp becomes The physical bed/window relationship is also impor­

a potential source of irritation, especially l u m i n a i r e s tant. To prevent discomfort from glare (excessive

that patients can adjust or rotate, potentially e x p o s - . brightness), windows without controls s h o u l d be to

ing the lamp. Bed placement can also be critical, one side (or b e h i n d ) patients - not directly i n front

Wall-mounted l u m i n a i r e s that provide i n d i r e c t gen­ of t h e m . Sorne hospitals provide each patient with

eral lighting are very suitable for side-by-side bed control buttons that operate motor-driven window

placement. (See Figure 4 . ) Floor lamps may create treatments.

9
A N S I / I E S N A RP-29-06

o 1 2 3 4 5 6

1 1 Jao .
, .. - - - - 3 (!] ( 1 • X 3 ' ) � FLOOR

l 6Ql (2' X 3')

FLAT B E D R E A D I N G C O N F I G U R A T I O N

1' x 3' R E A D I N G P L A N E
45°

1 •

1 1

SLANTED BED READING CONFIGURATION

Figure 2. Reading configurations far a flat bed and slanted mattress.

Be careful to consider possible resultant shadows or reflective glare

when the bed is elevated.

2
least 0.3 m (3 ft.2). For a nonadjustable lighting or has been elevated to a sitting position, the light­

arrangement, this area should be approximately 0.7 ed area might become the back of the patient s

2 2
m (6 ft . ). Light levels at the outer edge of each area head. This problem is further complicated by

should be at least two-thirds of the center area level adjustable beds. (See Figure 2.) Wall-mounted

for reasonable uniformity. For the c o m f o rt of patients luminaires with extension arms can help, but

who read while in their bed, the ceiling luminance patients may inappropriately use them as handholds.

should be such that there is minimal contrast Floor and table luminaires should likely be limited to

between the reading matter and the background. prívate-room use. They can help provide residential

ambiance in patient rooms, however their use is

The peculiarities of specific luminaires, from wall cautioned that they not interfere with housekeeping.

units to floor stands, should be recognized for

patient room lighting. S o rn e can provide both gener­ The more patients in a room, the less lighting con­

al illuminance artd readinq light. There are also trol is practica! to aftord to any one of them. Only in

mechanically-adjustable luminaires that attach to private rooms are there few such limitations.

the bed. Wall-mounted luminaires light a relatively Otherwise patient control of lighting far reading, vis­

small area when adjusted far reading in a prone iting, self-care, or viewing television is often limited.

position. When the bed is moved out from the wall The design should seek a proper balance between

o
A N S I / I E S N A RP-29-06

Figure 4. Patlent

room for m u l t i p l e

occupancy.

Separate wall­

mounted luminaires

provide task and

ambient light with

individual control

for each patient.

1
Figure 5. lndirect

i l l u m i n a t i o n at this

nurse station

provides low glare

l i g h t i n g for use of

computers w h i l e

creating a pleasant

working environment

and i l l u m i n a t i o n for

the corridor as well.

Adding some direct

l i g ht w i l l provide

additional task

l i g h t i n g to an indirect

lighting approach.

4. 3. 1 O Housekeeping. Housekeepers need o b l i q u e ing, writing, filing, monitoring, intercommunication,

l i g h t i n g ( l i g h t grazing, rather than falling perpendicu­ medication, and many other patient-related func­

lar) over horizontal surfaces to observe dust and t i o n s take place. Patient data entry and charting into

dirt. Sufficient light levels must also be available a computer means that low glare i l l u m i n a n c e s h o u l d

because d i rt may exhibit lbw contrast relative to the be considered to reduce reflections from the com­
4
surface b e i n g cleaned. puter s monitor screen. Also, account for the

reflectance of the surrounding surfaces and locate

4.4 N u r s i n g Stations luminaires outside the offending zone. (Light, if it

originates in this z o n e , reflects off the task and into

I n most hospitals patient care areas are coordinated the viewer s eyes as g l a r e . Glare is defined by tour

trom a n u r s i n g station. (See Figure 5 . ) H e r e , read- factors: size of the luminaire s luminous area, the
 •
' ANSI/ IESNA RP-29-06

is i m p o rt a n t . Eye adaptation events can be mini ­

mi zed by balancing near - and far -field illum inance

levels. Also, so rn e i l l u m i n a n c e at th e nursing station

must be connected to emer gency or au xilíary power.

Near the nursing station are o ff i c e s , utility rooms ,

medication stations , storage rooms , kitchens and/or

coffee rooms , and au xili a r y facilities. AII these areas

n eed transitional lighting so there are n o dark o r

bri ght spots ad j acent to dimmed areas. T he me d­

ication area re quires increased illuminance and

g ood color rendítlon for proper drug inspecti o n . This

may best be achieved with dedicated , supplemental

tas k light ing. Most medicatio n areas have two light ­

ing levels , one for general work and one f ar med ­

ication preparation . The med ication area is a good

candidate f ar an energy -saving motion sensor .

l m p o rt a n t here too is gla re control for accurate labe l

read íng. T ask lighting integral to mobile dispens ing

ca rts may be desired to insure adequate illumination

for accuracy.

Other utility areas will re quire ce íling lig hting and

task lighting under the cabinetr y in arder t o provide

ad equate illumination.

Figure 6. Nursing station in a pre-op area with indirect

l i g h t i n g , direct l i g h t i n g , and daylight. Make sure the

4.5 Critic a ! C are Areas
under-counter lighting does not physically interfere

with the computer monitor, and is positioned so that

its reflection is not seen on the screen. The term "critica! care area" as used in this

Practice includ es all units des ígned for specia lized

duty and intended f ar ex t r e m e l y ill patients. This

luminance, the geometrical configuration or the includes lntensive Care Units, Bum Care Units, a nd

location of the luminaire, and the contrast between Coro nary Care Units. Critica ! care areas may be

its luminance and the background luminance.) highly speciali zed or quite fle xible. In isolation

rooms and burn care rooms , ceiling -mounted heat ­

The nursing station is used continuously night and ing and ventilation e quipment provides spot heating ,

day. Full attention should be given to day-time light­ positive pressure areas, or negative pressure areas .

ing, night-time lighting, and coordination with the Coordination o f the lighting with the mechanical sys ­

adjacent corridor lighting such that continuous reti­ tems is i m p o rt a n t . Critica! care area s have an

na! re-adaptation for those walking to and from cor­ increasing dependency on monitoring and l i f e - s up­

ridors is prevented. (See Figure 6.) Full regard po rt systems that occupy most of the w a l l space in

should be given to the special needs of night s h i ft the head wall area . There may be a re q u i r e m e n t fa r

nurses. A lighting solution should be provided that increased space around the bed unit should the

addresses circadian rhythms yet encourages high trauma team be needed. AII these space limitations

a l e rt n e s s during overnight work hours. must be considered during the lighting design . (See

Figure 7 . )

Careful luminaíre placement is important. The nurs­

ing station luminaires must not create glare for A source wíth good color rendering properties will

patients or nursing staff, nor produce reflections in enable the medica ! staff to accurately note changes

the PC monitor screens. Far detailed information on in s kin color and pall ar.

lighting for workspaces with visual display terminals,

see American Natíona/ Standard Practice far Office Although visual task demands in critica ! care area s
4
Lighting, ANSI/IESNA RP-1-04. may be great, the patient s psyche m ust also be

carefully considered. For e xample, use of str ategi­

Since the nursing staff makes frequent trips from cally placed windows not only hel p the patients to be

their station to the patients rooms, lighting level aware of the outdoor env ironment, but a sol ser ves

transitions from the station to a hospital corridor to é o m p l y with building codes that req u i r e w i n d o w s

must be fully coordinated under both day and night in such facilit es. i

condltions, Multiple switching or dimming capability

1 1
ANSI/ I E S N A RP-29-06

Figure 7. Sorne

lntensive Care

Unit ( I C U ) rooms

keep the

headwall clear

for trauma teams

rather than

placing the bed

tight to the wall.

The lighting i n critica! care areas must serve m u l t i ­ allows the same facility ( 1 ) to h a n d l e extremely crit­

ple tasks and permit flexible .arrangements. Patient­ ica! patients requiring dedicated nursing attention;

controlled i l l u m i n a n c e s h o u l d work far prone and/or (2) to oversee intensive-care patients whose needs

sitting positions and not s u b m i t the patient to unrea­ allow one nurse to attend severa! i n d i v i d u a l s ; or (3)

sonable g l a r e . to operate as a step down facility with f u rt h e r

decreased nursing attentlon. AII these options are

I n addition to patient-controlled l i g h t i n g there s h o u l d available witnout moving the patients.

be a m bi e n t lighting, medical examination lighting,

and a surgical procedure task l i g h t . C o m b i n e d u n i t s 4.6 Pediatric and Adolescent Wards

or separate l u m i n a i r e s can satisfy each r e q u i r e m e n t .

Many patients are overwhelmed by a large hospital,

I n d i v i d u a l rooms in critica! care units u s u a l l y contain children often being the most affected. Therefore,

a washing area, which should be ílluminated in the c h i l d r e n s ward should have ample space with

accordance with the i l l u m i n a n c e selection methods carefully p l a n n ed lighting for diversion and educa­

presented i n Section 5.4.2. S i n c e the patient area is tional projects. lt is very important far little patients

u s u a l l y f u l l y v i s i b l e from the n u r s i n g station, patient to have a stimulating and interactive environment

illuminance in these spaces should be shielded to where they can participate and feel in control.

keep glare away from the nurse on duty. Colored l i g h t is one way to e n l i v e n the space. Color­

c h a n g i n g l u m i n a i r e s have been used to good effect

Life s u p p o rt systems monitored at the patient bed i n creating playful, dynamic environments with m i n i ­

and at the n u r s i n g station are critlcal, Proper i l l u m i ­ mal maintenance p r o b l e m s .

nance for these areas permits the VDT monitors and

e q u i p m e n t to be easily seen by staff without appre­ D a y l i g h t i n g and windows are important to relax and

ciable screen glare or reflection problems. While orient the y o u n g patient. Diffuse and indirect l i g h t i n g

most monitor screens are inte rnally illuminated, interspersed with h i g h l i g h t i n g of interesting areas in

adequate i l l u rn i n a n c e must be provided so the staff the waiting rooms and corridors, helps provide a

can read l a b e l s and operate controls. R F I / E M I may l i g h t , sunny, and pleasant e n v i r o n m e n t .

be of concern in these areas, particularly with the

trend toward telemetry systems that allow monitor­ S i n c e c h i l d r e n play on the floor, the l i g h t i n g at floor

ing of ambulatory patients. level s h o u l d be p l a n n e d for visual activity. A mix of

non-standard w i n d o w s i l l h e i g h ts should be c o n s i d ­

A newer trend towards "Uni ver sal Care" places di s ­ ered far different sized children. Multiple switching

tributed nursing stations with multiple viewing or dimming devices will allow staff to give young

options at o r n e a r each patient. (See Figure 8 . ) T h i s patients a sense of control over t h e i r environment.
 \ A N S I / I E S N A RP-29-06

Figure 8.

"Universal care"

nurse stations

can be tucked

into observation

alcoves.

Children s hospitals give critica! consideration to trol and d i m m i n g . Residential-type l i g h t i n g , such as

the i r patients psychological, social, recreational, table lamps, can help make the hospital environ­

and educational requirements, as well as th e i r med­ ment more f a m i l i a r and comfortable.

15
ica! needs. In general hospitals, where the chil­

dren s section is s m a l l e r and the patient stays short­ The nursing station s relationship to the children

er, the greater importance is given to medical deserves special lighting consideration. While the

requirements. nurse must observe the c h i l d , it is e q u a l l y important

that the c h i l d sees the n u r s e . Neither c h i l d nor nurse

AII y o u n g e r patients (infants to adolescents) use the s h o u l d be exposed to glare.

same hospital corridors, storage areas, waiting

rooms, l o b b i e s , and recreational facilities. S u ff ic ie n t 4.7 Nurseries

l i g h t is particularly important for toddlers, as objects

left strewn about on floors and carpet may otherwise Nursery l i g h t i n g s h o u l d allow the easy observation

l i e u n s e e n by anyone i n the space. For t h i s reason of infants in cribs and incubators. This lighting

i l l u m i n a n c e measurements s h o u l d be made at floor s h o u l d not be kept at h i g h levels very long because

level. Glare from windows or glass partitions may infants cannot protect themselves from retinal over­

also pose a safety p r o b l e m . exposure. (See Figure 9 . ) Ad j ustable indirect a m b i ­

ent lighting should be the norm for this type of

Light sources s h o u l d be selected that allow infants space. Luminaires far general lighting should be

the ability to appreciate and observe various colors selected and / or installed so that the l u m i n a n c e , as

of objects. Daylighting, when available, is consid­ seen from the normal bassinet p o s i t io n , is not

ered important, but a source allowing for consistent uncomfortable or harmful to the infant patie n t .

color s h o u l d be used at n i g h t to allow staff to identi­

fy colors accurately. To avoid retinal overexposure, F luorescent l i g h t i n g with a h i g h C R I is recommend ­

bright l i g h t i n g should not be placed directly above ed for recogni z ing m i n a r color changes i n the skin

infants. Movable screens can darken i n d i v i d u a l crib and sclera. Natural da y light or the use of contr o ls to

areas for n a p p i n g . create a pattern of l i g h t and dark t i mes is desired to

help set a d i u r n a ! pa tt ern for the infants .

Lighting for adolescents should be practically the

same as for adults. These patients deserve sorne S pecial publications are available with infor m ation

privacy and the l i g h t i n g s h o u l d permit i n d i v i d u a l con- on the treatment of infantile j aundice with fl u ore s -
A N S I / I E S N A RP-29-06

Figure 9. lndirect

i l l u m i n a t i o n prevents

infants from being

exposed to excessive

l u m i n an c e in this

nursery. Controls

allow the lighting to be

modulated, simulating

day/night cycles.

cent light (specific precautions are recommended great potential for use in holistic h e a l i n g methods as
16),
far such therapy and far u s i n g ultraviolet bacteri­ part of therapy. The l i g h t i n g should provide interest,
16• 1 7
cida! barriers i n pediatric areas. warmth, definition of space, and task illuminance

w h i l e serving the need far security and safety. Avoid

Special Care Nurseries (SCNs) or Neonatal · colors and patterns that contribute to distortion, dis­

lntensive Care Units ( N I C U s ) are intended far pre­ traction, or visual vibratlon,

mature and a i l i n g infants. Here, flexible l i g h t i n g lev­

els are needed. The n u r s i n g staff may prefer relative Mental facilities serve both in-patient and outpatient

darkness for sorne infants, yet need high intensity needs. Areas exclusively for outpatients can i n c l u d e

for medica! support during emergencies. Parents floor lamps, table l a m p s , and desk lamps. W h i l e the

often visit the SCN to feed or hold their infants. in-patient areas s h o u l d also e x h i b i t a relaxed home­

Dimming, or an area of individualized control, like quality, this is difficult to do and still keep the

s h o u l d be provided for family b o n d i n g . Also, a space l u m i n a i r e s away from the patients. H e r e , breakable

with ample daylight is desired to help the family products or glass lenses s h o u l d be avoided.

combat depression.

Daylighting should be aggressively designed into

4.8 Mental Health Facilities mental health facilities, especially for bedrooms, day

rooms, and d i n i n g rooms. D a y l i g h t provides orienta­

AII patients i n mental health facilities s h o u l d be con­ t i o n , a sense of therapeutic c a l m , and the h i g h l i g h t

sidered under maximum security. Patients are levels required to synchronize circadian rhythms

behind locked doors and windows or their move­ (regulates the sleep-wake cycle). Dark rooms for

ment is controlled through monitoring and alarms. I n night time s l e e p i n g are e q u a l l y important to circadi­

general, the lighting involves non-adjustable, an synchronization.

recessed, c e i l i n g u n i t s that are out of reach and pro­

tected from thrown objects. Pendant l u m i n a i r e s are Light sources s h o u l d have a color-renderínq index

inappropriate since they provide a support from (CRI) of 80 ( m i n i m u m ) to enhance human appear­

which patients could hang themselves. Lighting con­ ance. A color temperature between 4100 K and

trol options may i n c l u d e switches located within the 5000 K provides a good color m i x when fluorescent

room, remate control at the n u r s i n g station, or local lighting is used in conjunction with daylight.

key switches mounted i n the hallways. The nature of Otherwise, 3500 K offers a good compromise

the patients w i l l influence this choice. between daylight and the warmer tones desired.

Fluorescent luminaires should have electronic bal­

While mental patients exhibit a vast range of prob­ lasts to eliminate the flicker associated with mag­

lems, proper lighting can provide everyone with a netic ballasts. Often, decorative items and surface

relaxing and c a l m i n g atmosphere. Colored l i g h t has colors are chosen under lamps with specific color
 � A N S I / I E S N A RP-29-06

peratures and color rendering. This criterion needs s u c h , and the designer must allow for this p o s s i b i l i ­

to be coordinated with the hospital maintenance ty. Sorne surgeons u s e this · locatlon to dra w a sur­

staff for future r e l a m p i n g . face plan for surger y on the patient. Lighting that

facilitates this function , or the starting of intravenous

Avoid l u m i n a i r e s or l i g h t sources that produce glare lines and other pre-anesthetic activit es, i such as

or cause visual distortions for sorne patients. Both shaving, are especiall y useful. Fle x ible wall-hu n g

daylighting and electric l i g h t i n g can add to these dis­ bracket luminaires can serve this purpose so that

tortions. However, patients suffering from autism or one patient's preparation w i l l not disturb another.

schizophrenia benefit from evenness in i l l u m i n a n c e ,

pattern, and texture. Discussions with facility spon­ W here dedicated space for patient h o l d i n g is li m ited,

sors/users should provide sufficient information so wide corridors are o ft en appropriate . Thus low l u m i ­

that design decisions achieve "reasonably adapt­ nance o r indirect lighting should be available for

able" l i g h t i n g . occasional use i n these co rr ido r areas.

Luminaires selected and positioned to help define 4.1 O S u r g ic a l l n d u c t i o n Room o r A rea

special boundaries are recommended. Color, tex­

ture, and "wall wash" lighting, along with careful The patient is transferred from a stretcher to an

choices about furniture and its location, can produce operatin g table in the su gical induction room area.r /

a desirable definition. Here, anesthesia is sta ted a n d a va iety of monito r r r­

ing devices are attached to the patient.

4.9 Surgical H o l d i n g Areas

ldeally , the patient is brought to surgical inductio n

Surgical holding areas are designed for retaining u n d e r subdued l i g h t . A tas k light must be available

sedated patients on wheeled stretchers. (See to place a needle in a vein for anesthesia. O nce

Figure 1 0 . ) This keeps them out of the hospital's the patient is unconscious , illuminance can be

normal traffic stream for up to 30 m i n u t e s . increased . However , light reduct on capability s h o u l d

i

be available while the anesthesiologist inserts a

As with the patient room, controlling the l u m i n a n c e tube into the trachea with a laryn g oscope. T his light ­

of sources i n the bed-ridden patient's l i n e of sight is ed device provides onl y about 5 0 to 1 0 0 lux (5 to 1 O

important to provide comfort. Sorne patient supervi­ f e) , thus a low am b ient i l l u m i n a n c e is preferred b y

sion and observation is necessary, and providing a the anesthesiologis t.

subdued "slumber-type" illumination is advisable.

Preferably, the source of i l l u m i n a t i o n s h o u l d be out 4. 1 1 Sur g ic a l Sui te

of the recumbent patient's line-of-sight.

4. 1 1 . 1 Op er at i ng R o o m . O perating room l i g h t n g is
i

The h o l d i n g area is not u s u a l l y designed for surgical perhaps the most important l i g h t i n g in the hospital.

induction. However, sorne hospitals will use it as V arious tas k s ta k e place here and lighting needs are

Figure 1 O. In a

surgical holdi ng

area, provide for

individual control

of lighting at each

patient station.
A N S I / I E S N A RP-29-06

different for the surgical team, the circulating n u r s e , Interior surfaces, d r a p i n g , and gown fabrics used in

the anesthesiologist, and the room turnover staff. operating and delivery rooms s h o u l d have the tol­

E q u i p m e n t necessary for i l l u m i n a t i n g the operating lowing colors and reflectances:

room consists of:

• C e i l i n g s : near-white color with 90 percent or

• Ambient Líghting more reflectance.

• Externa! Surgical Field l l l u m i n a t i o n Systems • Walls: any non-glossy (matte f i n i s h e d ) pastel

• Fiber Optic l l l u m i n a t i o n Systems color with 60 percent reflectance. This f i n i s h

• Microscope l l l u m i n a t i o n Systems must be w a s h a b l e .

• Floors: reflectance in the 20 to 30 percent

The surgical field illuminance sources must work range preferred, but may be lower if

together, b l e n d i n g to h e l p the surgical team i n t h e i r conductive floors are required by the use of

various tasks. An assistant h e l p i n g on the opera­ f lam m a b le anesthetics. No one s h o u l d reject

tive field needs to see well while working with a the l i g h t i n g scheme or attempt to compensate

surgeon using a headlight or a surgeon using a with increased l i g h t i n g levels s h o u l d the floor

microscope without an assistant scope. Others reflectance be less than 20 percent.

working outside the s u r g i c a l f i e l d need appropriate • Fabrics for gowns and surgical drapes: a d u l l

task l i g h t that does not interfere with the surgical shade of b l u e - g r e e n , t u r q u o i s e , or pearl gray

tea m . The introduction of daylight into operating with 30 percent or less reflectance. This

rooms has had positive effects on the surgical prevents the surround from distracting the

tea m. (See F i g u r e 1 1 . ) physician from the operating f i e l d .

• Surgical instruments : non-reflecting matte

Shadows should not prevent surgeons and assis­ finish to m i n i m i z e reflected glare in the

tants from seeing the patient s tissue, organs, b l o o d , operative cavity.

and body cavities exactly as they are. Sometimes • Any plastic materials u sed in d r a p i n g : matte

surgical teams must work for hours and the l i g h t i n g finish.

should not contribute to their discomfort. Doctors

g l a n c i n g to and from t h e i r work s h o u l d not have t h e i r X-ray, anesthesia, and ventilation e q u i p m e n t com­

eyes constantly readjusting to large l u m i n a n c e dif­ petes with the l i g h t i n g system for the available c e i l ­

ferences. Heat from the surgical lights must be m i n ­ ing space. (See Figure 1 2 . ) Because surgical pro­

imized. Even more important is patient safety. cedures vary, the general lighting should suit the

Exposed body tissues must not be heated or dried v i s u a l requirements of the surgeon and staff. A u n í ­

by the l i g h t i n g . formly distributed i l l u m i n a n c e with level adjustment

Figure 1 1 . The

window in this

operating room

a l i g n s with an

exterior wall

window, allowing

daylight into the

surgical space.

Care must be

exercised so

that direct

s u n l i g h t does

not enter the

operating room.

16
 A N S I / I E S N A RP-29-06

Figure 1 2 . The

perimeter areas

outside the surgical

field are uniformly

illuminated creating a

comfortable contrast

ratio and ease of eye

adaptation between

the various l i g h t i n g

levels. The surgical

task area is h i g h l y

illuminated by special

ceiling-mounted

task luminaires

(adjustable-recessed

and arm-mounted).

provisions may be installed u s i n g recessed, s h i e l d ­ reflections are absent, this is not always possible.

ed l u m i n a i r e s , w h i c h give diffused l i g h t and prevent For e x a m p l e , surgical sp o nge s are very white and

glare. Great care must be taken to e n s u r e that a l l many surgeons do not use satin-finished instru­

moveable devices can be used with minimal inter­ ments. S p e c u l a r reflections from s h i n y metal f i n i s h ­

ference from other e q u i p m e n t . The growing list of es can reduce visibility.

ceiling-mounted operating room hardware now

includes: Blood and irrigation can collect during "wet field"

surgery. These fluid pools have a meniscus that

• G e n e r a l l i g h t i n g for the entlre room reflects l i g h t c a using harsh glare. Keeping tissues

• Track-mounted surgical l i g h t s moist is important and the e l i m i n a t i o n of such pools

• Pedestal-mounted surgical l i g h t s is not always practical, The a n g l e of the incident l l l u ­

• X-ray or image i n t e n s i f i e r mounted on a b r i d g e , m i n a n c e and the use of a diffuse l i g h t source can be

which s l i d e s on overhead tracks, or pivots from critica! to reduce such g l a r e .

a c e i l i n g pedestal

• Pedestal-mounted surgical l i g h t s on a bridge Fluorescent luminaires i n the surgical suite should

u s i n g the same tracks as the x-ray e q u i p m e n t be designed so that electromagnetíc interference

• Microscope m o u n t s (EMI) will not interfere with delicate electronic or

• Ventilation g r i l l e s monitoring e q u i p m e n t . Specially s h i e l d e d construc­

• Anesthesia c o l u m n with booms or masts for t i o n , lenses with an electrically-grounded conductive

gas and electrical cables coating, and radio frequency filters may be required

e Overhead monitors dis playin g patient data or to protect sensitive e q u i p m e n t .

i m a g e - i n t e n s i f i e d television pictures

Patient appearance s h o u l d not change significantly

As general illuminance increases, luminance bal­ u n d e r the surgical l i g h t or the general room illumi­

ance between large areas within view of the surgical n a n c e . T h i s is best achieved by matching tne spec­

team assumes greater import a n c e. To achieve t h i s tral power distributions of these two light sources,

balance, luminance ratios no greater than 3 to 1 1

but usually it is o nl y practica! to match t h e i r color

should exist between the wound and the surgical temperatures. For e x a m p l e , if the ma i n surgical l i g h t

f i e l d , and no greater than 5 to 1 between the surgi­ has a color temperature of 4000 K, then the gener­

cal field and the instrument table. L u m i n a n c e ratios al room lllumínance s h o u l d be provided by sources

between the s u r g i c a l field and the room s lighter sur­ with a s i m i l a r color temperature. Fluorescent l a m p s

faces s h o u l d also be no greater than 5 to 1 . While with a h i q h C R I are recommended.

visual comfort is probably greatest wh e n bright

17
A N S I / I E S N A RP-29-06

The surgical task lighting system should produce

adjustable i l l u m i n a n c e . The l i g h t output at its highest

setting the system s h o u l d provide at least 25,000 lux

(2,500 fe) directed to the center of a 20 cm (7.8 i n . )

[or larger] circular pattern on a surgical table. This

pattern is an area w i t h i n which the center-to-edge

illuminance tapers evenly so that the edge illumi­

nance is no less than 20 percent of the center i l l u ­

minance. Uneven lighting or hot spots can make

surtace determination difficult d u r i n g surgical sculp­

ture. For c e i l i n g - s u s p e n d e d surgical l i g h t i n g , the íllu­

m i n a n c e and patterns are measured 1 0 0 cm (39 i n . )

from the lamp tace cover glass, (if a cover glass is

used), or 1 0 0 cm (39 i n . ) from the lower edge of the

outer reflectors (if a multiple-reflector unit with i n d i ­

vidual covers over each light source is u s e d ) .

The light output should be adjustable to relatively

low levels, especially when illuminating a patient s

face. Far many surgical procedures, the patient may

be totally or partially conscious, and the l u m i n a n c e

of the task light can be very uncomfortable. This can

involve a delicate balance. The operating team

needs e n o u g h i l l u m i n a n c e for good resolution, yet

the patient, whose eyes may be exposed to bright

l i g h t s , s h o u l d still be comfortable.

Figure 1 3 . Surgical task l i g h t i n g system often

The l i g h t from fixed surgical l i g h t i n g systems s h o u l d
consists of two to five adjustable luminaires,
emanate from several sources dispersed over a
recessed or arm-mounted, to provide the surgical

wide angular area. (See Figure 13.) While wall team with shadow-free task i l l u m i n a t i o n . Smaller

sources might be needed, they are an inefficient l u m i n a i r e heads incorporating LED sources will help

to reduce ceiling clutter.

way to achieve the required illuminance. Highlight

and shadow provided in the illuminated surgical

area h e l p s give objects a t h r e e - d i m e n s i o n a l appear­

ance (depth). Objects i l l u m i n a t e d uniformly appear advantages . U sers should c om pare t he a b il i t y of

flat and lose shape detail. The surgeon s h o u l d be various li g hts to m i n i m i z e head , shoulder, and hand

able to adjust the i l l u m i n a n c e to reveal depth and shadows and to help define pa t i e n t conto u rs .

contour or . m i n i m i z e shadows. The l i g h t i n g just dis­

cussed is a m í n i m u m requirement for general surqi­ As a test for adequate s h adow reduct ion in i l l u m i n a ­

cal procedures. I n many specialized instances h i g h ­ tion, a surgical lighting system should provide at

er i l l u m i n a n c e s , various pattern sizes/shapes, and least 1 O p ercent of its intended illumination at the

i l l u m i n a n c e level controls are desirable. Pattern size i n s i d e bottom 'ot a flat b lac k tu b e that is 50 mm (2

can change by rnovinq . the l i g h t closer to ( or farther in.) in diameter and 76 mm (3 i n . ) long, positioned

f rom) the patient. S orne luminaires also provide a directl y above a photodetector on t he opera t ing

focusing control that varies pattern size. U sers table . The l u m i n a i r e should be positioned at a dis ­

s h o u l d evaluate t h ose l u m i n a i r e s that give a usable tance of 1 0 0 0 mm (39 i n . ) above the photodetector.

pattern over the depth of field required. They s h o u l d A disc 2 5 0 mm (1 O in.) in diameter to obstruct the

use a color - and cosine - corrected i l l u m i n a n c e meter light should be p laced 58 0 mm (23 in.) above the

that ind i cates the average i l l u m i n a n c e level over a p hotocell and normal to the a x i s of t he tube. W hen

3 . 8 cm ( 1 . 5 i n . ) diameter for all measurements. multiple lam p heads comprise t he system under

test , the 1000 mm (39 i n . ) distance s hould be mea ­

E xterna ! l i g h t s h o u l d reach the operating area from sured from the center tace of ea c h l a mp h ea d to t he

wide angles to prevent the surgeon s hands, head, p hotodetector. (See Fig u re 14.) Thi s test is valid far

and instruments from producing obscuring shadows . l u m i n a i r e s with a m i n i m u m light - emanating su rf ace

Shadow reduction is a function of optical design, of 470 mm (1 8 i n . ) dia m e t er .

positioning , reflector size, and the n u m b e r of l i g h t i n g

systems a i med at the site. M ulti - system u n i t s , each C onsidera t i on should be g i ve n to using a light wit h

consisting of broad expanse lighting, offer ma j or m u l t i p l e lamps i n a s i n g l e lam p head , or a l u m i n a í r e

18
 A N S I / I E S N A RP-29-06

Radiant heat produced by surgical lights must be

m i n i m i z e d to protect exposed tissues and provide

comfart far the surgical team. The absorption of

infrared energy ( i n the 800 to 1 0 0 0 nm region) by

water should be minimized. Excessive heat from

the l i g h t i n g q u i c k l y dries tissues, r e q u i r i n g more fre­

quent irrigation. Surgical lighting manufacturers

BLACK
need to provide data and recommendations regard­
DISK 250 MM DIAMETER

( 1 0 IN)
ing the nature of their equipment s energy level,

and its effect on delicate, thin, dry or otherwise

abnormal tissue. (Consult with the IESNA

Photobiology Committee far additional research

1000 MM

(39 IN) related to thermal injury.) An irradiance factor

2
REMOVABLE MATTE (W/cm /fc) can be helpful when determining the
BLACK S C R E E N I N G
580MM
TUBE 76 MM (3 IN) total irradiance of a lighting system. Also refer to
(23 IN)
X 50 MM DIAMETER
Section 6.4.2.4 on total irradiance.
(2 IN)

Fiber optic cables and instruments can also get hot

and burn a patient, especially when using high

OPERATING TABLE
intensity light sources. Fiber optic junctions

obstructed with blood or tissue and size mismatched

/
b u n d l e s can develop excessive heat e n o u g h to b u r n

a patient. Care needs to be exercised during

surgery when u s i n g or resting such devices on or in

t
the patient.
10%

For general surgery, l i g h t from the l u m i n a i r e s h o u l d

Figure 1 4 . In this test for shadow reduction, with the
have a color within an area described by a five­
distances and object sizes as shown, at least ten
sided polygon on the CIE* chromaticity diagram
percent of the incident l ig h t s h o u l d be seen on the

photodetector at the bottom of the tube. (see Figure 1 5 ·or the IESNA Lighting Handbook,
1).
Ninth Edition

with m u l t i p l e lampheads. Headlights and fiber optic The range of C I E coefficients is defined by the fol­

illuminated instruments can minimize shadows by lowing x and y v a l u e s :

moving the l i g h t to an axis closer to the surgeon s

eyes or into the operative field itself. S u c h sources X y

are better as supplements (rather than replace­

ments) far adjustable externa! l i g h t s . 0.310 0.310

0.400 0.375

Headlights and fiber optic illuminated instruments 0.400 0.415

can m i n i m i z e shadows by moving the l i g h t t o a n axis 0.375 0.415

closer to the surgeon s eyes or into the operative 0.310 0.365

field itself. A g a i n , such sources are better as sup­

plements (rather than replacements) for adjustable

externa! lights. When the points just listed are plotted on the CIE

chromaticity diagram, the area bounded by the plot

Surgical i l l u m i n a n c e requirements vary from lighting results in correlated color temperatures between

broad surface structures, to examining deep cavities 3500 K and 6700 K as represented by the points

with narrow openings, to endoscopic access. along the black-body spectrum locus (horseshoe­

Adjustable systems accommodate these needs by shaped curve) w i t h i n the described boundary. Light

focusing lig ht down an open cavity or providing even source color does not determine color rendering

illuminance (or shadow highlights) over a body. properties, thus, sources selected should have a

Separate systems are often needed far endoscopic spectrum similar to a complete radiator at the
1
cavity access. For certain applications, externa! desired temperature. ª

l i g h t i n g systems s h o u l d be able to evenly i l l u m i n a t e

broad expanses of the body. M u l t i p l e l i g h t heads are

often necessary to accomplish these more demand­

*Commission lnternationale de l'Eclairage (lnternational Commission on

ing tasks involving broad i l l u m i n a n c e . lllumination)

19
A N S I / I E S N A RP-29-06

Figure 1 5 . C I E
0.8
Chromaticity

Diagram with a

five-sided area

(polygon)

0.7 identifying the

--i-r- ±�r· suggested

,-+--+-+--t-f--l-+-!-t- .....1� 7 e color for

general surgery

lighting.
1 1 1

0.6

0.5

0.4

0.3

0.2

o. t

-
t
o
o 0.1 0.2 0.3 0.4 0.5 0.6 0.7
X
t t t t t
o o o o CD CD o o o
8 8 o o o o LO eo o o o
o o LO CXJ CD CXJ ('")

o CD .._¡- ('") N N � � �
N �

C o l o r Temperature I n K e l v i n

Second o n l y to optical quality is the surgical l i g h t i n g Directionality and focus can be achieved by permit­

unit s flexibility. T h i s may be derived from movable ting the scrubbed surgeon to adjust a sterile h a n d l e .

units suspended from the c e i l i n g or from the electri­ H a n d l e s s h o u l d be d e m o u n t a b l e for sterilization, or

cal switching of stationary ceiling-mounted units. use disposable sterile sheaths. They must also be

L i g h t i n g u n i t adjustability ( i n the extended position) smooth to avoid glove puncture, and have a guard

can increase patient and surgical team comfort. to prevent contact with non-sterile areas.

Lights that come clase to the floor can l i m i t stretching

a patient s neck when surgeons work b e h i n d the ear. Directional flexibility requirements for main task

As an operation evolves, the task that needs i l l u m i ­ lighting will vary with the surgeon and the proce­

nance may change. Moving the l i g h t i n g system trom d u r e . Limits are also imposed by NFPA 7 0 , * * Article
19
one position to another s h o u l d require m i n i m a l effort, 5 1 7 , w h e n using flammable anesthetic agents. (lf

yet the lights must retain their orientation without drift. only nonflammable anesthetics are used, which is

With such system flexibility comes the need to protect the norm i n today s surgical facilities, these restric­

operating room staff from injury. Luminaires should tions do not apply.) Often the l i g h t i n g system selec-

not have sharp edges, and be d e s i g n e d to m i n i m i z e

harm should someone b u m p their head on the u n i t . **National Fire Protection Association

20
 '
it A N S I / I E S N A RP-29-06

tion cannot be s i m p l y defined since infinite flexibility yellow than Xenon and the b u l b wall temperatura is

may be desired. The lighting requirements for ortho­ cooler. Light intensity can vary with voltage changes,

pedic operations differ greatly from those far cardio­ and as l a m p s age, their intensity deteriorates.

vascular surgery. lt is important to find out from the

users of the space what their needs are. Easy lamp replacements in fiber optic illuminators

Prospective purchasers must be aware that all are critica! d u r i n g surgery. Hot lamps are dangerous

equipment has limitations, and to ascertain if the and failures not immediately replaced can lead to

selected e q u i p m e n t w i l l meet the stated n e e d s . disaster. Manufacturers should provide a simple

way to identify b u l b s with degraded i l l u m i n a n c e or

Two-team surgery is now a frequent practice. Far otherwise near f a i l u r e . F i b e r optic l i g h t sources need

example, one team may remove a vein from the cooling systems with q u i e t fans that do not disrupt

t h i g h w h i l e another team implants it into the heart. the operating room.

Thus additional light heads or satellite units may

extend from the primary luminaire mounting. Fiber optic cables are f r a g i l e . The m u l t i p l e filaments

However, b r i n g i n g two or more l u m i n a i r e s into one can break, severely restricting the a m o u n t of light

surgical field must be done with care because ther­ delivered through the cable. Frequent visual inspec­

mal energy and i l l u m i n a n c e intensity are additive. tion of these cables is necessary to maintain ade­

quate i l l u m i n a n c e levels. (Looking into a fiber optic

Supplemental surgical task illuminance is of two cable when it is attached to a l i g h t source can h u rt

main types: One uses a beam encompassing the the eyes.) A cable end can melt when connected to

entire f i e l d ; the other directs l i g h t t h r o u g h a glass or a l i g h t source that is too hot for that particular cable.

plastic fiber optic bundle. Where flammable anes­ Light transmission also d e p e n d s on the cable ends

thetic gases are employed, everything must be remaining polished. When cable ends are not pol­

explosion proof or limited i n movement to 1 .5 m (5 ished, little light is transmitted and the light is
2
ft.) above the floor ( i n accordance with NFPA 99 º). absorbed i n the i l l u m i n a t o r as heat instead.

Freestanding lights must be safe from tipping, as Fiber optic instruments can be a complex (an oper­
2
prescribed in NFPA 99, º and must have a reason­ ating microscope) or s i m p l e (an illuminated retrac­

able "memory" for retaining their position when tar). Endoscopic surgery is enabled with fiber optics

bumped. No part of a portable wide-beam lamp whereby a dark cavity s only illuminance comes

h o u s i n g s h o u l d project below 1 . 5 m (5 ft.) from the from the fiber optic source. There is no significant

floor i n areas where f l a m m a b l e anesthetics may be contribution from the operating room lighting.

used. The entire u n i t must be grounded t h r o u g h a However, the surgeon needs ambient room and sur­

third wire in its power c a b l e . gical field illuminance for placing the scopes and

tools, or monitoring the externa! surface. The e n d o ­

A fiber optic u n i t consists of a l i g h t source, a cable, scopic surgical team w i l l move t h e i r view from the

and an instrument or headlight. When used in a monitors (or i n sorne cases the ends of the scopes

sterile f i e l d , the cable and instrument must be capa­ themselves), to the instrument stands, to the

ble of sterilization or else be encased in a water­ patient. Sorne operations require externa! f i e l d illu­

proof and sterile static-free barrier. lrradiance m i n a n c e for o n e regían w h i l e endoscopic work takes

intended for insertion into an i n c i s i o n s h o u l d be no place elsewhere. Adjustable-intensity sources per­

2•
more than 0.025 W/cm (See Annex G . ) mit the balancing of illuminance levels, minimizing

fatigue and visual shock.

Fiber optic l i g h t sources can be very bright, espe­

cially when the fiber optic cable is not inserted into Working with the operating microscope usually

the connecting port. A cover must be available to requires a coaxial light source (most often f ib e r

protect others from this bright l i g h t . When used with optic). (See Annex H.) Microscope light sources

overhead lighting, fiber optic source illuminance can generate significant heat, and remate m o u n t i n g

needs to be matched with the overhead system s (away from the microscope head) lowers patient

output. Adjustments on each system permit a b l e n d ­ exposure. Dual surgeon heads and other attach­

ing of the available l i g h t . ments divide the available l i g h t . Intense i l l u m i n a n c e

may be required to compensate so enough l ig h t

Fiber optic sources use different lamp classes. reaches the task that the surgeon is focusing on.

Xenon lamps produce a b l u i s h spectral output and Sorne lighting can be intense e n o u g h to endanger

require a relatively l o n g time befare b r i g h t n e s s and the patient by heating the operative field. Sorne

color stabilize. These lamps have a s i n g l e intensity manufacturers l i m i t the more intense fiber optic l i g h t

and l i g h t level changes are done externally with a sources to microscopes that are used for certain

variable slit or a screen. Halogen lamp output is more operations that do not involve the eye. A surgical

21
 A N S I / I E S N A RP-29-06

team working through the scope can have magnifi­ Rooms where flammable anesthetic agents are

cation and reasonable illuminance. But assistants used or stored are defined by Standards for the Use
19
working outside the scope optics can be b l i n d e d by of l n h a l a t i o n Anesthetics (NFPA 9 9 ) as hazardous
19
the b r i l l i a n t i l l u m i n a n c e and w i l l be limited as to what locations. The National Electrical Code (NFPA 70)

tasks they can perform. lt is common to employ specifies the electrical construction and e q u i p m e n t

simultaneous, yet separate, operating fields; one permitted in hazardous locations. In Cariada, the

u s i n g the microscope, the other u s in g the m a i n task Code for Use of Flammable Anesthetic (CSA
21
l i g h t . Adequate i l l u m i n a n c e adjustability in each field Standard 232) and the Canadian Electrical Code

is essential for comfort. (CSA Standard C 2 2 . 1 and C 2 2 . 2 ) Part I and Part I I

22
apply respectively.

Limited incision surgery means all work is done

through a small access. Delivering l i g h t to a work 4 . 1 1 . 2 Operating Room Suite Corridors. Corridors

area remete from the incision can be d e m a n d i n g . An in the operating room suite are used for pre-surgery

adjustable task system that can deliver a narrow scrubbing, record keeping, patient holding, and

cone of illuminance is a valuable tool. Headlights e q u i p m e n t storage. A general i l l u m i n a n c e of 1 0 0 0 lx

and instruments e q u i p p e d with fiber optics (such as (100 fe) is appropriate here, with higher levels

retractors and suction) s u p p l e m e n t the task l i g h t i n g . around scrub sinks and lower levels in patient

h o l d i n g areas,

lnstruments with b u i l t - i n l i g h t pipes that can retract

tissue and deliver lig h t to the work area have 4.11.3 Scrub Area. Scrub areas ( see Figure 16)

become essential tools . . A sterile fiber optic cable and corridors adjacent to the operating room are

attaches at the end of the instrument, u s u a l l y as part areas where personnel can adapt t h e i r eyes to the

of the h a n d l e . The instrument s light-emitting end is operating room i l l u m i n a n c e . Here, the surgical team

often deep i n a wo u n d and must be kept clean of should experience the same l i g h t level, color tem­

blood to maintain illuminance levels. Suction perature, and color rendering that they will

devices, often usad by an assistant to clear the view encounter in the operating room.

of f l u i d s , may have the ability to retract tissue. But

excessive traction on the fiber tube can destroy its lt should be possible to reduce the scrub area i l l u ­

light-delivering ability. The need for both a suction minance whenever the upcoming surgery w i l l take

tube and a lig h t cable makes using the device place i n a low light environment or when the scrub

somewhat awkward. room is not in use.

Low voltage lighting equipment (less than 8 volts) 4.11.4 Special Lighting for Photography and
2
may be used i n accordance with NFPA 99 º if sup­ Television. Operating room television camera sys­

plied from an isolating transformer "connected by an tems can be grouped into six categories:

anesthetízing location cord and p l u g " or from dry cell

batteries or from a transformer above the " 1 . 5 m (5 • Systems b u i l t into the l i g h t h e a d , where the

ft . ) level." lsolating transformers should have a television field and the lighted field co i n c i d e ,

grounded case and core if used near flammable although the camera a n g l e and depth of focus

anesthetics. are u s u a l l y adjustable.

The anesthesiologist relies on instrumentation and • Systems attached to a separate arm of the

monitors for provision of care. Visibility of these surgical l i g h t i n g . They allow more control of

instruments can potentially suffer from v e i l i n g reflec­ the viewing a n g l e , but require a s k i l l e d

tions or reflectad glare do to the nature of th e i r dis­ operator working near the sterile f i e l d .

plays. (See Annex C.) This equipment should be

s h i e l d e d from the operating task l ig h t and the gen­ • Systems separate from the l i g h t i n g mounted

eral room illuminance. lnstrumentation featuring on booms, d o ll i e s , or platforms. They allow

large, high-contrast readings that are easily. seen by h i g h e r quality images, but require more space

the surgeon and the anesthesia team should be and special camera operator s k i l l s .

used whenever possible. Other d e s i g n t e c h n i q u e s ,

O
such as providing a separate zone of l i g h t i n g control Systems u s i n g miniatura video cameras

for the anesthesiologist area s h o u l d be considered. attached to headbands, often along with a

Such control may also provide the anesthesiologist headlight. (See Section 4 . 1 1 . 5 . )

supplemental l i g h t i n g that he may use for monitoring

the patient s tace color d u r i n g surgery.

22
 A N S I / I E S N A RP-29-06

Figure 1 6 . Task

l i g h t i n g is required at

scrub sinks to ensure

adequate i l l u m i n a n c e

whenever the surgical

team prepares for

surgery.

• Systems for Endoscopic surgery video, where Headli g hts are u s u a l l y i l l u m i n a t e d through a f le x ible

a miniature camera is attached to the fiber - optic cable that p l u g s into a l i g h t source b ox. A

endoscope. The surgeon manipulates few models use lo w - v oltage lamps powered from a

iristruments by watching an enlarged image of battery or s m a l l trans t ormer.

the endoscopic field on a television monitor.

The facto r s to consider in evaluating headlights

• Systems with a microscope-mounted camera include:

attached to beam splitters. This allows other

members of the surgical team to see what the • Spot si z e at the anticipated w o r king distance

s u r g e o n sees. • Need for an ad j ustable spot s i z e

• l l l u rn i n a n c e at the anti c i pated wor k ing distan c e

Photographic needs can range from basic before­ • Ab i lity to pi v ot and a i m the l i g h t beam in

and-after documentation to the production of v arious d i r ections

sophisticated teaching videos that require versatile • W eight of both t h e h e a d l i g h t and the ca b le

optical e q u i p m e n t . • C omfo r t and ad j ustment of the sup p ort i ng

headband

4.11.5 Surgeon Headlights. Headlights worn by • C able si z e, durability , and ease of

surgeons can supplement overhead surgical lights, maintenance . ( C ables s h o u l d have c l i p s to

or provide l i g h t from unique angles. Typical head­ t r ansfer the cable w eight to the surgical g own

light-to-task distances depend on what working dis­ and m i n i m i z e headband d i s p l a c e m e n t w h en

tance the surgeon is comfortable with and range the surgeon mo v es )

from 30 to 60 cm ( 1 2 to 24 i n . ) . • E ase of light a i m i n g u s i n g a r emovable h a n d l e

that can be sterili z ed ( o r a ste r ile sheathed

Headlights are especially useful for seeing into . handle - not often practica ! )

small access, deep body cavities where the light

beam must be parallel to the surgeon s line-of-sight T he factors to conside r i n evaluating fi b er - o p ti c i l l u ­

(coaxial). A typical surgical headlight system con­ m i nato r s to po w er the headlight i n c l u d e :

sists of a headband-mounted headlight, a cable,

and a l i g h t source. The l i g h t head is usually adjusted • S i z e, w eight , and mobility

to lie close to the axis of the surgeons eyes or near­ • Ease of l a m p r eplacement

by on the forehead. lt most often mounts on a head­ • L i g ht intensity and color

band, but can be attached to a magn i fying l o u p e . • l nte n sity ad j u stment

23
A N S I / I E S N A RP-29-06

• N u m b e r of fiber-optic cables the light source . otologists prefer self-lamped head mirrors, or fiber­

can power s i m u l t a n e o u s l y optic headlamps.

• Exit face energy e m i s s i o n

4.12.3 Neurosurgery. The visual requirements of

The a m o u n t of l i g h t energy at the exit tace w i l l be neurosurgery are s i m i l a r to those i n general surgery.

one factor in determining the amount of light that Sorne neurosurgeons prefer fiber-optic headlamps.

can be launched into the fibers. lt is one measure of Recently, surgical microscopes containing t h ei r own

the horsepower of the fiber optic illuminator. The illuminance source have been employed in dark­

an gl e /()f the exiting light also plays a factor in ened rooms. These microscopes may be c e i l i n g or

whether that l i g h t makes it into the fiber or whether wall mounted. Neurosurgeons often require a hori­

it gets attenuated or reflected. One method of mea­ zontal (rather than vertical) light beam. Thus, lumi­

s u r i n g this exit face l i g h t energy is to place a l i g h t naires are needed that can be brought as clase to

meter at the exit face of the i l l u m i n a t o r . the task as possible.

Occasionally, a m i n i a t ur e television camera and a 4 . 1 2 . 4 Orthopedic Surgery. The lighting needs of

h e a d l i g h t are both mounted on the headband. The orthopedic surgery are like those of general surgery,

camera is positioned coaxially between the sur­ but better x-ray e q u i p m e n t may be necessary. This

geon s eyes and the headlight is placed on the fore­ x-ray e q u i p m e n t , and its m o u n t i n g , must be coordi­

head. This is not a desired practice because either nated with the lighting system. Frequently there

the resultant video is of poor quality or the illumi­ needs to be a l u m i n a i r e positioned on the side of the

nance is too low for effective viewing. operating table for low level l i g h t i n g of the patient s

hip. Fluoroscopy with i m a g e intensification (or tele­

4.12 Specialized Operating R oom s vision) permits use of a lighted room. Extra negato­

scopes (viewing boxes) are u s u a l l y utilized for such

4.12.1 Eye Surgery. Rooms used for eye surgery procedures.

contain a fixed pedestal or c o l u m n connected t o a n

operating microscope. This e q u i p m e n t may contain Orthopedic surgeons also use the surgical micro­

luminaires and beam-splitting devices that permit scope and sometimes employ l a m i n a r airflow cham­

viewing by more than one person and an electro­ bers when i m p l a n t i n g new joints. However, convec­

magnet for removing ferrous particles from the eye. tion currents from surgical luminaires can disturb

Camera or television e q u i p m e n t may be attached, laminar airflow. These s i tuations are difficult to

and lasers may be present. avoid . Assuming the overriding needs of surgical

task illuminance are met, surgical luminaires that

General room i l l u m i n a n c e is n o m i n a l l y the same as interfere the least with air currents s h o u l d be chosen.

found i n the general operating room. The eye sur­

g e o n , however, w i l l sometimes require less general 4 . 1 2 . 5 Plastic Surgery. Operating r oom i l l u m i n a n c e

i l l u m i n a n c e and may prefer almost complete dark­ needs for p lastic surgery can be very d e m a n d i n g .

ness to reduce reflections from the eye s spherical They can encompass a l l the re q u i rements t h u s far

surface. T h u s , the ability to switch or d i m lamps to discussed and necessitate that a broad even i l l u m i ­

achieve lower illuminance while maintaining the nance extend over the body during sculpture. A

same illuminance uniformity become mandatory. plastic surgeon can be d o i n g craniofacial surgery on

The anesthesiologist may need separate l i g h t i n g to the head , operating deep inside the nasal cavity,

observe critica! e q u i p m e n t . using endoscopic tools, performing microsurgery

with the microscope, wor k ing on an a b d o m i n a l wall

Pendant c e i l i n g - m o u n t e d surgical lights are used to reconstruction, rebuilding a breas t , reattaching a

work on m u s c l e s , t i s s u e , and lachrymal g l a n d s sur­ limb, doing hand surge ry , or reconstructing almost

r o u n d i n g the eye. These lights s h o u l d be selected any part of the body.

by applying the surgical suite l i g h t i n g criteria to the

ophthalmologist s requirements. M ulti-team wor k occurs freque n tly, r e q u i r i n g m u l t i p l e

tas k heads and fiber optic sour c e s . M aximum i l l u m i ­

Heat produced by microscope l i g h t i n g needs careful nance ad j ustment ( from d i m o bright ) is essential to
t

consideration. (See Annex H . ) balance all the c o m m o n l y used l i g h t sources.

4 . 1 2 . 2 Ear, Nose, and Throat Surgery. The l i g h t i n g 4.13 Postanesthetic Recovery Room

needs of ear, nose, and throat s u r g e ry are identical

to those of eye surgery. Microscopes are used for M eticulous monitoring and emer g e nc y proc e dure

operations on the i n n e r ear. (See Annex H . ) Sorne ca p abilit y are c o m b i n e d i n the post a nesth e t ic recov-

24
 '
' A N S I / I E S N A RP-29-06

Figure 1 7 . This

recovery room

�=, � has ceiling­

mounted exam

lights, wall­

mounted

charting lights,

a n d a window

opening for each

bed location.

Individual

lighting controls

are required.

ery room. (See Figure 1 7 . ) C h a n g e s in the patient s 4.14 Cystoscopy Room

skin color must be immediately evident. And vari­

able light is needed so oscilloscope presentations Cystoscopy is normally carried out by an urologist

(electroencephalographic and electrocardiograph) seated in a dark room, but the cystoscope is intro­

can be recognized. duced i n a líghted room. For female procedures, a

gynecologic examining light should be provided.

Patients, recumbent and f u l l y s u p i n e , w i l l be looking F l a m m a b l e anesthetics are not u s u a l l y used, so the

into a ceiling luminaire (if conscious). Thus glare l u m i n a i r e s h o u l d be positioned just above the urolo­

and heat must be avoided. Uniform lighting from gist s s h o u l d e r .

large area l i g h t sources (such as 2 ft. x 4 ft. pris­

matic lens troffers) can work well but w i l l not provide R oom darkening s h o u l d be possible w ith switch ng i

t h r e e - d i m e n s í o n a l detail of patients if such detail is or d i rn m ing . T he lowest l i g h t level s h o u l d still permit

i m p o rtan t . the anesthesiologist to see the e q u i p rn e n t and rec ­

ogni z e t he patient s skin color . U nli k e open surger y,

lmportant tasks may take place in the post anesthe­ the anesthesiologist cannot see the patie n t s b lood

sia recovery area that d e m a n d s three d i m e n s i o n a l to recognize color c h a n g e s .

detail and good visualization for healthcare

providers and patients. Dual level lighting control S urgical lighting capability, centered to illu rn inate

should be considered that can be d i rn for patient the lower end of the cystosco p ic table , should be

comfort yet bright far tasks when needed. This addi­ available fa r sorne o p era ti ve procedures. O t h er

tional lighting should be able to illuminate a large l i g h t i n g directed toward the anesthesia instru m enta­

surface area of the patient far evaluation of the tion is also v a l u a b l e .

patient.

4 . 1 5 N o n u o o
r l g ic Endosc o py R ooms

Low a m b i e n t l i g h t levels are also needed far certain

emergency procedures (such as laryngoscopy), so Typical procedures i n the n o n u r o l o g i c a l endoscopy

l i g h t reduction capability s h o u l d be available. room are esophagoscopy, gastroscopy , proctosig­

moi d oscopy, an d colonoscopy. T he surgical s te i

Windows, though often required and desirable for may be viewed directly through optical instru m ents .

orienting patients, can produce special light, heat, Thes e i n s t r u rn e n t s are introduced in subdued

and humidity p r ob l em s . light , ad ustable

j to near darkness durin g clinical

25
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A N S I / I E S N A RP-29-06

Figure 1 8 .

Birthing rooms

often feature a

home-like

atmosphere

within the

institutional

setting.

observation. The rooms should have peripheral " b i r t h i n g rooms" for observation, labor, and delivery

lighting, downward-dimmable from 1100 lux (11 O d u r i n g routine births. S u c h rooms have a "home like"

fe), and severa! outlets for fiber-optic illuminators atmosphere (See Figure 1 8 ) and contain a specíal­

and other e q u i p m e n t . ly designed " b i r t h i n g bed." (See Figure 1 9 . ) A mov­

able examination light should be available. Sorne

For most forms of endoscopy, i n c l u d i n g laparoscopy, facilities i n c l u d e c e i l i n g - m o u n t e d narrow-beam spot­

arthroscopy, and cholecystectomy, video is rapidly lights over the foot of the bed w h i l e others have l u m i ­

replacing direct optical viewing. The optics feed a naires hidden in the c e i l i n g (until needed) that can

tiny video camera and the surgical site image is extend down into the room during the delivery.

enlarged and shown on a monitoring screen. Sorne Guidelines s i m i l a r to those used for the operating

surgeons prefer a p a r t i a l l y - d i m m e d room so back­ room (see Section 4 . 1 1 . 1 ) s h o u l d be followed. The

ground luminance levels are just below that of the l i m i t e d general i l l u m i n a n c e s h o u l d have good color

video monitor. rendering to detect cyanosis (blueness) or other vis­

1
ible c l u e s to the patient's c o n d i t i o n . º

These facilities need not be greatly different from

bronchoscopy. A c e i l i n g spotlight may be valuable to 4 . 1 6 . 2 Labor Rooms. Labor rooms are used by the

i l l u m i n a t e biopsy e q u i p m e n t . obstetric patient u n d e r stress. Monitors track uterine

contractions and the heart beat of the u n b o r n c h i l d .

A task l i g h t at s h o u l d e r height s h o u l d be available S u c h data may be p e r i o d i c a l l y printed out and must

for the sitting gynecologist during introduction of be observed by attendants. Examinations performed

peritoneoscopy and culdoscopy procedures. in t h i s room are u s u a l l y m a n u a l and do not require

Switching or dimming may be desirable for the visual control. However, blood pressure measure­

endoscopic procedure. ments and visual assessment of the patient's gener­

al status require good color r e n d e r i n g . Any cyanosis

4.16 Obstetric Delivery Suite must be obvious.

4.16.1 Birthing Rooms (LDRs or LDRPs).*** H i g h general l u m i n a n c e s h o u l d not be i n the recum­

Recently there has been a growing acceptance of bent patient's visual field. Reading lights can corn­

p l e m e n t the general l i g h t i n g . Horizontal task l i g h t i n g

should flood the lower abdomen and perineum. A

***Labor Delivery Recovery (LDR): newborn and mother are separated.
portable task l i g h t with a movable arm and castors
Labor Delivery Recovery and Postpartum ( L D R P ) : newborn and mother

remaln together. can do the job.

26
 A N S I / I E S N A RP-29-06

Figure 1 9 . (a) L D R P room in the recovery/postpartum mode where a multitude of

l u m i n a i r e s offer the occupant a wide variety of l i g h t i n g choices. (b) LDRP room in

the delivery mode where a portable task l u m i n a i r e provides additional i l l u m i n a n c e

for the obstetrician.

Walls w i l l u s u a l l y be of low reflectance and the ceil­ The d e l i v e ry room s general illuminance level

ing a sound-absorbing tile containing l u m i n a i r e s that should be s i m i l a r to an operating room. Typically,

can be easily c l e a n e d . Room colors s h o u l d be cho­ t h i s is achieved with recessed l u m i n a i r e s i n the ceil­

sen for v i s u a l comfort and emotional effect. Beds i n g . Here there is less competition for c e i l i n g space

s h o u l d be located with the windows to one s i d e . from other equipment and high CRI fluorescent

l a m p s are r e c o m m e n d e d .

4 . 1 6 . 3 Delivery Area. The delivery scrub area should

be i l l u m i n a t e d l i k e the surgical scrub area, with color The d e l i v e ry room task l i g h t s h o u l d focus and pro­

quality matching the delivery room task l i g h t . duce at least 25,000 l u x ( 2 , 5 0 0 fe) at its beam cen-

27
A N S I / I E S N A RP-29-06

ter at its m a x i m u m setting. ldeally, it s h o u l d be cen­ 4.17.2.1 Waiting Area. Waiting areas should be

tered over the shoulder of a sitting obstetrician. partially illuminated by windows that still insure

Since the delivering mother is conscious during patient privaey. Supplemental lighting should be

delivery, the task l i g h t output and position s h o u l d be adequate far r e a d i n g , but s u b d u e d . Points of inter­

adjustable to accommodate her comfort. Mounting est, such as flower arrangements s h o u l d be e m p h a ­

2
should be in accordance with NFPA 99. º Portable sized. (Deeorative table lamps add a warm ambi­

units are also available. I n sorne d e l i v e ry rooms the ence.) lndirect lighting can help achieve a restful

anesthesiologist will ban flammable anesthetics, atmosphere.

removing the explosion hazard.

Planning should ensure that patients on wheeled

Delivery room wall and ceiling reflectance values stretchers do not look directly into any light source.

should be the same as in the surgical operating

room. 4.17.2.2 General Radiographic/Fluoroscopic

Room. Most fluoroscopy is now performed with

A special lighting plan should exist for the area image intensification and a television screen.

where newborn infants are resuscitated. The light­ Rooms with image intensifiers require l i g h t d i m m i n g

i n g s h o u l d have good color rendering capability, par­ switches - 1 0 0 0 - 1 5 0 0 lux ( 1 0 0 - 1 5 0 fe) d i m m e d to

ticularly for identifying cyanosis and jaundice. 20 l u x (2 fe) - but complete darkness is no l o n g e r

However, the newborn must be protected from necessary. The general lighting should have d i rn ­

excessive i l l u m i n a n c e . m i n g capability as i n d i v i d u a l radiologists prefer dif­

ferent ambient l i g h t levels.

4.16.4 Post-Dellvery Recovery Area. A task light

with good color rendering s h o u l d be provided in the C e i l i n g space is at a p r e m i u m in radiography/fluoro­

postdelivery recovery area for i l l u m i n a t i n g the per­ scopic rooms. Luminaire placements must avoid

ineum. In addition, soothing, low-level, residential­ conflict with the raceways and tracks required far

type lighting is recommended. Visitors and family medical equipment. (See Figure 20.) These con­

may be present, so a flattering l i g h t quality is also flicts make perimeter lighting units almost impera­

important. tive. Dimmable l i g h t sources - 750-1500 lux (75-

1 5 0 fe) d i m m a b l e to 20 lux (2 fe) - s h o u l d be used

4.17 Radiographic Suite when a i m i n g x-ray tubes and viewing image intensi­

fier screens.

4.17.1 General. The modern radiographic suite

involves a wide variety of visual tasks performed I n many rooms a m i n o r surgery task l i g h t producing

with complex equipment. Most radiographic hard­ about 2000 lux (200 fe) s h o u l d be provided for spe­

ware has vertical-horizontal mobility. The lighting cial procedures, which include bronchial brushing,

must be p l a n n e d with care, taking into consíderatlon intravenous medication, sialography, arteriography,

the radiologic p e r s o n n e l and the need to minimize bone marrow biopsy, and myelography. An infrared

glare, which can disturb patients. Furthermore, filtered spot lamp in the c e i l i n g may be needed far

patients are often apprehensive about t h e i r appear­ frequently performed tasks. A m o b i l e floor lamp may

ance, so flattering ( h i g h C R I ) incandescent or fluo­ be used if the surgeon prefers.

rescent l i g h t i n g is preferred. Since radiologists fre­

quently view video screens, dimmer switches in Light-intensive procedures s u c h as lymphangiogra­

each diagnostic or treatment room are needed. phy are sometimes carried out i n the radiology suite.

l l l u m i n a n c e v a l u e s may range from 20 to 2000 l u x (2 In this case an operating room light producing

to 200 fe). The higher illuminance levels in that 25,000 lux (2,500 fe) s h o u l d be available and oper­

range are needed d u r i n g room c l e a n i n g and when ationally flexible. Many hospitals have a separate

patients are transferred on and off radiology tables. suite far cardiac catheterization. While no unusual

Sorne radiology rooms require special task lights far l i g h t i n g d e m a n d s are present i n these rooms, d i m ­

i n s e r t i n g needles and catheters. A v i s u a l adaptation ming must be available when special procedures

period must follow these procedures when the radi­ are performed.

ologist prepares to view the video screen. Radiology

room l i g h t i n g needs can vary from hospital to hospi­ Like the cardiac catheterization room, the emer­

tal d e p e n d i n g on the procedures performed. gency angiography room needs a minor surgery

task l i g h t u p to 25,000 lux (2,500 fe) for introducing

4 . 1 7 . 2 Diagnostic Section. For its diagnostic mis­ n e e d l e s , good general l i g h t i n g of 7 0 0 - 1 5 0 0 lux (70-

s i o n , the r a d i o g r a p h i c suite i n c l u d e s a waiting room, 1 5 0 fe) for patient transfers and c l e a n i n g , and l i g h t

general fluoroscopy, a bariurn kitchen, and f i l m and d i m m a b l e to 7 l u x ( 0 . 7 fe) for viewing i m a g e intensi­

digital image processing/viewing f a c i l i t i e s . fier screens.

28
 , A N S I / I E S N A RP-29-06

4 . 1 7 . 2 . 4 Film Sort Area. Most modern suites con­

tain a room where ñ l rn s are sorted and prepared for

reading. Such a space contains one or more

negatoscopic u n i t s . General lighting should supply

2000 lux (200 fe) a t a standing bench 9 1 cm (38 i n . )

high. Good color rendering is not an important

requirement here.

4.17.2.5 Barium Kitchen. The barium kitchen

should have overhead l i g h t i n g that produces 1100

l u x ( 1 1 O fe) with additional l i g h t i n g underneath those

storage cabinets that hang over the work surface.

The availability of "ready mixes" has permitted de­

emphasis of l i g h t i n g in t h i s area.

4.17.2.6 Dark Room. Lighting requirements are

m i n i m a l far dark rooms. Safe lights must be avail­

able and selected to match the f i l m type. General

lighting with a protected switch (prevents inadver­

tent actuation) is necessary far cleaning. Double

doors or opaque rotating doors assure that light

does not enter accidentally. Dark rooms are being

supplanted by daylight developing systems and

conveyor systems that feed sheet f i l m directly from

the f i l m i n g u n i t to the processor.

4 . 1 7 . 3 Radiation Therapy Section. Those seeking

radiation therapy are often depressed cancer

patients so psychological considerations are

extremely important. Lighting can do m u c h to ele­

Figure 20. L i g h t i n g in radiology or x-ray rooms
vate t h e i r mood. The waiting space ( u s u a l l y s m a l l e r
requires careful coordination with the ceiling tracks

that support the machinery. than the therapy area) s h o u l d follow the g u i d e l i n e s

of the diagnostic space.

4 . 1 7 . 2 . 3 Viewing Rooms. I n the viewing rooms with I n teletherapy camera rooms and patient radioiso­

traditional film images, the general overhead l i g h t i n g tope rooms, overhead lighting should be unobtru­

is subordinate and only used when no f i l m is b e i n g sive. Dimmable indirect (valence) lighting may be

inspected. D u r i n g viewing of traditional f i l m s , a l l i l l u ­ helpful. Wall murals and other devices that soften

m i n a n c e w i l l be s u p p l i e d by the negatoscopic e q u i p ­ the "ultrascience" i m a g e s h o u l d be stressed.

ment (viewing boxes). About 700 cd/m2 (70 cd/ft.2) is

typically provided at the surface of these units, often I n the isotope kitchen, overall l i g h t i n g of 1 0 0 0 - 2 00 0
2)
augmented with another 500 cd/m2 (50 cd/ft. to lux ( 1 0 0 - 2 0 0 fe) s h o u l d permit the accurate reading

transilluminate dense films. An additional spotlight of instructions and syringes. Overhead l i g h t i n g can

unit is also often used. lt is worth noting that the produce specified i l l u m i n a n c e s at bench level w h i l e

advent of digital image technology is rapidly replac­ under-cabinet supplemental lighting can also ·be

ing the use of film images. With this technology, useful.

radiologic images are viewed on a video or comput­

er screen. This application is s i m i l a r to any comput­ 4.17.4 Diagnostic lmaging Techniques/Equip·

ar VDT. For detailed infarmation on l i g h t i n g for work­ ment. Computer-assisted tomography (CAT) e q u i p ­

spaces with v i s u a l display t e r m i n a l s , see American ment, magnetic resonance i m a g i n g ( M R I ) systems,

National Standard Practice far Office Lighting, and positron emission tomography (PET) units ali
4
ANSI/IESNA RP-1-04. require three basic spaces far control, power, and

scanning. Because the huge equipment appears

There may be an administrative work area i n or near i n t i m i d a t i n g , the patient s f i e l d of view in the scan­

the viewing room which w i l l need task l i g h t i n g far a n i n g area s h o u l d be v i s u a l l y relaxing and free from

dictation transcriber or computer workstation. A tran­ areas of uncomfortably high luminance. (See

sition zone is recommended to allow adaptation Figure 2 1 . ) View boxes and/or VDT are present i n

between the h i g h and low l i g h t i n g extremes. the control room. A u x i l i a ry l i g h t s and warning l i g h t s

29
A N S I / I E S N A RP-29-06

indicate that the e qu i p m e n t is in use. I n the sean­

ning room, general lighting should produce illumi­

nances of approximately 300-330 lux (30-33 fe) dur­

ing patient treatment and h i g h e r i l l u m i n a n c e s u p to

1 5 0 0 lux ( 1 5 0 fe) for patient transfer and for e q u i p ­

ment maintenance. Many patients experience

claustrophobia lying in the ring for CAT scans or

when placed inside the tube-like structure of MRI

units. Sorne may feel distraught contemplating the

radiation treatment they are u n d e r g o i n g . This feel­

ing can be m i n i m i z e d with soft l i g h t i n g and pleasant

images or interesting c e i l i n g features. For this rea­

son, the general lighting s h o u l d be adjustable with a

dimming system to produce an environment com­

fortable and calming for the patient. (See Figure

22.) The lighting for each diagnostic installation

must be individualized as installations differ widely.

4.18 Dialysis U n i t

The dialysis u n i t removes wastes or toxins from the

patient s blood, a process normally performed by

the kidneys. Dialysis unit l i g h t i n g m u s t :

• Provide e n o u g h l i gh t so the staff can set u p

e q u i p m e n t , attach it to the patient, observe

e q u i p m e n t g a u g e s , observe the patient, and

clean u p after treatment.

Figure 2 1 . Sorne type of ceiling feature or design

element should be provided for spaces containing

magnetic resonance imaging ( MR I) systems and

• Be comfortable. Patients are attached to the

other s i m i l a r equipment. e q u i p m e n t for u p to 1 5 h o u r s . (See Figure 23.)

Figure 22. Patients

can be comforted

with something

pleasant to view

while lying prone

for exams or

treatment.

Graphics of the

sky, especially

with modulated

l i gh ti n g, is an

example of this

approach.

30
 - A N S I / I E S N A RP-29-06

Figure 23. Patlents

undergoing dialysis

or chemotherapy

infusion should have

a comfortable

environment with

daylight views (as

shown)becausethey

must remain

i m m o b i l e for an

extended period.

Provide interestlng

exterior lighting

when these spaces

are also used d u r i n g

night time hours.

Figure 24. Each

patient chair in t h i s

dialysis unit is

provided with an

individually­

controlled luminaire.

Dimmable controls

enable each patient

to select the light

level they personally

desire.

Local l i g h t i n g is u s u a l l y required for placing c a n n u l a Waiting area design s h o u l d consider the emotions of

and making connection from patient to cannula. A patients frightened by dialysis treatment. The light­

spotlight providing 2000 l u x (200 fe) is recommend­ ing should give a "homelike,'' non-institutional
23
ed. The lighting color quality should enable visual atmosphere.

detection of cyanotic skin coloring.

4.19 C l i n i c a l Laboratories

During treatment, the patient may wish to read,

sleep, watch television, or simply relax. Reading 4.19.1 General. Hospital laboratories perform tests

l i g h t controls s h o u l d be convenient for the patient. on patient body f l u i d s and tissues. Laboratory suites

Wall and c e i l i n g colors s h o u l d be considered from may comprise facilities for cherntstry, hematology,

both a visual and psychological perspective. Many microbiology, and nearby support areas (such

patients have a sallow complexion. Flattering light as blood banks). Here, specialized test e q u i p m e n t

( h i g h red content) may improve t h e i r sense of well and personal computers are in constant use.

b e i n g . (See Figure 24.) Recommended are easily cleaned direct, direct/indi-

31
A N S I / I E S N A RP-29-06

rect, or indirect luminaires with lenses, louvers, 4.20.1 Specimen Collecting (Venipuncture) and

and/or reflectors that minimize glare on VDT Donor Areas for the Blood Bank. Specimen col­

screens. Where cabinets are mounted above coun­ lecting areas draw blood from patients for laborato­

ters, under-cabinet local task lighting can reduce ry tests. Patients spend from five to 15 minutes

shadows on the counter top. here. Task lighting is usually required on the

venipuncture site at counter top, armchair, or bed

4.19.2 Laboratory Types. Clinical laboratories for height. Oblique i l l u m i n a n c e s h o u l d come from c e i l ­

chemistry, hemato/ogy/sero/ogy, uríno/ogy, toxíco/o­ ing l u m i n a i r e s or task lights because v e i n s are best

gy, and hísto/ogy!cytology are common to a health seen in other than flat light. The walls should be

care facility. The next five sections present a brief pastel with a matte f i n i s h for patient and donor com­

description of t h e i r functions. fort. Walls with 45 to 50 percent reflectance are also

acceptable so long as they are not specular. Waiting

4.19.2.1 Chemistry Laboratory. Chemistry labora­ areas (if provided) s h o u l d be l i g h t e d to give patients

tories study specimen s a m p l e s to isolate and identi­ a reassuring atmosphere.

fy disease-causing organisms. Specialty laborato­

ries found within one main laboratory may include 4.20.2 Microscope Reading Room. Pathologists

virology (viruses), parasitology (parasites), bacteri­ spend considerable time reading microscopic mate­

ology (bacteria), mycology ( f u n g í ) , and i m m u n o l o g y rial. T h e i r microscope tables - placed 8 1 O mm (32

( i m m u n e system). Visual comparisons of test tubes, i n . ) above the floor - are u s u a l l y f i n i s h e d with a low­

petri dishes, reagents, and stains require lighting reflectance countertop material. The room lighting

sources with good color rendering. Higher illumi­ should be adjustable for long-time viewing. While

nances are also recommended for reading culture special lighting is not required when slides are

plates and microscope s l i d e s . viewed on a video monitor, v i s u a l comfort s h o u l d still

be considered.

4.19.2.2 Hematology/Serology Laboratory.

Hematology laboratories analyze blood samples 4.20.3 Blood Ba n k . Blood banks store blood and

(red and white blood c e l l count, and platelets). Self­ blood components and allow the testing, typing, and

i l l u m i n a t e d automated processors and microscopes cross-matching of blood for transfusions. Bench­

may allow reduced general l i g h t i n g levels. Serology mounted equipment includes microscopes, cen­

laboratories study blood to detect the presence of trifuges, and incubators. The refrigeration may have

antibodies. integral l u m i n a i r e s .

4 . 1 9 . 2 . 3 Urinology Laboratory. U r i n o l o g y laborato­ 4.20.4 Central Sterile Supply. The central sterile

ries prepare and analyze urine samples. Bench­ s u p p l y provides infection control. Soiled goods, s u r ­

mou nted automatic analyzers and centrifuges are gical instruments, and l i n e n are b r o u g h t to dedicat­

the typical e q u i p m e n t u s e d . ed rooms for d e c o n t a m i n a t i o n . Washed goods are

sterilized and placed in sterile storage. Washed

4 . 1 9 . 2 . 4 Toxicology Laboratory. Toxicology labo­ l i n e n is inspected, packed, and stored.

ratories analyze blood for d r u g s , c h e m i c a l s , or other

toxic substances. The inspection area should have general lighting

while special areas where delicate equipment is

4 . 1 9 . 2 . 5 Histology/Cytology Laboratory. Histology e x a m i n e d s h o u l d have increased i l l u m i n a n c e .

laboratories prepare microscope slides of tissues

removed d u r i n g surgeries or autopsies. Pathologists In the decontamination area, illuminance levels at

then examine the slides to determine or confirm the washers and sterilizers s h o u l d permit safe load­

diagnoses. Cytology laboratories prepare and read ing and u n l o a d i n g . (See Figure 25.) D u e t o the h i g h

microscope s l i d e s of exfoliated c e l l s (pap s m e a r s ) . humidity near this equipment, wet- or damp-rated

Tissue preparation is done at stand-up workstations l u m i n a i r e s s h o u l d be considered.

with sit-down workstations used for v i e w i n g . These

spaces hold microscopes and automatic staining Sterile assembly areas consist of large counters

m a c h i n e s . Light sources with excellent color render­ where the washed goods are packed for f i n a l steril­

ing s h o u l d be e m p l o y e d . ization. Luminaire locations should be coordinated

with the counter layouts. Stainless steel counters

4.20 Laboratory Support Areas may require reflected glare consideration.

Laboratory support areas provide ancillary functions Sterile storage holds goods for distribution t h r o u g h ­

necessary for laboratory operation. Most are located out the hospital. Luminaire locations s h o u l d be coor­

near the laboratory s u i t e . dinated with storage rack placement for aisle l i g h t i n g .

32
 •
� A N S I / I E S N A RP-29-06

Figure 25.

Luminaires in

the central

sterile supply

decontaminati

on area may

need to be

wet- or damp­

rated d u e t o

the h i g h

humidity

conditions

expected.

4 . 21 Cardiac and Pulmonary Function 4.22 Dental Suites

Laboratories

In the dental operatory the luminance differences

4.21.1 Cardiac Function Laboratory. In the car­ between the patient s mouth, face, and b i b , relative

diac function laborator y , re c umbent p atients are to the instrument tray (and surrounding areas)

susceptible to ceiling glare. C eiling luminaires should be no greater than three to one. However,

should be shielded and the general room lighting many dentists prefer 24,000 lux (2400 fe) or more

should ha v e dimming c apabi l it y . Small changes in on the patient, w h i c h can push t h i s l u m i n a n c e ratio

oscillosco p e screen patterns ( di ff icult to study u n d e r higher.

full i l l u m i n a n c e ) must be o b ser v ed. Ad j acent to the

oscillosco p e there are o f te n switches and d i a l s that L i g h t i n g s h o u l d be provided at the level of the d e n ­

must be seen clearl y . tal patient s face and the instrument tray. For an

acceptable surrounding luminance, the ceiling

Glass covers that protect instrument faces can pro­ should be a near-white sound-absorbing material

duce v e i l i n g reflections, particularly i n h i g h ambient with at least 70 percent retlectance : walls should

light situations. This can sometimes be remedied have a l i g h t finish with a b out 6 0 per-cent re f l ectance .

with a s h i e l d or by s l o p i n g the i n s t r u m e n t face away F loor reflectances should be 20 to 40 p ercent . T he

from the normal l i n e of sight. (See Annex C . ) general l i g h t i n g color quality must e n a b l e the d entist

to match f i l l - i n g and tooth colors. A window can h e l p ,

Larger e q u i p m e n t , such as ergonometric bicycles, but daylight may not al w ays be available. R ecent

must also be i l l u m i n a t e d . A writing desk and desk ad v ances now i n c l u d e a s m a l l camera that c an be

lamp are u s u a l l y present for recording results. inse rt ed in the oral cavity. A monitor ad j ace n t to the

patient s chair allows both the dentist and patient to

4 . 2 1 . 2 P u l m o n a r y Function Laboratory. I n the p u l ­ v i ew the magnified image. VD T glare nee d s to be

monary function laboratory, there are meters that considered in these types of a p plications .

must be read and tape recorders that need fine

adjustments. Good color rendition l í g h t i n g is helpful. O ral cavity lighting should be supplied f rom an

ad j ustable luminaire that k eeps high illuminance

4.21.3 lnhalation Therapy Units. Most inhalation away from the patient s eyes, yet pro v ides l i g h t the

therapy is carried out in sm a l l c u b i c l e s . The patient dentist needs to see fine detail. T he l i g h t le v el and

is seated facing the e q u i p m e n t for a relatively short its color characteristics should be suita b le f or the

time. Sometimes there are printed instructions, color matching of teeth , f i l l i n g s , and for f i n d i n g a ny

which the patient may read. denture o c c l u s i o n s . Ade q uate l i g h t i n g is also i rn p o r ­

tant to j u d g e d r i l l i n g depth i n preparation for f i l l i n g s .

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A N S I / I E S N A RP-29-06

Figure 26. An

adjustable task

l u m i n a i r e provides

the dentist or oral

surgeon with

adequate i l l u m i n a t i o n

· of the oral cavity.

lncreased use of

television monitors

for the staff and for

patient viewing

during dental

procedures s h o u l d

be considered.

Shadow-reduced l i g h t at the oral cavity is important. tional l u m i n a i r e s or portable lights (coupled with a

A l u m i n a i r e about 70 cm (2.3 ft . ) away s h o u l d l i g h t lower level of general i l l u m i n a n c e ) provide l i g h t i n g at

an elliptical area with a feathered cutoff to protect the the center of the operating area. Such luminaires

patient s eyes. (See Figure 2 6 . ) Such a source is are usually adequate far examination and emer­

s i m i l a r to those developed for surgical l i g h t i n g . Refer gency surgery. (See Figure 27.) Caution must be
24
to ISO 9680 for detailed dental l i g h t requirements. exercised because emergency room task lights are

often old, low quality operating room lights that cre­

Laboratory prosthetic work requires speed, accura­ ate h i g h shadows and lack adjustability. These less­

cy, and close inspection. Therefore, the general er quality l u m i n a i r e s cause discomfort for the patient

lighting should be provided with supplementary and fatigue for the s u r g e o n , especially when emer­

l i g h t i n g at each workbench. gency procedures are performed on patients u n d e r

local anesthesia. Headlights can sometimes be used

Good color matching is vital to dental prosthetics as a supplement, but this may create an unpleasant

and s h o u l d take place u s i n g l i g h t the patient w i l l nor­ i l l u m i n a n c e differential with the instrument stand.

mally be seen under. Metamerism of artificial versus

natural teeth poses a great c h a l l e n g e , considering R e p a i r of lacerations and treatment of wounds are

that the teeth w i l l eventually be seen u n d e r a variety frequently performed in the emergency room. This

of l i g h t sources meticulous work has the same i l l u m i n a n c e needs as

surgery in the operating room. However, the surgical

lf a dental suite has a separate recovery room with field is often much s m a l l e r i n the emergency room

low-level l i g h t i n g , a provision for h i g h e r i l l u m i n a n c e and procedures can be quite long and d e m a n d i n g .

may be needed to handle emergency examinations. Balance between ambient and task illuminance is

essential.

4.23 Examination and Treatment Rooms

Sorne emergency suites contain a "trauma r o o m . " lt

In addition to the recommendations in Section should be lighted like a large operating room with

4.3.5, for examination and nonsurgical treatment, the capability of i l l u m i n a t i n g multiple surgical sites on

consider supplementing the general lighting with a s i n g l e patient so that severa! surgeons can work

additional lightíng on the examination table. There simultaneously. Since few patients are moved from

should be a special lamp here for gynecological trauma to the main surgical suite, it is imperative to

inspection. consider proper lighting systems for this space.

4.24 Emergency Suite 4.25 Fracture Room

The emergency suite should be self-suffícient to The fracture room requires only the illuminance

handle most cases. Fixed ceiling-mounted direc- needed for s u p e rf i c i a l surgery.

34
 � A N S I / I E S N A RP-29-06

Figure 27. Each

patient area ln

the emergency

suite is provided

with separately­

controlled

general lighting

and specialized

task l i g h t i n g for

performing

minar surgical

tasks.

4.26 Autopsy Suite 4.27 Physical Therapy Suites

Essentially the same illuminance is needed for Gymnasiums, tank rooms, and treatment areas

autopsies as for major surgery. However, due to the require moderate illuminance. The most demanding

absence of deep cavity procedures, narrow-beam visual tasks here (reading notes and charts) are of

light intensity is less critical, While dissection is s h o rt duration.

meticulous and tissue planes must be visualized,

careful placement of sutures and instruments to Room finishes should be pastel shades having 40 to

control bleeding are not required. 70 percent reflectance.

Three types of lighting can be found in the autopsy 4.28 Pharmacy

suite:

Optimum pharmacy illuminance is essential. Small

Task Líghting - The surgical-type task light must be print on labels, and the counting, weighing, and

an adjustable, concentrating light source. Both task identification of drugs creates an extremely

and ambient illuminance sources require balance demanding visual task. Most work is done at coun­

and must provide good color rendition for tissue ters 91 cm (36 in.) above the floor. Overhead light is

recognition. The autopsy table work plane is 76 cm not enough and supplemental task lighting is

(30 in.) above the floor. required. (Any person working here casts shadows

on the work area.) Options include cool-operating,

Ambient Lighting - The same ambient lighting used glare control luminaires placed on the underside of

for s u r g e ry should be available: Lighting that can wall cabinets - or adjustable task lights. The phar­

reduce contrasts and permit small perimeter instru­ macy s upper walls and ceiling should be a light

ments to be seen. Floor, wall, and ceiling finishes color with high reflectance.

should have 50 to 80 percent reflectance.

Refer to special luminaire requirements in the tire

Morgue Líghting - General ambient lighting suit­ prevention codes whenever flammable liquids are

able for reading pencil and typewritten notes is stored or used in the pharmacy.

required. Floor, wall, and ceiling finishes should cor­

respond to those in the autopsy room. Shadow-free high intensity light should illuminate

the laminar flow areas where fine dosages are mea-

35
 A N S I / I E S N A RP-29-06

s u r e d . The visual task is e q u i v a l e n t to the prolonged 4.31 Other Service and Business Areas

reading of p e n c i l h a n d w r i t i n g .

Practically all of a health care facility s general ser­

S i n c e little c o l o r matching or c o l o r recognition is per­ vice areas (entrance foyer, offices, food service,

formed h e r e , l i g h t source color rendering is not crit­ laundry, parking lots, loading docks) are the same

leal. But the h i g h theft potential means that partial as the corresponding areas of other commercial

lighting during nonworking hours is desirable. buildings. Details on l i g h t i n g these areas are found

Emergency l i g h t i n g is also required as set forth in in other IESNA publications (available via

· federal/state/provincial cedes. http://www.iesna.org). I n areas where patients may

be transported on gurneys or by other means where

4.29 Medical lllustration Studio the patient w i l l be l o o k i n g directly at the c e i l i n g , light­

ing s h o u l d be provided by indirect l u m i n a i r e s , h i g h ­

General room l i g h t i n g for a medical illustration stu­ level wall sconces, or strategically placed direct

d i o s h o u l d be variable. F u l l output s h o u l d be 2000 luminaires that keep the light source out of direct

lux (200 fe) in the "shooting" area. A n o n d i r e c t i o n a l , line of the patients direct view.

even light throughout permits hand-held camera

work. The c o l o r quality of the l i g h t s h o u l d be as the Entrances must provide appropriately lighted

photographic f i l m requires. . spaces to a l lo w transition trom the exterior to the

interior and visa versa where illumination levels in

Electric outlet strips should be at shoulder height each of those discreet spaces may be quite different

along a wall that is never used as a background. d e p e n d i n g on the time of day. The person may be

These provide power for local lighting equipment. momentarily unable to distinguish the location of

Especially desirable are ceiling-mounted power steps or be able to read directional signage w h i l e

tracks to carry other l i g h t i n g . t h e i r eyes adjust to the new l i g h t i n g level. The rate

the eye can adapt to changes in i l l u m i n a t i o n levels

P a l e, neutral colors s h o u l d be on the walls and floor. significantly slows as a person ag e s. Use of daylight

White light, reflecting from a colored surface, will in the architectural design of entrys will help to

add tint to any color photo. address this i n a natural m a n n e r .

4.30 Geriatric Facilities Stair treads, l a n d i n g s , and handrails s h o u l d be i l l u ­

minated sufficiently for emergency egress condi­

Geriatric facilities are similar to nursing homes. t i o n s as a m i n i m u m (see Section 4.32 and Table 1 )

Those knowledgeable about the elderly s h o u l d be as well as h i g h e r levels if intended for frequent use

consulted as the aging eye needs more light for by personnel. Designers should select and locate

ordinary seeing tasks and exhibits greatly increased luminaires to evenly light the treads and landing.
11
g l a re sensitivity. Refer to ANSI/IESNA RP-28-98 Shadows w h ic h obscure the definition of step edges

for additional information. must be avoided.

Most a g i n g eyes have sorne opacity (cataract) and 4.32 Emergency Lighting

lens yellowing. lf the cataract is removed, the

patient s retina may be particularly sensitive to ultra­ Emergency l i g h t i n g is needed to h e l p perform two

violet l i g h t . W h i l e recent l e n s i m p l a n t s take this into essential tasks:

consideration, special evaluation is required of any

25
geriatric l i g h t i n g d e s i g n . • Evacuate patients u n d e r adverse conditions
19
(Lite Safety per NFPA 7 0 ) .

Basic i l l u m i n a n c e can be provided with fluorescent

lamps. U ni ts d e s i g n e d for hospital rooms may pro­ • Provide life-support services to patients who
19
vide adequate l i g h t i n g for the o l d e r person. A d d i n g cannot be evacuated (Critica! per NFPA 7 0 ) .

supplemental reading lights is recom-mended to

create at least 50 percent more localízed illumi­ The job may be considered i n terms of two emer­

nance. D i m m i n g capability helps avoid glare when gency l i g h t i n g systems: ( 1 ) A low i l l u m i n a n c e system

special (large-type) reading matter is u s e d. Also, allowing ambulatory mobility; (2) A higher illumi­

reading lamps should be easily adapted to the nance system (equal to the r e g u l a r l i g h t i n g ) i n areas

patient s prone 'or seat-ed posture. The l ig h t s h o u l d where critica! care or surgery takes place.

be adjustable so it does not produce direct or

reflected g l a r e .

36
 A N S I / I E S N A RP-29-06

With more electrical power used i n operating rooms cannot quickly adapt to. Temporary v i s ibi l ity reduc­

and critica! care areas, increasingly r e l i a b l e electri­ tions occur whenever the eye is torced to look at

cal service is needed. Regular room lighting widely different l u m i n a n c e s . (See Section 5 . 3 ) .

becomes the emergency lighting whenever critica!

care areas switch from normal to emergency power. 4.34 A m b u l a n c e Lighting

(See NFPA 99 for information about essential elec­

trical systems for hospitals.)" Where l i g h t i n g is concerned, an ambulance interior

s h o u l d be treated as an examination and treatment

The r e mai n i n g hospital areas s h o u l d have low-level room (see Section 4.23). For further information,

emergency l i g h t i n g to give the l u m i n a n c e levels rec­ see requirements for patient compartment i l l u m i n a ­

ommended i n Section 5.4.3. This l i g h t i n g s h o u l d be tion described in Federal Specifications for

27
directed at the task area. Guidance through a Ambulances and other applicable state or local

smoke-filled area with light at floor level may be specifications.

more important than i l l u m i n a t i o n intensity. A n u m b e r

of different designs w i l l work in accordance with the

19
National E/ectrical Code (NFPA 70) and other 5.0 C R I T E R I A FOR HEALTH C A R E FACILITY

applicable codes. Battery power provided to one or LIGHTING

more lamps (in selected multiple-lamp fixtures) is

one method used to meet current code require­

ments for emergency l i g h t i n g . However, connecting 5.1 General

to the on-site emergency generator is the most often

u sed method. Criteria for health care facility l i g h t i n g are based on

the h u m a n visual response as l i g h t i n g and environ­

4.33 Lighting for Safety mental conditions vary. They relate to psy­

chophysics (sensations that correspond to mea­

The health care facility l i g h t i n g design s h o u l d com­ sured amounts of i n c o m i n g light) and to psycho/ogy

pensate for human limitations. lt is easier to see (an observer s response to brightness, color, and

u n d e r low-light conditions when objects in the envi­ the color rendering qualities of i l l u m i n a n c e ) .

r o n m e n t have a pronounced value contrast (relative

to t hei r background). This is p a rt i c u l a r l y important Special conditions, such as those found in patient

where surface levels c h a n g e , such as at stairs and care areas, may require different i l l u m i n a n c e levels.

l a n d i n g s , parking curbs, and car stops. Where safety is a factor, higher levels may be

required. (See Section 5.4.4.) In other situations,

Any factor that aids seeing increases the probability such as for sorne endoscopy and radiologic proce­

that staff, patients, and visitors will detect danger dures, greatly reduced i l l u m i n a n c e levels, i n c l u d i n g

and act to avert accidents. S h i ft workers may be at total darkness, may be necessary. Where lig h t is

a h i g h e r risk for assault r e q u i r i n g additional security reduced or absent, alternate methods of ensuring

l i g h t i n g considerations. For more in-depth informa­ safe operations must be relied u p o n .

tion on this topic, see IESNA G-1-03 Guide/ine on

Securíty Lighting for People, Property, and Public The l i g h t i n g d e s i g n e r needs to understand lighting
26
Spaces. principies and how people respond to light. Such

knowledge, involving the production, control, and

When accidents are officially attributed to poor i l l u ­ distribution of electric and natural light, is basic to

m i n a n c e , the cause is often marked as "noticeably selecting the task illuminance and predicting per­

poor quality of i l l u m i n a t i o n " or "practically no i l l u m i ­ celved brightness. Perceived brightness of the task

nation at all." However, many more subtle illumi­ and its immediate s u r r o u n d - i n g s affects visual com­

nance problems can promote accidents. Sorne of fort and task performance.

these are: direct g l a r e , reflected g l a r e , harsh shad­

ows, and lack of v i s u a l cues (hazards inadequately 5.2 Lighting Design Procedure

marked). Even visual fatigue alone may lead to an

accident. Delayed eye adaptation experienced W h i l e the primary goal of a health care facility light­

when moving from bright s u r r o u n d i n g s into darker ing design is a des i r a bl e visual environment, the

ones (and vice versa) is also a factor. l i g h t i n g must also be compatible with all acoustical,

thermal, spatial, and aesthetio requirements.

M a x i m u m l u m i n a n c e ratios are important. A v i s u a l l y O p t i m u m d e s i g n is possible only when the architect,

safe installation must be free of glare and large, interior de s i gn er , e n g i n e e r , b u i l d i n g owner, and any

uncontrolled luminance differences that the eye spe-cialized consultants cooperate.

37
A N S I / I E S N A RP-29-06

Always evaluate alternatives. Compare potential 2) Find the d e s i g n criteria that are listed as

l i g h t i n g system solutions with user needs relative to: "very important," "important," or "somewhat

important" tor that application or task.

O
Visual comfort

• Compatibility with the architectural d e s i g n 3) Rev i e w the d i s c u s s i o n s of the design issues

• Coordination with c e i l i n g - m o u n t e d e q u i p m e n t in t h í s chapter to unde r stand the design

(x-ray m a c h i n e s , air g r i l l e s , sprinkler heads) cr i terion.

• Flexibility of l u m i n a i r e arrangement, location,

and orientation 4 ) R eview other chapters for discussions of ho w

• Compatibility with air c o n d i t i o n i n g design to appl y the relevant d e s i g n criteria for the

°䶭dž Compatibility with acoustical requirements p a rt i c u l a r applicat i on u n d e r considerat i on,

• Performance in meeting task l i g h t i n g and for a be tt er u n d e r s t a n d i n g of other

requirements criteria that might not be listed i n the d e s i g n

• Ease of access for c l e a n i n g and g u i d e , such as maintenance .

decontamination

• Aesthetics 5 ) R ev i ew the portion of this chapter discussing

• H u m a n response: physiological, psychological, i l l u m i n a n c e selection. U se pr o fessional

and social j u d g m e n t to decide if the values presented

• E c o n o m i c s : establishing and m a i n t a i n i n g the are j ust i fied given the specific situation and

system s i l l u m i n a n c e level is an ongoing relative im p ortance of other d e i g n i s s u e s .

expense. This includes i n i t i a l installed cost,

maintenance and other a n n u a l expenses, cost 6) Document the entire l i g h t i n g d e s i g n process,

of rearrangement, and depreciation/ including j u d g m e n t s for any deviations f rom

replacement costs the specific recommendations fa r every

design issue.

To h e l p the l i g h t i n g d e s i g n e r evaluate the criteria for

visual comfort and performance, the I E S N A devel­ 5.3 Design lssues

oped the " L i g h t i n g Design G u i d e " as p u b l i s h e d i n the

IESNA Líghting Handbook, Ninth Edition.' A Design 5.3.1 Appearance of Space and Luminaires.

G u i d e tailored specifically for Health Care Facilities A ppearance i n c l u d e s both the arrangement of ele ­

is presented in Section 5.4.2. The Design Guide ments, such as furnishings, in a space and their

format lists several design issues that are important relationship to one another . lt is important that the

for the visual environment. Each criteria is ranked st y le of the luminaires coordinate with, and

for a particular location/task in terms of importance: enhances, the d e s i g n and architecture of the space .

"very i m p o rt a n t , " "important," "somewhat important," L ighting can also help create an ima g e for a space

and "not important or not a p p l i c a b l e . " ( e.g., " casual," or " home y ," or "high - tech") and

esta b lish a mood.

Each of the design issues is discussed just ahead i n

Section 5.3 to give the reader a better understand­ Generally, lighting systems prov i de either di ff use

íng of each criteria and how it applies to Health Care light or focused highly directional l ight. "Point

Facilities. Many of the criteria are also discussed source" d irectional l i g h t , such as from incandescent

elsewhere in this Recommended Practice i n . the sources , can b ring out the sur f ace texture of ob j ects

context of a particular Health Care Facility or appli­ ( modeling). Di ff use light, such as from fluorescent

cation. A designer, with specific knowledge of a pro­ direct or indirect li g hting s y stems , can mas k form

ject and past experience, may deviate from the rec­ and texture . T h r e e - d i m e n s i o n a l tasks should be i l l u ­

ommendations presented in the Design Guide of minated with directional l i g h t complemented by dif ­

Section 5.4.2. The designer, however, is strongly fuse l i g h t to relieve harshness .

encouraged to document and explain any deviation

from the recommendations h e r e i n . The p hysical environment has a di r ect effect on the

h e a l i n g process . A pleasing en v ir o nment is not s i m ­

In summary, the suggested lighting design proce­ ply a luxury . lt promotes more e ff icient healing,

dure follows these steps: resulting in shorter stays, faster r ecovery of the

patients, and improved staff perform a nce . T hus,

1 ) G o to the D e s i g n G u i d e presented i n Section special consideration s h o u l d b e given to th i s issue

5.4.2 and find the application or task in w hen translating the architect s or interior desi g ner s

consideration. conce p ts into practica ! l ighting designs. O ne devel­

opment is the new trend of themed design w here

38
 A N S I / I E S N A RP-29-06

entire hospital floors are given a motif, such as have better red content than the older halo-phos­

"natura" or "sea lite." The pleasing environment that phor lamps in color temperaturas >3000 K. In a

results may justify a h i g h e r i n i t i a l cost. space with lower illuminances, visual acuity and

brightness perception can be improved by using

5.3.2 Color and Color-Rendering Capability of lamps with h i g h e r spectral power in the blue-green

the llluminance. I n the health care facility, colors range (frequently found in lamps with a CCT above

must be properly perceived in many situations. 4000 K). However, this s h o u l d be balanced with the

Secondarily, the needs of users for each space dic­ subjective aesthetic appearance of warmer sources,

tate the selection of surface color combinations, the which are often judged as visually pleasing at low

ligh t source color, and the color rendering capability illuminances.

of the l i g h t source. Selection s h o u l d involve consul­

tation with an architect and interior designar. Daylight (with a CCT of approximately 5000 K and

C R I of 1 0 0 ) is well balanced and renders object col­

In ali medical task situations, proper color percep­ ors accurately. Sorne electrical sources of "white"

tion and accurate color rendering are essential. For l i g h t at or above 5000 K have spectral power distrí­

the hospital staff, perceived color is mostly informa­ butions containing mostly b l u e and yellow cornpo­

tional. I n other situations involving the patient s food nents, with perhaps sorne green, but have inade­

and vísitors, perceived color is aesthetic and infor­ quate red-content (e.g., mercury-vapor and sorne

mational, yet no less important. metal-halide lamps) for accurate color rendition.

Lamps with CCT of 5000 K and C R I of at least 90

The l i g h t i n g system d e s i g n a r seeks enhanced color are recommended for use wherever color percep­

perception for all occupants of an i l l u m i n a t e d space. tion and matching with daylight is critica!.

Success requires a thorough knowledge of task sur­

face characteristics, and the i l l u m i n a n c e s color and Selectiva reflectance absorption from walls, ceil­

color rendering properties. The color-related infor­ ings, and furniture can rob a well-balanced illumi­

mation conveyed by the i l l u m i n a t e d task must cor­ nant of its needed constituents. Therefore, except

relata with the function, identity, and meaning of far minar colored areas and accents, the recom­

each task element. mended surface reflectance should be achieved

with pastel colors. lf this is d o n e , absorption w i l l not

Colorad surfaces are properly perceived only when be concentrated at one wavelength, and none of the

they reflect specific amounts of l i g h t of certain wave­ i l l u m i n a n t s important color constituents w i l l be sig­

lengths. lf the incident i l l u m i n a n c e lacks any r e q u i ­ nificantly weakened.

sita wavelengths, then the object will have an unex­

pected appearance and may not be identifiable. An old axiom says, "Proper color match should

occur among all l i g h t sources" in an overall health

Correct color information w i l l reach the task observ­ care environment. Certainly gross color differences

ar only if the i l l u m i n a n c e is "balanced" ( i . e . , has sut­ among i l l u m i n a n t s s h o u l d not occur because of the

ficient b l u e , g r e e n , and red components). The b l u e chromatic adaptation personnel would undergo

of cyanosis and the yellow of jaundice are not well when passing between adjacent areas. However,

delineated under incandescent illuminance that equating the colors of adjacent illuminants is less

exhibits poor spectral power i n the important b l u e ­ important than equating the color rendering charac­

to-yellow r a n g e . lt is important to use sources with teristics of those i l l u m i n a n t s .

adequate blue-to-yellow spectral power in spaces

where patients are observad. Color temperatura Pe r c e i v e d coloration can be important to the

alone is not an indicator of color rendition. Many patient s morale, appetite, sense of well b e i n g , and

sources with a color temperatura of 3000 K or less perhaps even h e a l i n g . O n c e , low color temperatura

(e.g., incandescent, high pressure sodium, warm illuminance was considered advantageous without

white fluorescent) are deficient i n the b l u e and green regard to color r e n d e r i n g , perhaps because incan­

portions of the spectru m . descent l i g h t is prevalent "at h o m e . " But today color

rendering by the illuminant is considered the con­

Fluorescent lamps also may lack adequate spectral trolling factor. lf the illuminance s color rendering

power i n the b l u e portian of the spectrum d e p e n d i n g capability is good and spectral power distribution is

on t heir chromaticity and spectral power distribution, balanced, medical personnel may make an accurate

especially if the CCT is below 3000 K. S o rn e fluo­ diagnosis, the patient s complexion will appear

rescent sources may lack adequate red content to healthy, and food will look attractive, promoting bet­

provide good color perception far observing flesh ter appetite.

tones. Rare earth (tri-phosphor) fluorescent lamps

39
A N S I / I E S N A RP-29-06

5.3.3 D a y l i g h t i n g . Sorne fenestration is essential in directly from the source to the eye. Glare may be

patients rooms. W h i l e an outdoor panorama can be characterized as "disability glare," "discomfort

psychologically satisfying and relaxing, arrange­ glare," or " overhead glare." Díscom f ort from direct

ments that bring large high-luminance areas into glare can be reduced by:

view can cause discomfort. Big luminance differ­

ences between daylighted spaces and other interior • Decreasing the l i g h t i n g e q u i p m e n t lumi-n a nce

areas must be avoided. (See Section 5 . 4 . ) This is or a tt enuating l i gh t from other sources, such

best accomplished by controlling the d a y - l i g h t with as windows and overhead s k ylights. ( See

filtering or shading devices. l u m i n a n c e limitations for specific areas i n

Section 4 . 0 . )

Daylight distribution throughout a room interior

O

depends on the total window area, the window s D i m i n i s h i n g the area of uncomfortable

light transmission properties, and the relationship l u m i n a n c e s (with the l u m i n a i r e l u m i n a n c e

between window h e i g h t and room width. For f u rt h e r held constant) .

2
information, see I E S N A R P - 5 - 9 9 . ª

• lncreasing the a n g l e between the light source

Careful selection of window glass, wíndow s h a d i n g , and the line - of - sight.

and room surface reflectance produce comfortable

seeing conditions. • lncreasing the g e n e r a l l u m i n a n c e i n the room.

S in c e many health care facilities, particularly acute­ The maximum luminance and the average l u rn i ­

care hospitals, must be available at all hours, any nance of a source are si g nificant glare factors.

daylight use must be backed u p with suitable elec­ H owever, where the p otential for glare exists, aver­

trie l i g h t . age l u m i n a n c e s are recogni z ed as be i n g more per­

tinent. L u m i n a i r e l u m i n a n c e data, and t he ratios of

Daylighting should not be used where the general ma x imum-to - average l u m i n a n c e , s h o u l d be p rovid­

lighting must be held constant. Such areas may ed for the angles within the glare z one as measured

i n c l u d e specíal laboratories, operating rooms, treat­ i n the laboratory u s i n g I E S NA-approved procedures

29
ment rooms, and radiology rooms. Daylight is cer­ and i nstruments.

t a í n l y an important i n f l u e n ce on círcadian rhythms

since h u m a n alertness is dírectly related to the con­ W i l l a l i g h t i n g system produce significant discomfort

t i n u o u s changes i n h e r e n t i n natural light. Wíndows glare? Proposed installations of direct lighting

are very necessary i n patients rooms and íntensive­ equipment can be rated with the V isual C omfort

care areas. Windows are desirable, but not Probabilit y ( V C P) system. A VC P evaluation is

absolutely necessary, in routíne laboratories, based on: ( 1 ) room size, shape, and surface

offices, staff l o u n g e s , waiting rooms, kitchens, din­ reflectance ; ( 2) illuminance levels; (3) luminaire

i n g roorns, and classrooms. Lighting in windowless type, si z e , average luminance, maximum l u rn i ­

spaces used by people should provide for subtle n ance, and light distribution; (4) number of

temporal modulations i n l i g h t intensity and color. luminaires; ( 5) luminance in t he fie l d of view ; (6)

observer location and line-of-sight; and (7 ) differ ­

Daylight control is difficult, particularly if the visual ences i n indi-vidual glare sensitivity. Since each fac­

task must stay at the brightest location. This is why tor can vary considerably, a standard set of c o n d i ­

surgical operating theaters do not have skylights tions has been established and used as a bas i s for

and are typically f o u n d i n windowless areas of the VC P tables."

hospital.

lt s h o u l d be noted, that the r e are l i m i t a t i o n s on the

Areas in the health care facility where the visual ap p licabilit y of V isual C omfort P robability in many

tasks (such as bed making) are relatively simple healthcare applications , particularly fa r tasks that

may u s e f u l l y employ d a y l í g h t . W h i l e s u n l i g h t reflec­ re q uire other tha n a standard u p r i g h t seated p osi­

tions can be an important secondary l i g h t source, tion, such as a patient reading or l y i n g prone in a

sun positíon, window orientation, roof overhangs, bed. Further understandin g on the appl i cation of

and externa! reflectance may introduce glare and VCP can be obtained from the IESNA Lighting
1
v e i l i n g reflections. T h u s , methods to control excess Handbook, N i n t h E d i t i o n .

daylight and glare are necessary.

5 . 3 . 5 Flicker and Strobe. Flic k er is the rap i d varia ­

5.3.4 Direct Glare and Visual Comfort Probabil- . tion i n l i g h t source i ntensi t y , u s u a l l y mos t no t i ceable

ity. Glare can cause discomfort and interfere with in peripheral v i s i ó n . lndividuals v ary wi d e l y in flicker

visibility. Direct glare occurs when light travels sensitivit y . S orne p e o p l e su ff er from d i sorders, such

40
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� A N S I / I E S N A RP-29-06

as m i g r a n e headaches, w h i c h can be very d i s a b l i n g . LR == LUMINANCE OF A SECONDARY AREA

As a r u l e , l i g h t sources with h i g h degrees of flicker LUMINANCE OF THE TASK AREA

s h o u l d not be used in patient care areas of health­

care facilities. lf the secondary area is dimmer, with luminance

one-third that of the task area, then LR = 0 . 3 3 3 / 1 . 0

5.3.6 Light Distribution on Surfaces. Lighting = 0.333. lf bright sky is v i s i b l e t h r o u g h an adjacent

systems tend to provide either diffuse light or window, then the LR might be 1 0 / 1 . 0 or 1 O . lf the LR

focused, directional light. Form in objects (model­ is considerably greater (or less) than 1 . 0 , as i n the

i n g ) and "point source" d i r e c t i o n a l l i g h t i n g can bring examples of Table 1 , t h e n s e e i n g i n the secondary

out surface texture. Diffuse l i g h t i n g s u c h as f l u o r e s ­ area may be difficult and ultimately dangerous.

cent direct or indirect lighting systems can mask Worker attention must be held to the task area. T h u s

form and texture. Patterns of l i g h t on room surfaces l u m i n a n c e ratios s h o u l d be somewhat less than 1 . 0 ,

can e n h a n c e the architectural form or create confu­ m a k i n g the task the brightest and the most conspic­

s i o n and distraction. Patterns of l i g h t s h o u l d corre­ u o u s area w i t h i n the visual f i e l d .

spond with architectural features. Variation of sur­

face b r i g h t n e s s in a space can h e l p orient visitors

Table 1 : Recommended luminance Ratios*
and provide clues for way f i n d i n g . This is often a

problem in hospitals as they can be large, maze­

To achieve a comfortable balance in health
like b u i l d i n g s .
care facilities, it is desirable to l i m i t l u m i n a n c e

ratios between areas of appreclable size from

5.3. 7 Light Distribution on the Task Plane
normal viewpoints as follows:
(Uniformity). Patterns of light on the task p l a n e can

be distracting, confusing, or beneficia!, varying on

1 to 0.@33 between task and aejaeent surroundinqs
the application. These patterns of light can affect
(such as between a book and the tabletop)
task visibility, comfort, and perception. In general,

the task i l l u m i n a n c e s h o u l d be greater then the sur­

1 to 0.200 between the task and more remate darker
round. In many applications in the healthcare set­
surfaces (such as between a book and the floor)
t i n g , task performance is critica! to the health of the

patient. I n these cases, · t h e primary g u i d e l i n e for the

1 to 5 between the task and more remate lighter
design of the i l l u m i n a t i o n s h o u l d be to aid the per­
surtaoes (such as between a book and the ceiílng)
torrnance of the task.

*These ratios are recommended as maximums, reductions are

5.3.8 Luminance and Luminance Ratios. generally beneficia!.

Measured l u m i n a n c e is a correlate of what the nor­

mal observer perceives as "brightness." Marked

discrepancies between measured luminance and 5 . 3 . 9 Modeling of Faces and Objects. L i g h t i n g can

perceived b r i g h t n e s s do o c c u r d u e t o psychological reveal the depth, shape, and texture of an object.

factors. Nevertheless, l u m i n a n c e distribution p r i n c i ­ Through creation of or elimination of shadows,

pies have been estab-lished which, if properly objects can have more or less contrast. Certain

applied, could provide an e ff i c i e n t , comfortable medical procedures require effective modeling of

visual e n v i r o n m e n t . Task areas are the focal points surface shape and texture. These three-dimensional

of illumination design, with the surroundings con­ tasks s h o u l d be i l l u m i n a t e d with directional lighting

tributing (in the case of good design) to task c o m p l e m e n t e d by d i ff u s e d or inter-reflected to pro­

visibility. Good design eliminates glare, enhances vide effective shadowing without excessive contrast.

positive feelings about interior spaces, minimizes

energy c o n s u m p t i o n , and facilitates m a i n t e n a n c e . 5 . 3 . 1 O Points of lnterest. A point of interest is an

object or place to which attention is drawn, using

When the eye scans a task area ( e . g . , chart, surgi­ movement, l u m i n a n c e contrast, or color contrast.

cal wound), it establishes a luminance adaptation

level. As the eye moves from the task to an area of 5.3.11 Reflected Glare and Veiling Reflections.

different l u m i n a n c e , there can be a sudden loss of Reflected glare can be as annoying as direct glare.

sensitivity to contrast or detail in the new area u n t i l Due to geometry, reflected glare entering the eye

the visual system adapts. To avoid this, the lumi­ from the side or below is harder to deal with than the

nance ratios associated with the l u m i n a n c e of sec­ glare from above. The typical cause · is a mírror

ondary areas (relative to the l u m i n a n c e of the task image of a light source reflected from highly pol­

area) should be kept small. For illustration, the ished wood or glass covered countertops. Such

L u m í n a n c e Ratio ( L R ) is defined as: glare can be reduced by using high reflectance

matte surfaces and by implementing veiling

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A N S I / I E S N A RP-29-06

Table 2 : Recommended Surface Reflectance

reflectance reduction procedures. Large area, low

luminance l u m i n a i r e s are used when specular sur­

Surlace Reflectance Equivalent
faces cannot be avoided. L u m i n a i r e s that might oth­
Range (percent)
erwise be reflected in the glass lenses of viewing
C e i l i n g finishes* 70-80
machines or computer screens need glare shields

or louvers. lndirect líghting may also be appropriate.

Walls 40-60

Furniture 25-45
Task visibility has been found to vary with the nature

of lighting and its entire luminous surround.

Equipment 25-45
Substantial losses in task contrast (and hence visu­
Hoors 20-40
al performance) can occur when something as sub­

tle as specular ( s h í n y ) print on matte paper reflects *Recommended reflectance is for finish only. Overall average

l i g h t . The "veil" cast over a task from a reflected l i g h t reflectance of acoustic materials may be somewhat lower.

source may go unde-tected by the eye. W h i l e the

individual factors that contribute to veiling reflections

have long been known, the problem is integrating 5 . 3 . 1 5 . 2 Room Surfaces. The finishes used on ceil­

the effects of these ínterrelated factors. This process ings, walls, and floors strongly influence the lumi­

is outlined i n Annex C . nance ratios between the room s l i g h t í n g e q u i p m e n t

and its s u r r o u n d i n g s , and between the task and its

5.3.12 Shadows. U n d e r directional lightíng, visual more remate s u r r o u n d i n g s . Matte f i n i s h e s with the

difficulties result when harsh shadows are produced recommended reflectance help prevent excessive

in task areas. Matte wall surfaces with a high l i g h t l u m i n a n c e ratios and specular reflections.

reflective value are effective secondary light

sources that can reduce such shadows by reflecting S m a l l spaces can appear larger and less crowded if

considerably diffused l i g h t into otherwise shadowed the walls and furniture have s i m i l a r colors. However,

areas. Where h i g h task i l l u m i n a t i o n involves rn u l t i ­ colors contrasting in h u e , chromaticity, or l i g h t n e s s

ple concentrated l i g h t sources, each source must be could decorate sorne surtaces. Small touches of

located with respect to possible obstructions; other­ strongly contrasting color (accents) give the space

wise, true task detail may not be d i s t i n g u i s h e d from vitality and interest. The colors selected for large

the shadow pattern. Surgical lighting is particularly areas should fall within the reflectance ranges of

prone to this problem. Table 2.

5.3.13 Source/Task/Eye Geometry. The angular Ceilings, walls, and floors act as secondary large­

relationships between the viewer, the task, and the area l i g h t sources. Care must be taken so that these

l u m i n a i r e are frequently critica! to task visibility. This surfaces do not present glare that could impact a

geometry can both enhance contrast and reduce it. person who is visually impaired or whose eyes

adjust slowly to changes i n i l l u m i n a t i o n variances. lf

5 . 3 . 1 4 Sparkle. S m a l l points of h i g h l u m i n a n c e can they are finished with the recommended reflec­

enhance visual interest. tances of Table 2, increased l ig h t utilization and

fewer shadows w i l l result. Many attractive colors for

5 . 3 . 1 5 Surface Characteristics. Object character­ these surfaces are available that exhibit the recom­

istics such as texture, color, and reflectance values mended reflectances.

of surtaces can affect the many elements of visual

performance and the v i s u a l perception of space. Although wall surface reflectances should generally

fall w i t h i n the recommended range, h i g h e r or lower

5.3.15.1 Surface Reflectance. A comfortable bal­ values may be desirable u n d e r certain conditions.

ance of room luminances may be achieved with For example, the c e i l i n g f i n i s h may be carried down

matte finishes on room and e q u i p me n t surfaces. the walls to the level of pendant l u m i n a i r e s that have

The reflectance recommended i n Table 2 s h o u l d be a large upward l i g h t component. This technique can

achieved for the specific areas mentioned in produce a ten percent increase i n room i l l u m i n a n c e .

Section 4.0. L u mi n a n c e ratios will generally be The l i g h t i n g design in rooms containing recumbent

within the practica! limits established as b e i n g desir­ patients should consider the c e i l i n g s as a "fifth w a l l . "

a b l e . (See Table 1 . ) Sufficient emphasis can s t ill be lf the lighting is prduced by recessed luminaires,

produced in the visual environment if key lumi­ reducing the c e i l i n g reflectance could prove unde­

nances are deliberately unbalanced within the spec­ sirable since this w i l l increase contrast relative to the

ified ratios. Glare from h i g h l y polished surtaces can h i g h e r l u m i n a n c e of the l u m i n a i r e s .

be uncomfortable, especially for people who are

visually impaired.

42
 A N S I / I E S N A RP-29-06

Small areas of the room may have reflectances task and worker characteristics. The values given

h i g h e r or lower than as r e c o m m e n d e d by Table 2. are target maintained i l l u m l n a n c e s ,

lf these areas are considered "color accents," and

are no more than ten percent of any room occu­ 5.4.2 l l l u m i n a n c e Selection for Interior Spaces.

pant s visual field, they will not affect the lighting l n i t i a l l y , the designer rnust know what activities w i l l

system efficiency or the key l u m i n a n c e ratios. Thus, be performed i n each hospital space b e i n g l i g h t e d .

the e n v i r o n m e n t can be both pleasant and v i s u a l l y Data from post-occupancy evaluations can be used

interesting. to d o c u m e n t and then meet user n e e d s .

When window-shielding materials serve as a wall, A survey of the hospital staff can provide informa­

they s h o u l d have the reflectance recommended tor tion about the tasks and activities that may be per­

walls. formed in a given space. Surveyíng can d e t e r m i n e :

5.3.15.3 Color of Surfaces. Patients and medica! • What are the tasks and t h e i r background

personnel in an illuminated health care area refl ectance?

respond emotionally to colors. The colors perceived • How m u c h time is spent on each task?

in that environment affect t h e i r ease of s e e i n g , t h e i r • How many people are involved in each task?

task performance, and their comfort (sense of well­ • How important is each task?

being). Perceived color depends on the spectral • How important is speed?

reflectance choices made for objects, illuminance • How important is accuracy?

color, and on the color rendering capability of the • W h i c h tasks are most difficult (visually)?

available light sources. Color and color rendering • W h i c h tasks are most f a t i g u i n g ?

capability are controlled by the source s spectral • What are the ages of those persons

power distribution (SPD), which must be chosen performing the tasks?

with great care. • What position/orientation do p e r s o n n el take

w h i l e performing the tasks?

5.3.15.4 Equipment Finishes. Medical equipment • What are the needs for flexibility or

should have matte finishes for minimum specular adaptability?

reflection. The recommendations 'ot Table 2 apply.

Statistical intorrnation g a i n e d via the survey can pro­

5.3.16 System Control and Flexibility. Many vide the basis for developing light,ing criteria. When

spaces require different l i g h t levels tor a variety of staff members cannot be reached dírectly, an ínter­

tasks that occur in the space. Providing individual view with their supervisor may prove informative.

control of illuminance can enhance user satisfac­ (Note: Patient position and orientation should

tion. Recent research suggests that h u m a n perfor­ always be kept i n m i n d d u r i n g the survey a n d a s the

mance can be affected by variation in l i g h t level at task l i g h t i n g requirements are d e v e l o p e d . )

different times of the day. In the hospital environ­

ment, activity is often occurring at all times in the Table 3A o u t l i n e s general i l l u m i n a n c e selection cat­

day. Adjusting l i g h t levels to respond to the h u m a n egories. They are qrouped into different classifíca­

circadian system may help staff performance and tions of v i s u a l tasks: orientation and simple, com­

patient comfort. m o n , and s p e c i a l . Each of seven distinct task cate­

gories (A t h r o u g h G) is assigned a m i n i m u m recom­

5.4 llluminance m ended maintained i l l u m i n a n c e v a l u e .

5.4.1 General. The i l l u m i n a n c e quantity for a hospi­ Table 38 contains the recommended illuminance

tal space p r i m a r i l y depends u p a n the tasks, the hos­ categories for many common hospital areas and

pital staff, and the speed/accuracy needed when activities. For areas/activities not included, choose

these tasks are ,9efformed�", . the Iisted area or actívity closest to the one in ques­

tion. Note that there are two letter designations

Recommende� i l l u m i n a n c e \ategories for specific given at the end of each row (for horizontal íllumi­

interior faciliti�s are giv�ih tables presented in nance and for vertial í l l u m i n a n c e ) . These letter des­

Section 5 . 4 . 2 . ' l l l u rn i n a n c e values for those interior ignations are defíned as to task category and

facilities not listed can be closely estimated by u s i n g assigned a m í n i m u m recommended maintained i l l u ­

the i l l u m i n a n c e categories of s i m i l a r areas. The val­ m i n a n c e value i n Table 3A.

ues given i n have horizontal and vertical maintained

i l l u m i n a n c e recommendations to e n a b l e the l i g h t i n g lf severa! tasks must be accommodated that require

d e s i g n e r to select v alues based on knowledge of the different illuminance, the designar must choose a

space and occupant characteristics as w e l l as the level satisfactory for the most critica! task. Several

43
A N S I / I E S N A RP-29-06

Table 3A: Determination of l l l u m i n a n c e Categories

Orientation and simple visual tasks. Visual performance is largely u n i m p o rt a n t . These tasks are

tound in spaces where reading and visual inspection are only occasionally performed. H i g h e r levels

are recornrnended for tasks where visual performance is occasionally important.

A Public Spaces 30 lx (3 fe)

B S i m p l e orientation for short visits 50 lx (5 fe)

e Working spaces where simple visual tasks are performed 1 0 0 lx ( 1 0 fe)

Common visual tasks. Visual performance is important. Recommended llluminance levels differ

because of the characteristics of the visual task b e i n g i l l u m i n a t e d . H i g h e r levels are recommended

for visual tasks with critica! elements of low contrast or small size.

D Performance of visual tasks of h i g h contrast and large size 300 lx (30 fe)

E Performance of visual tasks of h i g h contrast and small size, 500 lx (50 fe)

or visual tasks of low contrast and large size

F Performance of visual tasks of low contrast and small size 1 0 0 0 lx ( 1 0 0 fe)

Specíal visual tasks. Visual performance is of critica! importance. These tasks are very specialized,

i n c l u d i n g those with very small or very low contrast critica! elements. Recommended llluminance

levels should be achieved with supplementary task l i g h t i n g . H i g h e r recommended levels are often

achieved by moving the l i g h t source closer to the task.

G Performance of visual tasks near threshold 3000 to 1 0 , 0 0 0 lx

(300 to 1 0 0 0 fe)

methods exist for handling conflicting illuminanee tion recornmendations presented i n Table 4 provide

criteria. For e x a m p l e , a d e s i g n may employ different g u i d a n c e for m í n i m u m acceptable illumination dur­

layers of l i g h t i n g to save energy. l l l u m i n a n c e can be ing these periods of reduced se rv ie e .

increased on an as-needed basis.

5.4.4 llluminance for Safety. The lighting recom­

Satisfying various task illuminance requirements me nd a t i o ns i n Table 3A and Table 3 8 are a g u i d e

may necessitate a flexible l i g h t i n g system. The l i g h t ­ for achieving m a i n t a i n e d levels s u eh that the visual

i n g s h o u l d be designed for the highest required level tasks may be performed satisfactorily; they are not

and be supplemented with dimming controls the regulatory requirements for mínimum illumi-nance,

user can adjust. A stepped ( m u l t i - l e v e l ) l i g h t i n g sys­ nor are they for safety. Table 5 lists i l l u m i n a n c e lev­

tem may also be suitable. els regarded as absolute m i n i m u m s for safety a l o n e .

To assure that these v a l u e s are m a i n t a i n e d , higher

lf such flexibility is not possible, one illuminanee init i a l levels must be provided. (See Annex F.) In

level may be used throughout the entire system. those areas that have no fixed l i g h t i n g , localized i l l u ­

One way to make this selection is the worst-case mination should be provided during occupancy by

approach. The d e s i g n a r sets the room l i g h t i n g level portable or vehicle-mounted l i g h t i n g e q u i p m e n t .

equal to the requirements of the most demanding

task. Relatively unimportant tasks or those not per­

formed frequently are not considered. 6.0 L I G H T I N G SYSTEM CONSIDERATIONS

5.4.3 l l l u m i n a n c e for Tasks During Emergencies.

Healthcare facilities often need to maintain opera­ 6.1 Energy Management

tions d u r i n g emergeneies and natural disasters. In

order to continua patient care d u r i n g power outage, The health care facility lighting criteria in Section

emergency standby power systems are provided. 5.0 are based on years of independent research

However, it is reasonable to provide a reduced level involving seores of projects eonducted by u n i v e r s i ­

of serviee d u r i n g these periods in order to maintain ties, government labs, and designers within the

cost-effective and reliable operation. The illumina- lighting industry. These recommendations, continu-

44
 •
A N S I / I E S N A RP-29-06

Table 3 8 : Ughting Design Guide for Health Care Facilities

Very l m p o rt a n t

l m p o rt a n t

Somewhat important

LOCATIONS AND TASKS B l a n k = Not important or not a p p l i c a b l e

i
s
.§

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.E ..e:
� � ·e

·ro
e e 2, :e
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o t: (].)
(/)

... o e I
:J
_J o o
(/)

(].)
ro
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u
(/)
g
t5 "O
o "O
u o: (].)
� (].)
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e
e o
ro �
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(/)
�

:J E w t5 ·x

ro (].) (/) (].)

"O
e
:J (/)
o E
u
(/)

x x
e (/) o ü: e
(].) �
'fü �

u
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O:'.'. �
"O
o e: g g
Cl:l
ro
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al o C) o ro

Q. (].)
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t, -�
e: � u Q)
.o Q.) N Q)

"'
Q)

:::s
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(].) e
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e
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Q.)

u
Q)
(].)

>, :e t5
ro
cii s :J :e :J

o �
:s U)
� �
o m
u.
cii �

m
w
�
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e "O
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:s
� �
·¡¡; � �

"'
.!!? Q.) Cl:l
.o (/) � Cl:l e e
u Q.) Ol �
"O
e
:§ ·;:: Q) o e> (/) Q.) s: o o
Q)
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e: e Q. e m
t, t,
u O)
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e
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e
ro Q.
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Q) Cl:l
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el:'.
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i5 i5 Cl:l .s (].)
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ro Q) e � t5 o u ro
e e
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32
·13
O) O)
(].)

Q.
o >,
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:E :E .E
"O e
Q) 'O
ca :J ro �
2
(/) Q.)
.E

2 "5
2
Q)
Q. o m �
.52 Ol Ol
:J
o ·5 � s: o Q. :J >, Q. Cl:l ro
e el:'. o o i5 ü: :.J :.J _J � a.. O:'.'. (/) (/) (/) (/) (/) (/) � o :§
o

Health Care Facilities

Ambulance entrance or driveup area

Anesthetizing locations

Autopsy and morgue

Autopsy, general

Autopsy table

Morgue, general

Cardiac function laborato

General inspection

lns ection

At s i n k s

Work areas, g e n e r a l

Processed storage

Corridors

N u r s i n g areas, day

N u r s i n g areas, n i g h t

Operating and laboratory areas

Critica! care areas

General

Examination

Handwashing

Cystoscopy room

Dental suite

General

lnstrument tray

Oral, cavity

Prosthetic lab - general

Pros.thetic lab - workbench

Prosthetic lab - local

Recovery - general

Recovery - emer '3ncy examination

Dialysis unit

Elevalo.r lobby

·- EKG and specimen room

General

On E ui ment

45
 A N S I / I E S N A RP-29-06

Table 3 8 : Lightlng Design Guide for Health Care Facilities (continued)

Very l m p o rt a n t

l m p o rt a n t

Somewhat i m p o rt a n t

LOCATIONS ANO TASKS B l a n k = Not important or not a p p l i c a b l e

Local

Endoscopy rooms

General

Peritoneosco y

Culdoscopy

Examination and treatment rooms

General

Local

Eye surge

Fracture room or Cast room

General

Local

Laboratories

S p e c i m e n collecting

Tissue laboratories

Microscopic reading room

Gross s e c i m e n review

Chemistry rooms

Bacteriology rooms - general

Bacteriology rooms - reading cultures

Hematology

Linens

Sorting soiled l i n e n

Central ( c l e a n ) l i n e n room

Sewing room, general

Sewing room, work area

U n e n closet

Lobby

Locker rooms

M e d i c a l records

Nurseries

General , ,
• 1 1

Observation and treatinen '

N u r s i n g stations

General

Desk

46
 A N S I / I E S N A RP-29-06

Very l m p o rt a n t

l m p o rt a n t

Somewhat i m p o rt a n t

LOCATIONS AND TASKS B l a n k = Not important or not a p p l i c a b l e

�
.§

rn � .E 2
.e
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·ro
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o e: ::i:
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rn
Q)
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Q)

o 2 g
.....J "O
o
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e: o e:
{ � ::::J E
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-
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Q)
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so o OJ e: e: o:: Q)
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en
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6 � ! �
Q) � "O
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Q) Q)

-
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a. Cll :s U)
u o o o o o
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6
e: � a> Cll Cll
<(
o o Cll
e:
Q)

32
E e: e:
o e CD
.E .E
.E
::::J ro U)
o ::::J o o. >,

o .....J (/) o: o: :§ :§

Medication station

Obstetric delivery suite

Labor rooms

General

Local

B i rt h i n g room

Delivery area

Scrub

General

Postdelivery recovery area

Substerilization room

Occupational thera

Work areas, general

Work tables or b e n c h e s

Patient rooms

General circulation

Observation

C h a rt i n g

Critica! e x a m i n a t i o n

Tasks such as reading or eating

Grooming

Toilets

Pharmacy

General

Alcohol vault

L a m i n a r flow bench

Parenteral solution room

Physical therapy de artments

G mnasiums

T a n k rooms

Treatment c u b i c l e s

Postanesthetic recovery room

General

Local

P u l m o n a r y function laboratories

R a d i o l o g i c a l suite

Diagnostic section

General

47
 A N S I / I E S N A RP-29-06

Table 3 8 : Lighting Design G u i d e for Health Care Facilities (continued)

Very l m p o rt a n t

l m p o rt a n t

Somewhat important

LOCATIONS A N D TASKS Blank = Not important or not a p p l i c a b l e

e
.§

--
Cf)
Cf) Cf)
E
·e :e
� .§ .Q'l
·ro

e
e
o
e 2- :e
.E o e Q)
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O)

o Cf)
e Q) :i:
::::¡
c5 o Q)
(tl
o g
...J
o o: � "O
o "O -@ Q) � (1)
:.a
"O
o e -@ Q)
e
ro
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Cf)
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ro Q) Q)
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e
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o E ¡¡::
Cf)

o
(/)
ro x x
Q) e
o
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o
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E o Q)
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ro
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(!)
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o ro
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t :::¡
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(1)

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(9 � Cf) in e é: e- e
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u: ...J (/) (/) (/) � o � o

Waiting e B

A A

F i l m sortin E e
l m a g e viewíng A A

B a r i u m kitchen E e
Radiation therapy section

General

Waitin area

lsotope kitchen

General

Ben ches

Computerized radiotomography section

S c a n n i n g room

E g u i p m e n t m a i n t e n a n c e room

Respiratory Care

Solarium

General

Local for reading

Stairways

Surgical suite

Operating table

Scrub room / area

lns\ruments and steríle s u p p l y room

Clean u room, instruments

Anesthesia storage

Substerilizing room

S u r g i c a l induction room or area

S u r g i c a l h o l d i n g area

Toilets

Utility room

Waiting areas

General circulation

Tasks such as reading

48
 A N S I / I E S N A RP�29-06

I Very Importan!
l m p o rt a n t

Somewhat important

LOCATIONS AND TASKS B l a n k = Not important or not a p p l i c a b l e

�
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..... (/)
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.2
Q) :E
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o e :E
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Q)
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Q)

u
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ro (/)
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x
Q) e
e C/)
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Q)
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ü:: e :s x
u .s E Q) o e ¿ ¿
ro
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"O :¡::;
r.n ro ..... (9 o ro

o o (/) e u
(1)
a. Q)
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u e e o:::
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Q)
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r:::
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i:5 i:5 ro .s (1)
E o o
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ai r::: � u o :g u ro
r::: e
r.n (1)
o t5 ..:;¿;_
©
e
Q) "O e .g
Q)
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OJ
Q) .E
OJ

a. 's,
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"O ¡¡:: ro ::::¡ ro tí Q) 2
(1)
a. o ro � .2
OJ O)
::::¡ o ·5 (!)
.e o a. ::::¡ >, a. ro ro
..:!
e <( u o i:5 ü:: ::i ::i _J 2 o, o::: (/) (/) (/) (/) C/) (/) u § u
=

Notes:

1 . Also see Chapter 1 6 in I E S N A H a n d b o o k for special considerations.

2. l l l u m i n a n c e values indicated in t h i s Table are not absolute. Values may need to be adjusted by as

much as +50% c o n s i d e r i n g age factor, room colors, reflectances, and d e s i g n issues listed in t h i s T a b l e .

t. Required i l l u m i n a n c e exceeds m a x i m u m levels found in Table 3A. See Section 4 . 2 2 far d e t a i l s .

:j:. Required í l l u m i n a n c e exceeds m a x i m u m levels found in Table 3A. See Section 4 . 1 1 far d e t a i l s .

O. 200 l u x (20 fe) recommended for circulation pathways . .

49
 •
A N S I / I E S N A RP-29-06

Table 4 : Recommended l l l u m i n a n c e on Tasks for Emergency Service

(for use when normal service is interrupted)*

Task Location Lux Footcandles

ExitWays

Corridors leading to exits, at floor 30 3

Statrways leadinq to exits, at floor 30 3

Exit directíon signs, on face luminaire 50 5

Exit doorway, at floor 30 3

Operating Room, surgical table 27000 2700

Operatínq Honm, ernergency table 2200 220

Delivery Room, obstetrical table 27000 2700

Hecoverv Rooms, for OR and obstetrical 100 10

Nurseries, infant, 76 cm [30 i n . ] above floor 100 10

Nurseries, premature, 76 cm [30 m . ] above flo.or 100 10

Nurseries, pediatric, 76 cm [30 i n . ] above floor 20 2

Medieatlon Preparation Area, loe-al 300 30

Nurses Station 50 5

Pharmacy 50 5

Blood Bank Area 50 5

Central Suenen P u m p Are.a 50 5

Telephone Switchboard, tace of board 50 5

Central Sterile Supply, issuing area 50 5

Psychiatric Patient Bed Area 30 3

Main Electrical Control Center 50 5

Hospital Elevator-Exit Lighting/Stairwells 50 5

Life Safety Areas (Life Support Areas) 50 5

Cardiac Catheter Laboratories 100 10

Coronary Care Units 300 30

Dialysis Units 200 20

Ernerqeney Hoorn Treatment Areas 500 50

lntensive Care Units 300 30

*These are the m í n l m u rn lighting levels. lt is particularly desirable that they may be increased to as near the levels normally provided in

these areas, as the available capacity of the emergency electrical supply will permlt,

Table 5 : l l l u m i n a n c e Levels for Safety in Areas Other Than Patient Care*

Hazards Requiring

Visual Detection -+ lnfrequent Common

(small risk) (significant risk)

Normal Activity Level -+ Low High Low High

l l l u m i n a n c e Levels +
Lux 5.4 11 22 54

Footcandles 0.5 1 2 5

* M í n i m u m for safety of staff, patients (under their own control), and visitors. Absolute m i n i m u m at any

time and at any location on any plane where safety is related to seeing conditions.

50
 •
ANSI/ I ESNA RP -29-06

ally being revised, reflect current research about ousl y achiev e mínimum des i red illuminance levels

people s fundamental seeing needs, rather than and any light í ng effects economically. The designed ­

generic lighting solutions. The designer is e n c o u r ­ for i l l u m i n a n c e is achieved and maintained through

aged to develop new aestheti-cally pleasing preventative maintenance t e c h n i q u e s .

approaches that promote health, cost less, and

reduce energy use. A p l a n n e d maintenance program can produce s u b ­

stantial benefits for the lighting system owner ,

Energy m a n a g e m e n t has g a i n e d importance since including reduced nominal labor costs, i mp r oved

the early 1970s when fuel conservation first appearance of the space, and a m i n i m u m l u m i n a i r e

became a majar concern. A clase examination of c o u n t for a space. B y r e d u c i n g the n u m b e r of l u rn i ­

how b u i l d i n g s are lighted has produced criteria that, naires, m aterial and energy cost savings will be

when applied to future designs, will use energy realized.

more efficiently.

P lanned lighting maintenance includes these

The amount of power available for lighting new techniques:

buildings, though now limited, still enables the

designer to provide a suitable lightíng system. • G roup relamping

Cutbacks, however, are o n l y o n e aspect of power • Luminaire cleaning

m a n a g e m e n t programs, s i n c e : • R oom su rf ace c l e a n i n g and repainting

• lnspection and troubleshooting

Energy = (Power) x (Time)

6.2 Electric Lighting

Electrical energy can be conserved by reducing

either the powerlevel b e i ng consumed (watts) or the 6.2.1 General. S o rn e electrically powered illumi­

time (hours) this power level is used. Available nance is essential to every inter i or spa c e in a

options include installing a more efficient lighting health-care facilit y . The f oregoing sections of this

system, r e p la c i n g system components with ones P ractice have established the environmental and

that use less power, or modifying the building s i l l u m i n a n c e re q uirements essential to visual com f ort

operating/occupancy schedule to pare n i g h tt i m e and effective - ness . The following sections discuss

operations. lf both power level and consumption the l i g h t sources and l u m i n a i r e s that s h o u l d be con­

time can be reduced, the energy savings potential is sidered when p l a n n i n g an elect r ic l i g h t i n g s y stem.

f u rt h e r increased.

6.2.2 Light Sources. F our basic types of light

An important first step is for owners to install l i g h t i n g sources are in common use today : incandescent ,

in existing buildings that complies with the same fluorescent, high i ntensity discharge (HID), and

power l i m i t s that apply to new buildings. Then an L ight Emitting D iodes (L EDs). Each light source

energy-reduction program must be developed. family has certa i n characteristics, advantages , and

There are many opportunities i n an existing facility disadvan - tages. P roper selection w i l l depend upon

to improve operating efficiency, save energy, and the part i cular re q uirements of each health care facil­

upgrade the l i g h t i n g quality. ity room/ a rea, economics ( see Annex E), user

requirements, and personal prefere n ces .

The most effective energy-saving procedure is to

turn off lights w h e n they are not needed. Occupancy Hospital management and the lighting designer

sensors, d i m m i n g controls, and d a y l i g h t harvesting s h o u l d study available l i g h t sources from the stand­

t e c h n i q u e s s h o u l d be considered to allow the occu­ point of efficacy, chromat i c i ty , color r e n d e r i n g , heat

pants to "tune" the l i g h t i n g as they see fit. Lighting gain, glare , economy, mainten a nce, and stora g e.

levels must not exceed what is needed for task System simplicity can be "designed in" by limiting

viewing. the n u m b e r of lamp types and s i z es deployed and

stocked. Contrarily, it i s i m p o s s i b l e to properly se r v e

Health care facilities llave special needs that must all hospital tasks with just one or two lamp t y p e s . A

be considered when evaluating energy efficiency healthy compromise should be reached .

opportunities. Since the typical health care room

has multiple functions, separately switched "lay­ 6.2.2.1 lncandescent L i g h t i n g . lncandescent l i ght­

ered" l i g h t i n g is recommended. These layers, if act i­ i n g has low initial cost, good color render i ng prope r ­

vated only w h e n n e e d e d , c an save energy. ties, good optical control capabilities , and reas o n­

able d i m m i n g e q u i p m e n t cost. B ecause these la m p s

P roactive or planned lighting maintenance orga­ are familiar at h ome, they contr i bute a sense of

ni z es time, labor, and ot h er resources to contlnu- security or comfort . However, designers also f ace

51
A N S I / I E S N A RP-29-06

short lamp lite, unwanted heat, and low lamp effica­ descent), color r e n d e r i n g that ranges from poor to

cy (fewer lumens per watt) when an incandescent very good, and a delay when first energized (or tol­

light source is chosen. The incandescent family lowing a power interruption) followed by a slow

i n c l u d e s the tungsten-halogen l a m p . increase in light output. Because of this slow turn-on

characteristic, incandescent or fluorescent lamps

A t a given wattage, halogen lamps provide a mod­ are necessary for standby emergency illuminance.

erate g a i n i n lamp lite and i n efficacy (more l u m e n s Most HlD lamps must operate in luminaires

per watt). Tungsten-halogen lamps can also be d e s i g n e d to contain hot quartz fragments should the

compact and provide whiter l i g h t . One note of cau­ are capsule rupture. Sorne HID lamps are specifi­

t i o n : u n l e s s the halogen lamp is made with a second cally d e s i g n e d to operate in open l u m i n a i r e s .

outer glass b u l b , it must be used i n enclosed lumi­

naires so hot fragments are contained i n the event Each H I D lamp type also has its own specific char­

of b u l b rupture. acteristics:

Low voltage (6-, 12-, and 24-volt) incandescent Mercury lamps - Mercury lamp use has d i m i n i s h e d

lamps provide advantages in many applications because of poor efficacy, poor color r e n d e r i n g , and

needing precise control. When compared with s i m i ­ sorne recently enacted energy codes. The l u m i n o u s

larly performing h i g h e r wattage sources, low voltage efficacy of mercury lamps is lower than that of most

lamps produce less heat and consume less energy. fluorescent l a m p s . Even t h o u g h mercury lamp life is

excellent, lumen depreciation is poor compared to

6.2.2.2 Fluorescent Lighting. Fluorescent lamps other sources.

provide high efficacy (more lumens per watt), long

lamp life, and good color r e n d e r i n g . However, they Metal halide lamps - The metal halide lamp is

generally cost more initially than incandescent basically a mercury lamp to which metal halides

sources. Fluorescent lamps are available in linear have been added. Compared to mercury lamps,

tubes of various diameters ( c o m m o n l y T-8 and T- metal halide l a m p s provide h i g h e r l u m i n o u s effica­

12), in U-shapes, and in circular forms. There are cy (75 to 1 2 0 l u m e n s per watt), good color render­

also s m a l l diameter (T-4 and T-5) "compact'' fluores­ i n g , and good optical control. A l t h o u g h only of cos­

cent lamps ( C F L s ) . The C F L is replacing incandes­ metic importance, noticeable color differences

cent lamps in many applications involving small eventually develop between metal halide lamps in

rooms, closets, and corridors, where d i m m i n g is not the same i n s t a l l a t i o n . The latest ceramic-type metal

desired (although d i m m i n g is possible at sorne addi­ halide lamps have more consistent color, longer

tional cost), and where precise optical control is not lite, and less lumen depreciation (over lamp life).

r e q u i r e d . A C F L uses m u c h less energy than a light­ Pulse-start metal halide lamps and ballasts are

equivalent incandescent l a m p . available featuring a faster re-strike than standard

metal h a l i d e l a m p s .

Fluorescent lamp technology uses various phos­

phor c o m b i n a t i o n s to generate a variety of "white" High pressure sodíum (HPS) lamps - The high

light. I n the past, most such lamps were produced pressure s o d i u m l a m p has greater l u m i n o u s effica­

and sold as "cool white" (4150 K, CRI = 65) and cy than any other HID lamp, good optical control

"warm white'' (3000 K, C R I = 50). The more recent characteristics, and a light output maintenance

triphosphor fluorescent lamps have CRls greater characteristic similar to the mercury lamp. While

than 70 and better efficacy than the old halophos­ color rendition is o n l y fair i n the standard H P S types,

phor cool white and warm white l a m p s . Triphosphor most colors are recognizable u n d e r these l a m p s .

lamps should be used where patient appearance

and good color rendering are both important. The Due to their relatively poor color rendering, HPS

current spectral characteristics of 4000 K and h i g h ­ l a m p s are p r i m a r i l y used for outdoor parking lot or

er triphosphor lamps work w e l l i n e n a b l i n g the med­ roadway lighting. W h i l e t h e i r lamp lite is excellent,

ica! staff to recognize minute amounts of yellow. the C R I of most H P S lamps l i m i t s t h e i r application i n

Such lamps are useful anyplace where newborn healthcare f a c i l i t i e s .

infants are checked far [aundice, (See Section

5.3.2.1.). 6.2.2.4 Light E m i tt i n g Diodes (LEDs). L E D s are a

new generation of light sources that exhibit long

6.2.2.3 H i g h lntensity Dlscharqe ( H I D ) Lighting. rated life (30,000 to 100,000 hours), are extremely

The high intensity discharge lamp family includes compact, need little maintenance, and are very

mercury, metal halide, and high-pressure sodium. energy efficient. They run on low voltage direct cur­

These lamps share several important features: long rent L E O drivers, operate without emitting ultraviolet

life and h i g h l u m i n o u s efficacy (compared to í n c a n - radiation, produce vivid saturated colors, are easily

52
 A N S I / I E S N A RP-29-06

controlled, and permit a nearly unlimited array of Therefore, LPS lamps _are of no value where color

lighting effects. The usual LEO output colors are rendition has any i m p o rt a n c e . One possible use is

white, red, green, blue, and amber. lntermediate outdoor security lighting and parking lot lighting.

hues like orange and pastel shades of p i n k , g r e e n , However, the poor color rendering of the LPS

and yellow are also available. The various color source may cause problems far hospital visitors

L E O s have different life ratings (red and amber last arriving by automobile. They could have trouble

l o n g a r than the b l u e and w h i t e ) . The white L E O has identifying vehicles by color, or locating color-coded

a b l u i s h tint and h i g h biological efficacy far the cir­ parking spaces.

cadian system. There are low and high brightness

L E D s , with the l u m e n efficacy of the h i g h brightness 6.2.2.6 Light Source Summary. A comparison of

product being 30 lm/W or more. Sorne disadvan­ majar . p e r f o r m a n c e characteristics guides the

tages of L E O are the need far heat s i n k s , h i g h glare choice of a l i g h t source far a particular application.

potential, and poor color rendering of flesh tones ( F u rt h e r information on the characteristics of light

(white L E O ) . These disadvantages can be partially sources can be found in the IESNA Lighting
1)
overcome by u s i n g red, b l u e , and green L E O s addi­ Handbook, Ni n t h E d i t i o n .

tively to form white l i g h t , or by m i x i n g the outputs of

white and amber LEOs. Although rapid advances Ali gaseous discharge lamps need a ballast to pro­

are b e i ng made, the current white l i g h t generated by vide starting voltage and limit the current during

LEDs, particularly through red-green-blue mixing, l a m p operatlon. Many ballast types adjust when l i n e

may be deficient in many areas of the spectrum voltage changes occur. Ballasts are type-specific for

making this source inappropriate far diagnostic the l a m ps and have thermal/noise characteristics

applications. Optical devices such as lenses or dif­ that are i n d e p e n d e n t of the l a rn p ,

fusers offer glare protection.

6.2.3 Luminaires. The total l i g h t i n g hardware ( l u m i ­

6.2.2.5 Miscellaneous Light Sources. For possi­ naire) consists of a l a m p , lamp parts that distribute

ble consideration i n l i g h t i n g the health care e n v i r o n ­ the light, components to position and protect the

ment are xenon short-arc Jamps and low pressure l a m p, and a ballast between the lamp and the power

sodium (LPS) /amps. supply. For more information see the JESNA
1
Lighting Handbook, Ni n t h E d i t i o n . Oetailed descrip­

Xenon short-arc lamps are sometimes used as t i o n s and illustrations of l u m i n a i r e performance can

operating room surgical lights, i n fiber optic i l l u m i n a ­ be f ou n d in each manufacturer s data sheets. No

tors, and in micro-projection equipment. Xenon one lighting system can be recommended exclu­

short-arc lamps are pressurized to severa! atmos­ sively since each has qu a l i t i e s that may best match

pheres and reach eighty percent of final output the requirements of a specific installation. The first

immediately after starting. The are color closely consideration should be what the medica! staff

approximates daylight (color temperature is about needs to see without distraction, eyestrain, or

6000 K). lts output spectrum is c o n t i n u o u s i n the vis­ fatigue. Second is to meet all other users needs as

i b l e l i g h t range and exhibits strong l i n e s i n the near­ determined by the d e s i g n concept and by analyzing

infrared {between 800 and 1000 nanometers), data from post-occupancy evaluations. A t h i r d con­

i n c l u d e s sorne weak b l u e l i n e s , and extends far into sideration is the lighting installation s appearance

the ultraviolet. Sorne characteristics of xenon lamps relative to the architectural and interior d e s i g n of the

include: health care facility. Factors that affect luminaire

selection i n c l u d e :

°䶭dž Constant color output despite voltage or

intensity adjustments • Task types performed and the l u m i n a i r e s

• N o f i l a m e n t (end-of-life is manifested by ability to provide proper v i s i b i l i t y ( p o i n t source,

starting difficulty) area sources, color)

• H i g h e r efficacy than incandescent, but lower • Type, placement, wattage, and physical size

than H I O and fluorescent of each l u m i n a i r e

O

Needs expensive starting and intensity-control • Quantity and q u a l i t y of the l i g h t provided

electronics ( g l a r e , unifarmity, and l u m i n a n c e )

• Externa! c o o l i n g required • L u m i n a i r e placement relative to the visual

background, brightness patterns, and spatial

Low pressure s o d i u m (LP S ) lamps have the h i g h e s t pattern - each affects users needs and the

efficacy of any commercially available lamp today­ d e s i g n concept

up to 150 lm/W includ-ing ballast losses. But the • Light distribution as it affects l u m i n o u s ratios

output is near-monochromatic yellow light. for efficient seeing and the display of objects

53
 •
A N S I / I E S NA RP-29-06

• Lamp life, maintenance, installation (ease), lamp s main b e a m , this heat does not disappear. lt

relamping (ease), and access to auxiliary ends up in the room atmosphere where it produces

components convection currents that can aftect airflow patterns.

• Ease of cleaning and disinecting

• Overall product quality Sorne surgical lights have fan-controlled exhaust

• The possibility of interchanging units d u r i n g systems that draw all luminaire-generated heat out

repair or maintenance of the operating room, possibly outside the b u i l d i n g .

• L u m i n a i r e design and structural qualities The amount of heat involved d e p e n d e upo n the i l l u ­

i n c l u d i n g stability (if applicable), fragility of minance level, pattern size, dichroic reflector effi­

moving members (if applicable), and ease of ciency, and any color correction.

lamp replacement

• Appearance coordinated with factors such The shape, d e s i g n , and location of l u m i n a i r e s may

as shape, proportion, color, texture, and affect filtered air movement. A careful study of u n i d i ­

m odu l a r size rectional (laminar) airflow is need-ed w he n lighting

• Physical compatibility with other room operating rooms or other critica! locations.

elements, especially the c e i l i n g or walls,

where the l u m i n a i r e is supported 6.4 Monitoring the Lighting System

• Control of radiant heat

• Cedes and standards for construction and 6.4.1 G�neral. l rn p l e m e n t i n g the recommendations

installation given i n th i s Practice for l i g h t i n g health care facilities

• Electrical and mechanical considerations w i l l generally provide a satisfactory visual environ­

• Thermal distribution ment that meets the needs of the medical staff. This

• Safety considerations includes consistent lighting in the operating room

• Efficiency and economics that is comfortable and safe while providing opti­

• Provision of an airflow seal for special mum visibility (illuminance) and excellent color

environments (sugery, isolation, bone recognition.

marrow transplants)

Conditions change d u r i n g the life of any l i g h t i n g sys­

Two l u m i n a i r e s with the same general appearance te m . The color and output of light sources may drift,

may differ i n l i g h t output and comfort performance. d i rt accumulation on diffusers may reduce light

Cpmparisons using distribution curves and photo­ transmis-sion, and the refractors infrared transmis­

metric test data are the only way to determine if sion characteristics may s h i ft . Surgical lights may

such l u rn i n a i r e s can provide equivalent lighting have other components that slowly degrade, affect­

results. ing the system s spectral power distribution.

Flickering fluorescent lamps should be remedied

6.3 Acoustical and Thermal Factors immediately by changing the lamp or replacing the

ballast.

Today s health care facility frequently requires light­

ing integrated with the acoustical and thermal treat­ Periodic lighting system inspections will help

ment of c e i l i n g surfaces. The reflectance of acousti­ reveal when correctiva measures are required.

cal material is important to the l i g h t i n g sch e m e . Performance factors that should be monitored for

general lighting i n c l u d e :

A i r - h a n d l i n g l u m i n a i r e s can effectively provide light,

while supplying fresh air, removing stale air, and • l l l u m i n a n c e level

transferring heat-either separately or in combina­ • Apparent color temperatura

tion. S u p p l y air enters the room through side slots,

typically via a ducted system. Return air may pass I n addition, operating suites and special-use rooms

through the side slots to the plenum, or pass s h o u l d b e monitored for:

through the lamp compartment where heat is

absorbed by the cooler room air and th u s trans­ • l l l u m i n a n c e level

ferred to the p l e n u m . At this point the hot return air • Uniformity of the l i g h t

can be exhausted outdoors, cooled and condi­ • Apparent color temperature of the l i g h t

tioned for reuse, or conditioned and transferred to • Total irradiance of the lights
O

the tacility' perimeter for heating purposes, Patterns of l i g h t

• Dichroic coating integrity on a l l lenses or

I n operating rooms, heat produced by the l u m i n a i r e s reflectors

can present special problems. While filters or

dichroic reflectors can m i n i m i z e infrared heat i n the

54
 •
ANSI/ I E S N A RP-29-06

6.4.2 Test lnstrumentation. The JESNA Lighting 6.4.2.4 Total lrradiance Measurements. The most
1
Handbook, Ninth Edition, Chapter 2 describes the precise method of measuring total irradiance (espe­

instruments that measure light and other radiant cially in the beam of surgical lights) is with a ther­

energy. The following discussion in this Practice cov­ mopile sensor. When properly calibrated and used,

ers precautions and procedures specifically oriented this device w i l l provide accurate results in watts per

to health care facilities. (See Annex G and Annex square centimeter. There are other devices, s i m i l a r

H.) to illuminance meters, with detectors that respond

into the near-infrared region. They are calibrated in

6.4.2.1 l l l u m i n a n c e Measurements. Most commer­ terms of irradiance. lf these devices are calibrated

cial light meters are color-corrected and cosine-cor­ regularly u s i n g a total irradiance calibration source,

rected for general illuminance measurments. The they may also be used for measuring incandescent

accuracy of these instruments is usually proportion­ radiation from far-infrared regions.

al to their cost. Most meters can read directly up to

1 0 , 0 0 0 lux ( 1 0 0 0 fe). However, for light in excess of 6.5 Special Considerations

1 0 , 0 0 0 lux ( 1 0 0 0 fe), many meters require placing

perforated grids or attenuators over the detector. At Dramatic advances have been made in understand­

high i l l u m i n a n c e , this t e chni q ue is usually less accu­ ing the role of light on the regulation of circadian

rate than u s in g direct-reading instruments. rhythms and its affect on human health and well­

being. Circadian rhythms are physiological and

l l l u m i n a n c e meters s h o u l d be recalibrated annually behavioral patterns that repeat themselves at

to ensure accurate readings. Evaluate meter opera­ approximately every 24 hours. Light/dark cycle,

tion if results are questionable. through the suprachiasmatic nucleus (SCN) or

"master clock" is the main synchronizer of these cír­

6.4.2.2 Operating Room Measurements. cadian rhythms to the solar day. Based on daily light­

lnstruments that measure operating room illumi­ dark cycle exposures, messages are sent to targets

nances s h o u l d receive special care. Proper photopic in the brain and other parts of the body to regulate

filter correction and accurate measurement ability at our circadian rhythm. Examples of the circadian

h i g h i l l u m i n a n c e levels are particularly important. lf rhythms that are affected by the light/dark cycle

multi-head operating room lights are used, each include body temperature rhythms, hormone pro­

head's apparent color temperature may differ by duction (e.g., melatonin and cortisol), sleep-wake

hundreds of Kelvin. Care must be taken to assure cycles, and alertness. llluminance quality, quantity

proper head adjustment and that the i l l u m i n a n c e or levels, distribution, as well as the t i m i n g and dura­

color temperatura measurement is truly an average tion of exposure to either electric light or daylight

( or at least representative of the average). can affect us. lt is known that elderly people have a

need for greater l i g h t i n g levels to affect their master

6.4.2.3 Apparent Color Temperature Measure­ clock because less light reaches the retina of olde r

ments. Meters are available that produce an appar­ adults as well as the fact that short wavelengths of

ent color temperatura reading. However, meters that light (blue light) is selectively filtered due to lens

use color filters to derive color temperature are not structure deterioration. For a more in-depth descrip­

reliable. The best method relies on a spectrora­ tion of proper lighting for ol d er adults, refer to the

diometer to find the spectral power distribution at dis­ IESNA Committee on Lighting for the Aged and

crete wavelengths across the visible spectrum. First, Partially Sighted.

chromaticity coordinates are d e t e r m i n e d . Then the

apparent color temperature is derived from this data.

55
A N S I / I E S N A RP-29-06

12. F e r g u s o n , W. J . W . , "Hospital L i g h t i n g : G ene r a l

REFERENCES
and Medica! Aspects," Transaction of the

11/uminating Engineering Society, ( L o n d o n ) , 2 9 : 1 0 5 ,

1964.

1 . Rea, M. S. (editor), IESNA Lighting Handbook,

Ninth Edition. New York: llluminating Engineering 13. American lnstitute of Architects, Guidelines for

Society of N o rt h America, 2000. Design and Construction of Hospital Health Care

Facilities, 2001 Edition.

2. IESNA Committee on L ib r a r y Lighting,

''Recommended Practice of L ib r ar y Lighting," 14. Berson, D . , " M e l a n o p s i n and Phototransduction

Journal of the 11/umínating Engineering Society, Vol. by R e t i n a l G a n g l i o n C e l l s , " Light and Human Health,

3, N o . 3 (April 1 9 7 4 ) p. 253, New York: llluminating Fifth lnternational LRO Lighting Research

E n g i n e e r i n g Society of No rth Ame rica, 1 9 7 4. Symposium, Electrical Power Research lnstitute

( E P R I ) , 2002, p . 89.

3. Subcommittee on Kitchen Lighting of the IES

Committee on lnstitutional Ughting, "Lighting far 15. Lindheim, R., et al, Changing Hospital

Commercial Kitchens," 1/luminating Engineering, Vol. Environments for Children, Cambridge: Harvard

5 1 , N o . 7 ( J u l y 1 9 5 6 ) p. 553, New York: l l l u m i n a t i n g University Press, 1972.

E n g i n e e r i n g Society of North America, 1956.

16. Sissons, T. R. C., "Visible Lighting Therapy of

4. IESNA Office Lighting C o mmit t e e , American Neonatal Hyperbilirubinemia," Photochemical and

National Standard Practice for Office Lighting, Photobiological Reviews, Vol. 1 . New York: P l e n u m

ANSI/IESNA RP-1-04, New York: llluminating P u b l i s h i n g C o r p . , p. 2 4 1 .

E n q i n e e r i n q Society of North America, 2004.

17. Kethley, W., and B ranch , K . , "Ultraviolet Lamps

5. I E S N A School and College Lighting Committee, for Room Air Disinfection," Archives of Environ­

American National Standard for Ughtíng for mental Health, Vol. 25 (September 1 9 7 2 ) p. 205.

Educatíonal Facilities, ANSI/IESNA RP-3-00, New 18. Beck, W. C . , et a l , ''The Color of the S u r geon s

York: llluminating Engineering Society of N ort h Task Light," Lighting Design + Application, Vol. 9,

America, 2000. No. · 7 (July 1979) p. 54. New York: ll l u m i n a t i n g

E n g i n e e r i n g Society of N o rt h America, 1979.

6. IESNA Industrial Lighting Committee, Recom­

mended Practice for Líghting Industrial Facilities, 19. National Electrical Code, NFPA 70, Boston:

ANSI/IESNA RP-7-01, New York: llluminating National Fire Protection Association, latest issue.

E n g i n e e r i n g Society of N o rt h America, 2 0 0 1 .

20. Standard for Health Care Facilities, N F PA 99,

7. IESNA Residence Lighting Committee, Design Boston: N a t i o n a l Fire Protection Association, 2002.

Gritería for Interior Living Spaces, RP-11-95, New 21. Electrica/ Safety and Essentla/ Electrical

York: llluminating Engineering Society of North Systems in Hea/th Care Facilities, (CSA Standard

America, 1 9 9 5 . 232-99), Toronto: Canadian Standards Association.

8 . AARP Bulletin, Vol. 43, No. 1 1 , December 2002, 22. Canadian E/ectrical Code, (CS A Standard

page 4. C22.1-02 and C22.2 latest edition), Ottawa:

National Research C o u n c i l .

9. Administration on Aging, A Profíle of Older

Americans: 2002, http://www.aoa.gov/prof/statistics/ 23. Rosenfield, N., "Environmental Design for

profi l e / 1 2 . asp Kidney D i a l y s i s , " lnteriors, December 1 9 7 4 .

1 O. Beck, W. C., "The L i g h t i n g of B i rt h i n g R o o m s, " 24. European National Standards in Dentistry, EN

Líghting Design + Application, Vol. 14, No. 7 (July I S O 9680: 1 9 9 3 Dental Operating Lights.

1984) p. 40. New York: llluminating Engineering

Society of N o rt h America, 1984. 25. Blackwell, O. M., and Blackwell, H. R.,

"Individual Responses to L i g h t i n g Parameters for a

1 1 . I E S N A Committee on L i g h t i n g for the Aged and Population of 235 Observers of Varying Ages,"

Partially Sighted. Recommended. Practice on Journa/ of the 11/uminating Engineering Society, Vol.

Lighting and the Visual Environment for Senior 9 No. 4 (July 1980) p. 205. New York: llluminating

Living, RP-28-98, New York: llluminating E n g i n e e r i n g Society of N o rt h America, 1980.

E n g i n e e r i n g Society of North America, 1998.

56
 ANSI/ I E S N A RP-29-

26. IESNA Security Lighting Committee, Guídeline 30. 1 ES Committee on Hecommendations of Quality

on Securíty Lightíng for Peop/e, Property, and Public and Quantity of l l l u m i n a t i o n . " O u t l i n e of a Standard

Spaces, G - 1 - 0 3 . New York: l l l u m i n a t i n g E n g i n e e r i n g Procedure for C o m p u t i n g V i s u a l Comfort Ratings for

Society of North America, 2003. I n t e r i o r Lighting," ROO Report No. 2 ( 1 9 7 2 ) , Journal

of the 11/uminating Engineering Society, Vol. 2 , No. 3

27. Federal Specifícations for Ambu/ances, KKK-A- (Aprll 1973) p. 328. New York: llluminating Engine­

1822, latest edition, General Services e r i n g Society of North America, 1973.

Administration, http://www.gsa.gov/gsapubs.htm

31. IESNA Roadway Lighting Committee, Líghting

28. IESNA Daylighting C o m m i tt e e , Recommended tor Parking Facilities, RP-20-98, New York:

Practice on Day/ighting, RP-5-99, New York: llluminating Engineering Society of North America,

llluminating Engineering Society of North America, 1998.

1999.

32. 1 ESNA Outdoor Environmental Lighting

29. I E S Testing Procedures Committee. " D e t e r m i n ­ Committee, Líghtíng for Exterior Environments, RP-

ation of Average L u m i n a n c e of Luminaires," Journal 33-99, New York: l l l u m i n a t i n g E n g i n e e r i n g Society of

of the 11/uminating Engineeríng Socíety, Vol. 1 , No. 2 North America, 1999.

(January 1972) p. 181. New York: llluminating

E n g i n e e r i n g Society of North America, 1972.

57
A N S I / I E S N A RP-29-06

Annex A - Designing the L u m i n o u s pied zone, overhead zone, and perimeter zone

Environment determine the overall effectiveness of the space.

A1 . 0 Determining the Visual Composition of Transitiona/ Considerations - When noticeable

the Space "change" is desired, rather than "continuity" between

adjoining spaces and activities, luminance differ­

Light can in fl u e nce an observer s unconscious inter­ ences should substantially exceed a 3:1 ratio. A

pretation of a space because his/her visual experi­ clear sense of change occurs at l u m i n a n c e ratios of

ence is based on form as modified by light. Both 5:1 or more.

aesthetic and psychological implications are

involved. Through the design and placement of Color Continuity ar Change ("Whiteness") - The

lighting elements, the designer controls which sur­ lighting of spaces adjacent to primary activities

faces are lighted, or left i n darkness, whích deter­ s h o u l d consider color continuity. Also, color continu­

m i n e s how the l i g ht pattern w i l l merge with the struc­ ity can impact the evaluation of a patient s condition

tural pattern. I n other words, the designer can spec­ as he/she travels from space to space.

ify how the visual perception of space is to merge

with the activity involved. Light identifies centers of Leve/ of Stimulation - There are few absolutes;

interest and attention, and complements the basic but three significant variables and their influence

mood of the activity performed in the space (as can be o u t l i n e d :

understood and interpreted by the d e s i g n e r ) .

• General Luminance Leve/ - L u m i n a n c e

2 2)
Additional information related to the tapie of q u a l i t y levels below 35 cd/m ( 3 . 2 5 cd/ft. are

of the visual environment may be found in Chapter associated with tw i l i g h t and may appear

1 O of the IESNA Lighting Handbook, Ninth Edition. "dingy" u n l e s s brighter accents are provided.

In practice this responsibility seldom lies entirely • Color and Shade - Warm colors may

with one individual. Usually the final design deci­ stimulate w h i l e cool tones soothe. Saturated

sions involve sorne combination of s k i l l s in architec­ colors are more stimulating than tints. Dark

ture, interior d e s i g n , lighting design, and electrical areas tend to relax, but they can also be

e n g í n e e r i n g . The l i g h t í n g designer s specific respon­ dramatic if focal accents are provided.

sibility is to recognize the importance of both spatial

and task-oriented attributes so that complementary • lnformatíon Content - An under-stimulated

technical efforts contribute to the total result. To do person becomes bored. lnterest and vitality

this, the following s h o u l d be considered: can be generated by stimulation t e c h n i q u e s

involving spatial patterns (brightness, ·color,

Focal Centers - The l i g h t i n g system s h o u l d prop­ and s pa r k l e ) .

erly identify centers of primary and secondary atten­

t i o n . D e p e n d i n g on the relative dominance desired, A2.0 Determining the Desired Appearance of

primary area l u m i n a n c e s h o u l d be five to ten times Objects in the Space

brighter than other nearby surfaces.

Lighting techniques affect the desired appearance

Overhead Zone - Though the ceiling is usually of objects in the space:

subordinate to the focal center, this overhead area

s h o u l d still be considered. For recumbent patients, Dtttusion - Diffuse light tends to de-emphasize

however, the ceiling should be considered a fifth variations in form (contour gradients), pattern, and

wall. texture . (F or example, a t e n n i s ball on an overcast

day can seem to disappear . ) H owever, diffus i on is

Perimeter Zone - In many cases (particularly desired in most work areas to prevent distracting

where a sense of relaxation is desired), the perime­ shadows at the task.

ter s h o u l d be brighter than the overhead zo n e. Here,

simplicity is also desirable. The intent for a subtly S urgical li ghting should pa rt ner direct i onality with

lighted background created with the perimeter zone significant diffusion to relieve harshness and dee p

may be u n d e r m i n e d by "visual clutter." shadows. F acial forms and e x pressions are dis­

cerned best under a similar combination of direc­

Occupied Zone - Activity e m p h a s i s usually occurs tional and diffuse l i g h t i n g .

in the occupied zone where the i l l u m i n a n c e objec­

tives are g e n e rally as listed in Table 38 ( see the Sparkle - The sense of v itality in a space is

main document). The balance between the occu- enhanced with sparkle and h i g h l i g h t . Thus concen-

58
 •
A N S I / I E S N A RP-29-06

trated "point" l i g h t sources interacting with polished shielding and cut-off a n g l e s , lamp ventilation, and

and refractive surtaces s h o u l d be given considera­ the mounted luminaire s intrusion into the space

t i o n . Exceptions i n c l u d e areas where sparkle would s h o u l d a l l be considered.

adversely affect the function of the space.

Lighted and Unlighted Appearance ot Lighting

Color Rendition - Paint and fabrics s h o u l d be cho­ Materials - Hardware appearance and quality of

sen u n d e r the actual l i g h t i n g they w i l l be used with. detail must be compatible with the general c a l i b e r of

Color rendition affects the appearance of patients, other materials in the b u i l d i n g d e s i g n .

food, and guests. Light sources s h o u l d not be com­

pared side-by-side because in a given space the lnitial and Operating Costs - Equipment costs

eye adapts over a wide range. Visual contrast is must be in l i n e with the expense of other materials

nearly always important. The eye is extremely sen­ and systems used i n the b u i l d i n g .

sitive to color differences in transition from one

space to another or from one d i s p l a y to another. Maintenance - The lighting systems must be

accessible for lamp replacement and cleaning.

A3.0 Selection of Luminaires to Fit the Hardware d i rt collection and deterioration character­

Concept of Visual Composition and to istics must be manageable and within accepted l i m ­

lmplement the Desired Appearance of its. What is the recommended maintenance inter­

Objects val? Can the l u m i n a i r e be cleaned effectively? (See

Annex G . )

While the visual implications of light can become

dominant in a space, good lighting is always a Energy Management - The proposed l i g h t i n g sys­

design objective. This end result is achieved tem d e s i g n should use energy efficiently.

through the careful selection and placement of light­

ing components. A3.2 The Architectural Study

lt is the d e s i g n , selection, and placement of l i g h t i n g Engineering considerations aside, luminaires and

devices that creates the luminous environment. other lighting components can become prominent

Hardware terms like "luminaire" and "lighting ele­ factors in the b u i l d i n g s architecture. T h u s , modern

ment" suggest that l i g h t control is also an option. lighting should be integrated into the architectural

Brightness control (far l i m i t i n g glare) and beam dis­ design in ways that are non-threatening. This pro­

tribution (for directing or d i ff u s i n g light) should be metes h e a l i n g and offers a sense of comfort.

considered.

I n health-care facilities the l i g h t i n g system assumes

A3.1 The Engineering Study aesthetic significance far beyond its electrical­

mechanical design connotations. Lighting devices

An initial e n g i n e e r i n g study can identify the alterna­ s h o u l d be j u d g e d by architectural standards in addi­

tives available to achieve d e s i g n objectives. From tion to analysis for e n g i n e e r i n g performance:

these options, a p r e l i m i n a r y selection can be made

that accounts for initial expenses, operating costs, Brightness, Color, Sea/e, and Form - The l i g h t i n g

maintenance, ruggedness, candlepower distribu­ equipment should assume an appropriate textura!

t i o n , and brightness control. role in the architectural composition. Does it con­

tribute to a sense of unity?

With the preliminary selection made, the problem

becomes one of testing and d e s i g n application. The Compatibility with "Period" Designs - The detall­

following e n g i n e e r i n g - o r i e n t e d criteria are important ing s h o u l d harmonize wlth the b u i l d i n g s architectur­

i n g u i d i n g the f i n a l selection of l i g h t i n g e q u i p m e n t : al period. Wall urns and chandeliers that give a

home-like atmosphere require an unobtrusive sys­

Distribution Characteristics and Color of Light - tem to produce comfortable, glare-free i l l u m i n a n c e .

The selected e q u i p m e n t must be able to achieve the

desired visual result (spatial i l l u m i n a n c e and i l l u m i ­ Space Requirement and Architectura/ Detailíng -

nance at the various task centers). (See discussion The physical space must be sufficient for necessary

u n d e r Sections A1 .O and A2.0.) l i g h t i n g cavities and recesses. The detailing and use

of materials s h o u l d be compatible with other b u i l d ­

Dimensional Characteristics and Form - The ing elements.

equipment s physical characteristics (shape and

size) must support the illuminance concept. Coordination with Other Environmenta/ Systems -

Reflector size and f i n i s h , lamp-to-diffuser distance, The l i g h t i n g system s h o u l d be functionally and phys-

59
A N S I / I E S N A RP-29-06
'

ically compatible with building s environment. This d e s i g n attitude survives today i n the develop­

Consider coordinating the l u m i n a i r e s with other ceil­ ment of sorne indirect electric l i g h t i n g systems. With

i n g elements and wall systems. appropriate shielding and careful control of l u rn l ­

naire brightness, l i g h t can be directed toward a spe­

A3.3 The Architectural Context of Luminaires cific surface or object - emphasizing these sur­

faces or objects - with little distracting influence

There are two basic alternatives to l i g h t i n g systems from reflectad brightness patterns.

and l i g h t i n g d e s i g n - the visual/y subordinate sys­

tem and the visual/y prominent system: A3.3.2 Visually Prominent Lighting Systems. A

specular luminaire may compel attention and

A3.3.1 Visually Subordinate Lighting Systems. become the d o m i n a n t factor i n the v i s u a l environ­

Throughout history, sorne architects have attempted ment. In architectural history, G o t h i c stained g l a s s

to introduce l i g h t so the effect is noticed, w h i l e the windows are probably the most obvious examples

light source itself is played down. For example, in of this approach. In contemporary construction,

sorne Byzantine churches, small unobtrusive win­ back-lit c e i l i n g s and w a l l s have a s i m i l a r d o m i n a n t

dows were placed at the base of a d o m e . The dome influence.

then became a majar focal center. Essentially a

h u g e reflector, the dome served as the apparent pri­ Where light-transmitting (rather than opaque) mate­

mary l i g h t source for the interior space. S i m i l a r l y , the rials are p r o m i n e n tl y involved as architectural forms

windows sorne Baroque interiors were partly con­ and surfaces, such self-luminous elements help

cealed from the normal view, so the observer s v i s u a l l y define the space and are important to the

attention was drawn to a brightly lighted adjacent general architectural organization of the rooms with­

wall. in a b u i l d i n g .

60
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II
A N S I / I E S N A RP-29-06

Annex B - Fundamental Factors of Task Time - lt takes time to see. The time needed to

Visibility decipher a given visual message and then take

action is an important measure of efflcíency.

B1.0 General Whenever seeing time increases, surgical proce­

dures may be slowed and the life of the patient

There are f o u r fundamental factors that determine e n d a n g e r e d . lncreasing the task l u m i n a n c e w i l l h e l p

task v i s i b i l i t y ; the size of the task components, the reduce the time required to see and comprehend

contrast of the task detail against its background, the details of a surgical incision. Thus the time to

the a m o u n t of time available to see the detail, and complete the surgical procedure is decreased.

the luminance of the detail and its background.

Luminance - Task luminance is a product of the

Size - The size of medical tasks varies from oper­ task reflectance and the quantity of illuminance

ating on a small vein to setting a large b o n e . As the f a l l i n g u p a n it. For a given task, the greater the i l l u ­

task size increases, v i s i b i l i t y increases and seeing m i n a n c e , the greater the l u m i n a n c e .

becomes easier ( u p to a certain p o i n t ) . Also, when

the task is small, its v i s i b i l i t y can be improved by 82.0 lnterrelated Factors

increasing i l l u m i n a n c e , a n d , therefore, l u m i n a n c e .

Size, contrast, t i m e , and l u m i n a n c e are all interre­

Contrast - To be visible, each critica! detall of a lated. But since task size a n d , usually, its contrast

seeing task must differ i n l u m i n a n c e or color from its are fixed, e n h a n c e m e n t s i n visibility and visual per­

background. Maximum visibility occurs when the formance can be made most easily through

l u m i n a n c e contrast between these details and t h e i r improvements in the lighting characteristics. (See

background is greatest (e.g., luminance contrast Section 5.0 i n the m a i n d o c u m e n t . )

between a dark vein and white tissue is high).

Conversely, this same dark v e i n , when seen against 83.0 Task Movement

blood-red tissue, may exhibit low luminance con­

trast. Where poor contrast conditions exist, v i s i b i l i t y Moving tasks, or tasks that may occur unexpectedly

can be improved by increasing the i l l u m i n a n c e level at any given moment, will require greater illumi­

or by us i ng a more effective lighting system. (See nance.

Section 5.3 i n the m a i n document and Annex C . )

61
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A N S I / I E S N A RP-29-06

Annex C - Veiling Reflections i n the eye fallowing cataract s u r g e r y ) . Moreover, the

task orientation to the light source may be

C1 .o General adjustable (far the surgeon or laboratory worker) or

very difficult to control.

For a long time lighting engineers and scientists

doing vision research have recognized that sub­ The relationship between the eye, the task, and any

stantial losses in contrast, visibility, and visual per­ offending light should be established. (See Figure

formance can result when l i g h t sources are reflect­ C1 . ) lf l i g h t rays are specularly reflected to the eyes,

ed in specular or s e m i s p e c u l a r visual tasks. This is v e i l i n g reflections or glare may occur.

true even in surgical operations. Several factors

contribute to these v e i l i n g reflections. People work on horizontal tasks t h r o u g h o u t a range

of viewing angles. Most such angles are about 25

C2.0 The Visual Task degrees as indicated by the approximate frequency

distribution curves (see Figure C2). These curves

The visual tasks i n a health care facility range from show that 85 percent of viewing angles are between

reading s i m p l e directional s i g n s to complex surgery. zero and 40 degrees, with larger angles reserved far

There are also tasks involving m u l t i p l e l i g h t sources, occasional glances.

such as viewing t h r o u g h a microscope or an endo­

scopic monocular instrument. Both devices are C4.0 The Lighting System

internally i l l u m i n a t e d , and ambient l i g h t i n g may pro­

duce v e i l i n g effects. (For spaces with v i s u a l d i s p l a y The worst type of task lighting is a highly-concen­

terminals [VDTs] see reference 4 in the main docu­ trated, h i g h - l u m i n a n c e source located in the offend­

ment: ANSI/IESNA RP-1-04, American Nationa/ ing zone with a large proportion of flux directed

Standard Practice far Office Lighting.) toward the task. (See Figure C 3 . ) Such a system

may create shadows that interface with hand-eye

C3.0 The Facility User tasks like w r i t i n g . Of course the worker can easily

escape v e i l i n g reflections s l m p l y by t i l t i n g a task so

People with viewing tasks i n the health care facility that specularly-reflected light does not reach the

i n c l u d e those with normal or well-corrected v i s i o n , eye. (This w i l l occur only when the task is truly a flat

and others with aged or even aphakic eyes (no lens matte surface.) Because of e m b o s s i n g and the cur-

OFFENOING ZONE

Figure C 1 . A
--- --- --- --- - ....... --- ---
generalized - .........

\
diagram of the
J
angular

relationships .,. 1
-- -- __.. ...,,,,.. I
involved when

analyzing I

v eiling I
reflections.
ANGLE OF /

INCIOENCE/

/
/
l.

ZONE OF

VEILING REFLECTION

62
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A N S I / I E S N A RP-29-06

(a)

o
z
i
""
s
o
,..
u
z
M,I

::,

o
..
""
CII:

o 10 20 30 .eo so 60

VlfWING ANGLE {FROM V E R T I C A L ) IN OEGREES

(b)
o
z

i
w

s
""
o
>-
;..;

z
"'
B
""
m:

"" ' ', .... ...... _

o 10 20 30 40 50
--- 60

VIEWING ANGlE (FROM VERTICAL I N DEGREES)

Figure C2. Task viewing angles: (a) People use a range of viewing angles

in their work but the peak is at about 25 degrees; (b) 85 percent of seeing

occurs within the O- to 40-degree range, with seeing at the larger angles

limited to occasional glances because of foreshortening and increased

viewing distances.

a b e

Figure C3. The greater the share of task light c o m i n g from immediately over a desk, the more serious the

visibility loss from veiling reflections (i.e., l ig ht reflected to the eye by glossy surfaces). Shown here are three

common installations with the .same i l l u m i n a n c e level: (a) widely·spaced luminaire rows (with a great

concentration of light in each row) that produce veiling reflections at desks in line with the rows; (b) more

closely-spaced l u m i n a i r e rows (with less light per row) that deliver more light from alternate dlrectlons and

produce fewer veiling reflections; and (e) a l u m i n o u s ceiling (with the least light falling directly downward on

the desk) that delivers the most lig ht from alternate directions, reducing veiling reflections still further.

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A N S I / I E S N A RP-29-06

a
b e

Figure C4. A l u m i n a l r e s light distribution pattern can also be effective in reducing ve iling reflections: (a) This

l u m i n a i r e has a strong downward component of light that is likely to produce the most serious v i s i b i l i t y losses;

(b) This l u m i n a i r e exhibits a diffuse distribution that is a considerable improvement over the l u m i n a i r e in (a);

and (e) This l u m i n a i r e delivers a controlled wide angle distribution that emits little light directly downward, thus

m i n i m i z i n g v e i l i n g reflections. (AII three example l u m i n a i r e s have the same total light output.)

vature of many visual tasks (books and m a g a z i n e s ) , • Flux c o m i n g from l u m i n a i r e s w i t h i n the

veiling reflections involving these tasks are not so o ff e n d i n g zone increases v e i l i n g reflections.

easily e l i m i n a t e d .

• F l u x c o m i n g from outside the o ff e n d i n g zone

At the other extreme w o u l d be overall l i g h t i n g placed decreases v e i l i n g reflections.

above the worker and the task. Here, the veiling

reflections would be s i g n i f i c a n t l y reduced (but never • Controlled l u m i n a n c e side l i g h t i n g s u c h as

e l i m i n a t e d ) since there w o u l d always be sorne, l u m í ­ from windows or l u m i n a i r e s with specifically

nance i n the offending z o n e . (Sée Figure C 1 . ) d e s i g n e d l i g h t d i s t r i b u t i o n (see Figure C4) is

effective i n r e d u c i n g v e i l i n g reflections. Far

Between these extremes líes a full range of lumi­ visual comfort, the facility user s h o u l d be

n a i r e s i z e s . They can be spaced to occupy various positioned so that the l i n e - o f - s i g h t is parallel to

portions of the ceiling, and employ materials that (or away from) windows lacking l u m i n a n c e

produce varying candlepower distributions. (See control. Users s h o u l d not face such w i n d o w s .

Figure C 4 . )

• Light source p o s i t i o n s on either s i d e of (and

es.o Reducing Veiling Reflections b e h i n d ) the user are preferred. Where work

surface positions are r a n d o m , as m u c h l i g h t as

While the exact evaluations of lighting systems, possible s h o u l d reach the task from sources

materials, and layouts are not yet established, sev­ outside the o ff e n d i n g z o n e .

era! general conclusions can be drawn from the

broad body of current k n o w l e d g e : • Any d e c i s i o n on a l i g h t i n g installation s h o u l d

i n c l u d e the considerations of efficiency and

• The written or printed task s h o u l d be on matte visual comfort in the space.

paper u s i n g n o n g l o s s y i n k s . The use of glossy

paper stock and hard p e n c i l s s h o u l d be Attention s h o u l d also be given to the color of objects

minimized. and the color of the l i g h t sources so that contrast is

not inadvertently reduced.

• As l o n g as the geometry of the situation is not

c h a n g e d , lost contrast can be compensated for

with increased i l l u m i n a t i o n .

64
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� A N S I / I E S N A RP�29-06

Annex D - lighfüng System Oharacterlstics so high ceiling briqhtness does not occur directly

above the l u m i n a i r e . The goal is a c e i l i n g e x h i b i t i n g

D1 .O General uniform luminance over its entire surtace. At high

illuminances, the ceiling luminance can become a

Luminaires for general lighting are classified in source of glare and v e i l i n g reflections (see Section

North America ( I E S N A ) and internationally ( C I E ) in 5.3.3 and Section 5.4.2 i n the main d o c u m e n t ) .

accordance with the percentage of total output ernit­

ted above and below the horizontal as shown ín When indirect l i g h t i n g systems are used in a health

Figure D 1 . The l i g h t i n g produced by each l u m i n a i r e care facility, luminaire cleaning problems must

type has a u n i q u e character. receive special consideration.

D2.0 lndlrect D3.0 Seml-lndlrect

With indirect l i g h t i n g , 90 to 1 0 0 percent of the l i g h t With semi-indirect lighting, 60 to 90 percent of the

is directed to the ceiling and upper walls, which l i g h t is directed upward (as in the indirect system),

reflect it to all parts of the r o o m . Matte f i n i s h , high­ w h i l e the rest is directed downward. Since t h i s sys­

reflectance room surfaces are essential far distrib­ tem also uses the c e i l i n g as the room's main source

uting the light. These surfaces must be cleaned of light, the considerations discussed in Section

regularly and kept in good condition to maintain D2.0 regarding ceiling luminance, room finishes,

t h e i r h i g h reflectance characteristics. and good maintenance s h o u l d be observed.

Light from an indirect system is h i g h l y d i ff u s e , and S e m i - i n d i r e c t u n i t s use l u m i n o u s surfaces that h e l p

produces m i n i m a l shadows. (For this reason three­ achieve low luminance ratios between the ceiling

dimensional work tasks may require supplemental and the luminaire. But since more light is directed

l i g h t i n g that w i l l produce modeling shadows.) With down, the resulting d i r e c t o r reflected glare and veil­

well-planned installations, both direct and reflected ing reflections may r equ i r e attention. (See Section

glare are minimized. Luminaire luminance should 5.3.3 and Section 5.4.2 in the m ai n document.)

approximate the ceiling luminance. The luminaire A g a i n , c l e a n i n g considerations are i m p o rt a n t .

should be suspended far e n o u g h below the c e i l i n g

Typical

candlepower

Percent Percent distribution

Classification up light down light curve

Figure D 1 . Luminaires

for general l i g h t i n g are

Direct 0-10 90-100 classified in five

<V categories by the Cl"E

(lnternational

C o m m i s s i o n on

l l l u m i n a t i o n ) according

6.0-90 to the percentages of

Semi-direct 10-40
total luminaire output
� emitted above and

below horizontal.

Actual light distribution

curves may take many

General diffuse 40-60 40-60
$ forms (within the limits

of upward and

downward distribution)

depending on the type

of light source and the

-w-
Semi-indirect 60-90 10-40
l u m i n a i r e design.

lndirect 90-100 0-10

f
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A N S I / I E S N A RP-29-06

04.0 General Oiffuse luminaires are mounted close to the c e i l i n g , the dis­

tribution characteristics of the l u m i n a i r e c h a n g e to

With general d i ff u s e lighting the light directed semi-direct. Note that luminaire luminance will

upward about equals the light directed downward increase when the l u m i n a i r e is mounted close to the

(each is 40 to 60 percent of the l u m i n a i r e output). Of ceilíng, and that ceiling l u m i n a n c e above the lumi­

the total illumination on a task, the larger part w i l l naire will often significantly exceed the luminaire

come from the downward directed light. General dif­ luminance. Befare deciding whether such lumi­

fuse luminaires distribute light about e q u a l l y in all naires are suitable for this type of m o u n t i n g , a study

directions. [Note: Direct-indirect is a special (non­ s h o u l d be made of the distribution c u rv e s .

C I E } category w i t h i n the General Diffuse classifica­

tion, in which the l u m i n a i r e s emit very little light at 06.0 Oirect

angles near the horizontal.]

With direct l i g h t i n g , 90 to 1 0 0 percent of the light is

These systems make good use of the source l i g h t , directed downward. This downward light may pro­

as little is lost within the l u m i n a i r e . However, shad­ duce disturbing shadows and reflected glare u n l e s s

ows may be more noticeable than with the indirect the lighting units are the large-area type, are close­

or semi-indirect systems. Sorne direct glare may ly spaced, or utilize the appropriate distribution.

be experienced from general-diffuse luminaires. (See Figure C4 in Annex C . )

Reflected glare and veiling reflections are also likely

to create problems. (See Section 5.3.3 and Section Because direct glare and excessive luminance

5.4.2 in the m a i n document.) ratios are very l i k e l y (see Section 4.0 i n the main

document), careful study should be made of the

05.0 Semi-Oirect luminaire's l i g h t distribution. High-reflectance room

and furniture surfaces are essential to redirect light

With semi-direct lighting, 60 to 90 percent of the light back to the c e i l i n g . The same precautions that apply

is directed downward toward the work surface. The to semi-direct luminaires s h o u l d be used to prevent

small percentage directed upward illuminates the reflected glare.

ceiling, increasing diffusion and reducing the lumi­

nance ratio between the l u m i n a i r e and the c e i l i n g . Ceiling-area lighting, extending essentially from

wall-to-wall, is a form of direct l i g h t i n g that greatly

With most of the light directed downward, shadows reduces reflected glare. Here, l i g h t from sources in

are more noticeable and greater reflected glare a large, high-reflectance cavity is directed down­

occurs. Shadows and reflected glare may be m i n i ­ ward, through cellular louvers , o r through translu ­

mized by design so that, in any task area, light cent ( or prismatic ) mater i al. T he same precautions

comes from many directions. Using large-area regarding direct or reflected gl are ta k en with the

sources helps soften shadows and reduce reflected other general lighting systems described in this

glare. Moderate reflectances and matte finishes on Annex s h o u l d be utilized. (S ee Section 5.3.3 and

furniture and e q u i p m e n t surfaces are also essential Section 5.4.3 in the main document. )

to minimize reflected glare. When general diffuse

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 A N S I / I E S N A RP-29-06

Annex E - Economics of Lighting Systems and other equipment should be carefully consíd­

ered. No compromise with illumination quality

Lighting costs are usually computed on an overall s h o u l d be made.

annual basis. The total cost of a l i g h t i n g system is

the sum of the awning and operating charges. W hi l e Table E 1 , a typical cost analysis form, lists the ele­

initial investment may be a d o m i n a n t factor in select­ ments normally included when making economic

ing luminaires or lamp types, there are capital comparisons between two or more l i g h t i n g systems.

expenses that s h o u l d also be considered.

Table E2 permits a recapitulation of gathered data

Such computations involve amortization of equip­ and presents cost analysis formulas far three dis­

ment and wiring, interest on investment, taxes, parate lamp replacement methods. Different individ­

insurance, cost of electric power, maintenance/labor uals may participate in gathering data and perform­

expense, and lamp replacement purchases. Health ing the calculations. Therefore, all lighting cost com­

care groups are often faced with the necessity of putations s h o u l d be checked to insure that they are

m a k i n g a low i n i t i a l investment, despite h i g h e r oper­ based on s i m i l a r energy rates, burning hours, and

ating costs. When such is the case, the l ig h t source depreciation s c h e d u l e s .

67
A N S I / I E S N A RP-29-06

Table E1 : Typical Lighting Cost Analysis Form

PAGE OF__

PROJECTAREA��������� LIGHTING LIGHTING

( g a m b l i n g floor, office area, store room) METHOD #1 M E T H O D #2

INSTALLATION DATA
2 2)
Are a, m (ft. of installation

N u m b e r of l u rn l n a i r e s

Lamps per l u m i n a i r e

Lamp type ·

L u m e n s per la rnp

Watts per l u m i n a i r e ( i n c l u d i n g accessories)

Hours per start

B u r n i n g hours per year

Group relamping interval or rated l i t e .

Light loss factor

Coefficient of utilization

Lux (Footcandles) maintained

CAPITAL E X P E N S E S

Net cost per l u m i n a i r e

lnstallatíon labor and w i r i n g

( l u m i n a i r e = labor & w i r i n g )

Total cost of l u m i n a i r e s

lnterest on investment (per year)

Taxes (per year)

1. Total capital expense per year

OPERATING ANO M A I N T E N A N C E E X P E N S E S

Energy expense

Total watts

Average cost per Kwh

2. Total energy cost per year

LAMP RENEWAL E X P E N S E

Net cost per l a m p

Labor cost each i n d i v i d u a l relarnp

Per cent lamps that fail befare

group relamp

Renewal cost per lamp socket per year

Total number of lamps

3. Total lamp renewal expense per year

CLEANING EXPENSE

N u rn b e r of washings per year

Labor hours each (estírnated)

Labor hours for washing

N u m b e r of dusting per year

Labor hours per dusting each

Labor hours for dusting

Total labor hours

Expense per labor ho ur

4. Total cleaning expense per year

REPAIR EXPENSE

Repairs (based on experience,

labor repair time)

Estimated total repair expense per year

5. Total operating and maintenance

expense per year

PAGE SUBTOTALS

(Lines 1 , 2, 3, 4, and 5)

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 A N S I / I E S N A RP-29-06

Table E2: Data Recapitulation and Lamp Replacement Methods/Formulas

PAGE OF__

PROJECTAREA��������� LIGHTING LIGHTING

(gambling tloor, office area, store room) METHOD #1 METHOD #2

INSTALLATION DATA
2 2)
Area, m (ft. of installation

N u m b e r of different l u m i n a i r e s

Total lamps

B u r n i n g hours per year

Lux (footcandles) maintained

CAPITAL E X P E N S E S

L u m i n a i r e type/page

L u m i n a i r e type/page

Luminaire type/page

L u m i n a i r e type/page

L u m i n a i r e type/page

Subtotal

OPERATING & MAINTENANCE E X P E N S E S

L u m i n a i r e type/page

L u m i n a i r e type/page

Luminaire type/page

L u m i n a i r e type/page

L u m i n a i r e type/page

Subtotal

PRO JEC T TOTALS

EQUATIONS

(Total watts) x ( b u r n i n g hrs per year) x (cost per Kwh)

Total energy cost per year =
1000

The following formulas give the a n n u a l cost per socket for lamps and replacement

and can be used to determine the most economical replacement method.

B (e + f)
I n d i v i d u a l replacement = dollars/socket/year
R

B ( e + g + Kc + Kf)
G r o u p replacement dollars/socket/year
A
(early b u r n o u t replaced)

8 ( e + g)
Group replacement dollars/socket/year
A
(no replacement of early burnouts)

where:

A = B u r n i n g time between replacement, in hours

8 = B u r n i n g hours per year

R = Rated average lamp b u r n i n g hours

K = Proration of lamps failing before group replacement (from lamp mortality curves)

e = Material cost per individual lamp in dollars ( i n d i v i d u a l replacement)

f = Labor cost per lamp in dollars (individual replacement)

e = Material cost per lamp in dollars (group replacement)

g = Labor cost per la mp in dollars (group replacement)

N o t e : No general rule can be given for use of group replacements.

Each installation s h o u l d be considered separately.

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A N S I / I E S N A RP-29-06

Annex F - L i g h t i n g System Maintenance The most significant factors are lamp l u m e n depre­

ciation ( L L D ) and l u m i n a i r e d i rt depreciation ( L D D ) .

AII lighting systems degrade with time, and illumi­ lmproving LLD and LDD means replacing lamps

nance can drop by 25 percent within 24 months of and c l e a n i n g the l u m i n a i r e s .

installation. Lighting e q u i p m e n t and room surfaces

s h o u l d be well m a i n t a i n e d and cleaned to preserve The average maintained illuminance level rises as

appearance, efficiency, and l i m i t spread of infection. the cleaning frequency increases. Cleaning at fre­

Luminaire accessibility should be considered for q u e n t intervals can often be justified d e p e n d i n g on

c l e a n i n g and relamping i n h i g h mounting areas. Any the conditions and the type of lighting system

overall loss of l i g h t may be d u e to: installed. Washing and repainting of room surfaces

at regular intervals is also recommended.

• Lamp L u m e n Depreciation ( L L D ) . The l i g h t

output of any lamp w i l l decrease to sorne lt is important that flickering lamps be replaced as

extent as the lamp is operated. This decrease soon as possible. lt is essential that such lamps be

depends upon the lamp type involved and its replaced i m m e d i a t e l y in psychiatric facilities, educa­

use cycle. tional areas, and living spaces for the ag e d .

• L u m i n a i r e D i rt Depreciation ( L D D ) . This is d u e Other considerations regarding maintenance prac­

to dust and d i rt accumulation on l u m i n a i r e tices have to do with down time and infection control

surfaces that r e f l e c t o r transmit l i g h t . requirements of a given space. S o rn e rooms, such

as surgery, need to be scheduled, cleaned, and

• Burned-out l a mp s that have not been replaced. sterilized after maintenance procedures.

(Always replace with the proper size and color

lamp.) lf the lighting system is to perform as designed,

knowledge of the required cleaning/relamping pro­

• Deterioration i n l u m i n a i r e surfaces that reflect gram must be conveyed directly to the maintenance

or transmit l i g h t . staff. After considering all applicable factors, the

designer (or engineer/architect) determines when

• Dust and d i rt accumulation on room surfaces. the lighting system should be serviced and then

makes the necessary recommendations personally.

• Temperature and voltage fluctuation.

(Fluorescent lamps are particularly affected by

changes i n temperature, and íncandescent

filament l a m p s by changes i n voltage.)

70
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A N S I / I E S N A RP-29-06

Annex G - Fiber-Optic l l l u m i n a t i o n Tests mately uniform illuminance. Fiber-optics require a

sensor cell only a few m i l l i m e t e r s (tenths of an i n c h )

G1 .O General in diameter to measure exit face i l l u m i n a n c e [or i l l u ­

m i n a n c e within 2 m m ( 0 . 8 i n . ) ] . lnaccurate readings

The radiant energy at the exit face of rnany fiber­ that are much too low w i l l occur if the cell area is not

optíc diagnostic and endoscopic illumination sys­ filled.

tems can accidentally produce a second-degree

burn. However, at a distance of just 30 m m (1 in.), G3.0 Testing Duration

the irradiance level is much less because of the

expanding i l l u m i n a t i o n cone. Superficial tests made at a fixed irradiance (to find

out how long it takes to reach the threshold of pain

Maximum s u m m e r s u n l i g h t at noon on the earth's on the e q u i p m e n t user s wrist) can provide a partial

surface is about 1 0 0 , 0 0 0 l u x ( 1 0 , 0 0 0 fe), and irradi­ safeguard against inflicting patient b u r n s . Far d u r a ­

ance from the entire visible and infrared spectrum is tions of 5 to 30 seconds - to the threshold of pain -
2 2)
about 0.1 watt/cm (0.645 watt/in. . The ratio of the time to the second-degree burn threshold is
2
microwatts/cm to lux is about one-to-one. Most about three times longer.

fiber-optic systems, on the other hand, produce

2
microwatts/cm -to-lux ratios of 10:1 to 15:1 at the When i r r a d i a n c e duration is less than that produc­

exit face. ( S u r g i c a l i l l u m i n a t i o n assemblies produce ing "threshold" p r i c k l i n g pain, the m a x i m u m tissue

a ratio of o n l y 3 : 1 because the infrared energy is fil­ temperature w i l l be less than 44ºC ( 1 1 1 ºF) with 0 . 1
2 2)
te.red o u t.) T h u s , for equal degrees of safety, fiber­ watt/cm (0.645 watt/in. i n c i d e n t radiant flux, and it

optic irradiance levels s h o u l d be held between one­ w i l l stay s l i g h t l y below 44ºC ( 1 1 1 ºF) when the s k i n

half and one-third the l i m i t placed on surgical i l l u m i ­ is blackened with i n d i a i n k and exposed for 5 to 1 O

nation assemblies. minutes. Skin blackened with india ink will absorb

90 percent of the radiant flux at all wavelengths

With special filtering that e l i m i n a t e s all infrared, and (400 to 1 4 0 0 nanometers) transmitted by fiber-optic

thereby limits a fiber-optic device's output to only vis­ bundles. lf skin blackened with india ink is tested

i b l e l i g h t (400 to 700 nanometers), light-colorad tis­ with an unknown fiber-optic be a m , and the time

sue can tolerate about 1 , 0 0 0 , 0 0 0 lx ( 1 0 0 , 0 0 0 fe) for required to produce "threshold" p r i c k l i n g pain is 60

60 seconds befare tissue temperature reaches the seconds or longer, then the irradiance of that
2 2)
threshold of p a i n . Most tissue can tolerate 200,000 unknown beam is 0 . 2 watt/cm ( 1 . 2 9 watts/in. or

lux (20,000 fe) for o n l y five or ten minutes with rea­ less. lf this same irradiance hits light-colored tissue

sonable safety, except for t h i n visceral tissue. (with 50 percent absorption), the m a x i m u m tissue

temperature probably w i l l be 44ºC ( 1 1 1 ºF) or less

G2.0 Measurement for an exposure time of 5 to 1 O m i n u t e s . For a fixed

irradiance, a 30-second interval to threshold pain

When measuring i l l u m i n a n c e or irradiance ( i n c i d e n t on blackened skin corresponds to about 120 sec­

, flux density per square centimeter), the l i g h t beam o n d s to threshold pain on dark-colored tissue (75

must completely f i l l the photo detector with approxi- percent a b s o r p t i o n ) .

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A N S I / I E S N A RP-29-06

Annex H - Stereo-Surgical Microscope addressed. See Section 4.11.1 in the main docu­

ment concerning the dangers of higher irradiance

When first introduced, stereo-surgical microscopes levels. Allowable energy levels will also vary

had tungsten l a m p s and were used continuously at d e p e n d i n g on the nature of the tissue and where it

levels s l i g h t l y h i g h e r than 6 5 , 0 0 0 l u x (6,500 fe) and is located.

2 2),
0.035 watt/cm (0.226 watt/in. and intermittently
2
up to 150,000 lux (15,000 fe) and 0.085 watt/cm Modern microscopes have moved the l i g h t source
2
(0.548 watt/in. ) a t a color temperature of 3200 K to away from the head of the microscope and use fiber

3400 K. The spectral distribution of the l i g h t beam optics to d e l i v e r a much more powerful i l l u m i n a n c e

produced by the 30 to 50 watt tungsten-halogen to the surgical field p e r m i tt i n g more accessories and

lamps and 2 m m (0.08 i n . ) thick K G - 1 heat-absorb­ observers. The extremely bright source can still

ing glass filter w i t h i n the microscope resulted in an deliver heat to the operative f i e l d , drying tissues too

irradiance ratio of 6 . 5 : 1 . (This is the ratio of the heat­ quickly. Very bright fiber optic i l l u m i n a n c e can cause

i n g effect with the 2 m m ( 0 . 0 8 i n . ) glass filter i n place retinal, cornea, and lens damage during eye

to the heating effect with the filter removed.) Table surgery.

H1 lists transmitted energy a t a 20 cm ( 7 . 9 i n . ) work­

ing distance for two types of microscope lamp Part of the problem is that beam splitters take part

sources. of the l i g h t for accessories, observers, and cameras.

Adding a splitter reduces l i g h t reaching the s u r g e o n ,

Assuming healthy patient tissue, no injury was removing it causes more l i g h t to reach the s u r g e o n .

reported to m i d d l e ear structures from such l i g h t lev­ Adjustable light sources can compensate, but

els, a l t h o u g h these tissues contain facile nerves and sometimes the surgical team w i l l need to take extra

isolated anatomical parts of low mass (the ear ossi­ precautions to protect t i s s u e .

cle ) . A normal eardrum is semi-transparent, and

optically transmits much i n c i d e n t l i g h t wave energy, Also of concern is the potential for eye damage to

which is then diffused and scattered in the space the patient and the operating room staff from s u r g i ­

b e h i n d the e a r d r u m . cal lasers. lrradiance levels from fiber optic i l l u m i n a ­

tion systems are discussed in Annex G and in

Research related to actual tissue exposed to such Section 6.4.2.4 of the m a i n d o c u m e n t .

heat energy rather than healthy tissue must be

Table H 1 : Summary of Data for Stereo-Surgical Microscope l l l u m i n a n c e with a 2 cm (0.8 i n . ) Front Lens

and a 20 cm (7.9 i n . ) Working Distance

EMF Current Kilolux Footcandles lrradiance lrradiance

2) 2)
(Volts) (Amperes) (watVcm (watt/in.

30-watt Tungsten Lamp

Normal 3200 K 7.2 5.5 60 5,600 0.035 0.226

Overvolt (intermittent)-3400 K 8.2 6.4 130 12,000 0.070 0.452

SO-watt Tungsten Lamp

Normal visual-3000 K 6.0 8.3 50 4,500 0.030 0.194

Normal visual-3200 K 7.2 9.0 75 7,000 0.045 0.290

Overvolt (intermittent)-3400 K 8.2 10.2 150 14,000 0.085 0.548

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 A N S I / I E S N A RP-29-06

Annex 1 - Glossary of L i g h t i n g Terms and ballast a device used with an electric-discharge

Health Care (Hospital) Terms lamp to obtain the necessary circuit c o n d i t i o n s (volt­

age, current, and wave form) for starting and oper­

11.0 L i g h t i n g Terms ating the l a m p .

Note: (For additional information refer to ANSI/

IESNA RP-16-05, Nomenclature and Definitions iot brightness (of a perceived aperture color) the

11/uminating Engineering.) attribute by which an area of color of finite size is

perceived to emit, transmit, or reflect a greater or

accent l i g h t i n g directional l i g h t i n g to e m p h a s i z e a lesser a m o u n t of l i g h t . No j u d g e m e n t is made as to

p a r t i c u l a r object or surface feature, o r t o draw atten­ whether the l i g h t comes from a reflecting, transmit­

tion to a part of the field of view. See directional t i n g , or self l u m i n o u s object.

lighting.

bulb see l a m p .

accommodation the process by which the eye

changes focus from one distance to another. candela (cd) the S I u n i t of l u m i n o u s intensity. One

candela is one lumen per steradian (lm/sr).

adaptation the process by which the all or part of Formerly, c a n d l e .

the retina becomes accustomed to more or less l i g h t Note: The fundamental l u m i n o u s intensity definition

than it was exposed to d u r i n g an i m m e d i a t e l y pre­ in the S I is the c a n d e l a . The candela is the l u m i n o u s

cedinq period. lt results i n a c h a n g e in the sensitivi­ intensity, i n a g i v e n direction of a source that emits
1 2
ty to l i g h t . See chromatic adaptation and photopic monochromatic radiation of frequency 540 ° 10

vlslon, hertz that has a radiant intensity i n that direction of

1 /683 watt per steradian. The candela so d e f i n e d is

ambient l i g h t i n g lighting t h r o u g h o u t an area that the base u n i t applicable to photopic q u a n t i t i e s , seo­

produces general i l l u rn i n a t i o n . topic q u a n tit i e s , and q u a n t i t i e s to be defined i n the

mesopic d o m a i n . ( S e e Figure 11 ).

average l u m i n a n c e l u m i n a n c e is the property of a

geometric ray. L u m i n a n c e as measured by conven­ candlepower, 1 = d<I>/dco (cp) luminous intensity

tional meters is averaged with respect to two inde­ e x pressed in c a n d e l a s .

p e n d e n t variables, area and salid a n g l e ; both must

be defined for a complete description of a l u m i n a n c e candlepower distribution curve a curve, general ­

measurement. ly polar, representing the variation of l u m i n o u s i n t e n ­

sit y of a lamp of luminaire in a plane through the

baffle a single opaque or translucent e l e m e n t to l i g h t c enter.

s h i e l d a source from direct view at certain a n g l e s , to

absorb or block unwanted light, or to reflect and c e i l i n g area l i g h t i n g a general lighting system in

redirect l i g h t . which the entire c e i l i n g is , i n e ff ect, o n e large lumi­

n a i r e . Note: C e i l i n g area l i g h t i n g i n c l u d e s l u m i n o u s

ceilings.

Figure 1 1 . Relationship between candelas, lumens,

lux, and footcandles. A point source ( l u m i n o u s

intensity == one candela) is shown at the center of

a sphere of one u n i t radius whose surface has a

reflectance of zero. The i l l u m i n a n c e at any point

on the sphere is one lux (one lumen per square

meter) when the radius is one meter, or one

footcandle (one lumen per square foot) when the

radius is one foot. The solid angle subtended by

the area A, 8, C, D is one steradian. The flux

density is, therefore, one lumen per steradian,

which corresponds to a l u m i n o u s intensity of one

candela, as o r i g i n a l l y assumed. The sphere has a

2
total area of 4:rt m or ft.2, and there is a l u m i n o u s

flux of one l u m e n falling on each unlt area (each

square meter or square foot). Thus, the source

provides a total of 4:rt ( 1 2 . 5 7 ) l u m e n s .

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A N S I / I E S N A RP-29-06

central (foveal) vision the s e e i n g of objects i n the d i s a b i l i t y glare the effect of stray l i g h t i n the eye

central or foveal part of the visual field, approxi­ whereby visibility and visual performance are

mately two degrees in diameter. lt permits seeing reduced. See veiling l u m i n a n c e .

much finer detail than does peripheral v i s i o n .

discomfort glare glare-producing discomfort. lt

chromatic adaptation the process by which the does not necessarily interfere with visual perfor­

chromatic properties of the visual system are m o d i ­ mance or visibility.

fied by the observation of stimuli of various chro­

maticities and l u m i n a n c e s . downlight a small direct-lighting u n i t that directs

light downward. lt can be recessed, surface mount­

coefficient of utilization (CU) the ratio of the l u rn i ­ ed, or s u s p e n d e d .

nous flux (lumens) from a luminaire calculated as

received on the work plane to the luminous flux efficacy see luminous efficacy of a source of

emitted by the l u m i n a i r e s lamp a l o n e . light.

color rendering general expression far the effect efficiency see luminaire efficiency, and luml­

of a l i g h t source on the color appearance of objects nous efficacy of a light source.

in conscious or subconscious comparison with their

color appearance u n d e r a reference l i g h t source. equivalent veiling l u m i n a n c e the l u m i n a n c e of the

reflected image of a bright surface that is s u p e r i m ­

contrast see l u m i n a n c e contrast. posed on a test object to measure the v e i l i n g effect

equivalent to that produced by stray l i g h t in the eye

contrast rendition factor ( C R F) the ratio of visual from a disability glare source. The disability glare

task contrast with a g i v e n l i g h t i n g e n v i r o n m e n t to the source is turned off when the reflected image is

contrast with sphere i l l u m i n a t i o n . turned o n .

contrast sensitivity the ability to detect the pres­ fenestration any o p e n i n g or arrangement of o p e n ­

ence of luminance differences. Quantitatively, it is i n g ( n o r m a l l y f i l l e d with m e d i a for control) for admis­

e q u a l to the reciproca! of the contrast threshold. sion of daylight.

cut .. off a n g l e ( o f a l u m i n a i r e ) the a n g l e , measured fixture see l u m i n a i r e .

up from nadir, between the vertical axis and the first

l i n e of si g ht at wh i c h the bare source is not v i s i b l e . fluorescent lamp a low pressure mercury electric­

discharge lamp in which a fluorescing coating

diffuse reflections the process by which incident (phosphor) transforms sorne of the ultraviolet ener­

flux is redirected over a range of a n g l e s . gy generated by the discharge into energy within the

v i s i b l e spectrum.

diffused lighting light that is not predominantly

i n c i d e n t from any particular d i r e c t i o n . flux see l u m i n o u s f l u x .

direct glare glare resulting from h i g h l u m i n a n c e s or footcandle (fe) the unit of illuminance, in older

insufficiently shielded light sources in the field of texts, where the foot is taken as the u n i t of length

view or from reflecting area of high luminance. lt rather than the meter. lt is the i l l u m i n a n c e on a sur­

u s u a l l y is associated with bright areas, such as l u m i ­ face one square foot in area on w h i c h there is a u n i ­

naires, ceilings, and windows that are outside the formly distributed flux of one l u m e n . (See Figure 1 1 . )

v i s u a l task or regían b e i n g viewed.

general l i g h t i n g l i g h t i n g d e s i g n e d to provide a sub ­

direct lighting lighting by luminaires distributing stantially uni f orm level of i l l u m i n a n c e t h r o u g h o u t an

90 to 1 0 0 percent of the emitted l i g h t i n the g e n e r ­ area, e x clusive of any provisio n for special local

al direction of the surface to be illuminated. The l i g h t i n g re q uirements.

term u s u a l l y refers to l i g h t emitted i n a downward

direction glare l u m i n a n c e w i t h i n the visual field that is suffi ­

ciently greater than the l u m i n a n c e to w hich the eyes

directional l i g h t i n g i l l u m i n a t i o n on the work plane are ada pted that causes annoyance , discomfort, or

(or on an object) that is predominantly from a s i n g l e loss i n visual pe rf ormance and vis i bility. S ee direct

direction. See accent l i g h t i n g . glare, disability glare, discomfort glare, and

reflected glare.

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 A N S I / I E S N A RP-29-06

high intensity discharge lamps (HIO) a general level of i l l u m i n a t i o n see i l l u m i n a n c e .

group of lamps consisting of mercury, metal h a l i d e ,

and h i g h pressure s o d i u m sources. light radiant energy that is capable of exciting the

retina and producing a visual sensation. The v i s i b l e

illuminance, E = dct>/dA the density of l u m i n o u s portion of the electromagnetic spectrum extends

flux incident on a surface at a point. The average from about 380 to 770 nanometers.

l u m i n o u s flux on an area is the quotient of the total

flux incident on the surface to the area of the surface. l i g h t loss factor (LLF) a factor used i n calculating

i l l u m i n a n c e after a given period of time and under

i l l u m i n a n c e { l u x or footcandle) meter an instru­ given conditions. lt takes into account temperature

ment for measuring illuminance on a plane. and voltage variations, d i rt accumulation on lumi­

lnstruments that accurately respond to more than naire and room surfaces, lamp depreciation, main­

one spectral distribution are color corrected. tenance procedures, and atmospheric conditions.

lnstruments, which accurately respond to more than Formerly called maintenance factor.

one spatial distribution of i n c i d e n t f l ux , are cosine­

corrected, i . e . , the response to a source of u n i t l u m i ­ local l i g h t i n g l i g h t i n g d e s i g n e d to provide i l l u m i n a ­

nous intensity, i l l u m i n a t i n g the detector from a fixed tion over a relatively s m a l l area or confined space

distance and from different directions, decreases as without providing any significant general surround­

the cosine of the a n g l e between the incident direc­ ing l i g h t i n g .

tion and the normal to the detector surface. The

instrument is comprised of sorne form of photode­ localized general lighting lighting that utilizes

tector, with or without filters, driving a digital or ana­ luminaires above the visual task and contributes

log readout through appropriate circuitry. also to the i l l u m i n a t i o n on the s u r r o u n d .

illumination the act of i l l u m i n a t i n g or state of b e i n g louvered ceiling a ceiling area lighting system

i l l u m i n a t e d . This term has been used for density of c o m p r i s i n g a wall-to-wall installation of m u l t i c e l l lou­

l u m i n o u s flux on a surface (illuminance) and such vers s h i e l d i n g the l i g h t sources mounted above it.

use is to be deprecated. See l u m i n o u s c e i l i n g .

incandescent filament lamp a lamp in which light lumen (lm) the unit of l u m i n o u s flux. (See Figure 1 1 . )

is produced by a f i l a m e n t heated to incandescence

by an electrical current. luminaire a complete l i g h t i n g u n i t consisting of a

lamp or lamps together with the parts d e s i g n e d to

indirect l i g h t i n g l i g h t i n g by l u m i n a i r e s d i s t r i b u t i n g distribute the light, to position and protect the l a m p s ,

90 to 1 0 0 percent of the emitted l i g h t upward, rather and to connect the lamps to the power supply.

than toward a horizontal task p l a ne below.

l u m i n a i r e dirt depreciation factor (LOO) the rn u l ­

intensity a s h o rt e n i n g of the terms l u m i n o u s inten­ t i p l i e r to be used in i l l u m i n a n c e calculations to relate

sity and radiant intensity. Often misused for i l l u m i ­ the initial i l l u m i n a n c e provided by c l e a n , new l u m i ­

nance. naires to be reduced i l l u m i n a t i o n resulting from d i rt

collection on the luminaires just prior to the time

lamp a generic term for a man-made source creat­ when c l e a n i n g procedures w i l l be instituted. This is

ed to produce optical radiation. By extension, the one c o m p o n e n t of the l i g h t loss factor.

term is also used to denote sources that radiate in

regions of the spectrum adjacent to the visible. luminaire efficiency the ratio of luminous flux

(Note: Through popular usage, a portable l u m i n a i r e (lumens) emitted by a l u m i n a i r e to that emitted by

consisting of a lamp with shade, reflector, enclosing the lamp or larnps used therein.

g l o b e , h o u s i n g , or other accessories is also called a

"lamp." In such cases, in arder to distinguish luminance the quotient of the l u m i n o u s flux at an

between the assembled unit and the light source element of the surface surrounding the point, and

within it, the latter is often called a "bulb" or "tube," if propagated in directions defined by an elementary

it is electrically powered.) See also l u m i n a i r e . cone containing the given direction, by the product

of the salid a n g l e of the cone and the area of the

lamp l u m e n depreciation factor (LLD) the m u l t i ­ o rth o g o n a l projection of the e l e m e n t of the surface

plie r to be used i n i l l u m i n a t i o n calculations to relate on a p l a n e p e r p e n d i c u l a r to the g i v e n d i r e c t i o n . The

the i n i t i a l rated output of l i g h t sources to the antici­ luminous flux may be leaving, passing through,
2
pated m í n i m u m rated output based on the r e l a m p i n g and/or arriving at the surface. L = d <I> / ( d w d A c o s e ) .

program to be u s ed . Formerly, photometric brightness.

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luminance contrast the retationship between the portable lighting lighting by means of e q u i p m e n t

luminances of an object and its immediate back­ designed for m a n u a l portability.

ground.

portable luminaire a lighting u n i t that is not per­

luminance difference the difference in l u m i n a n c e manently fixed i n place.

between two areas. lt u s u a l l y is applied to contigu­

ous areas, such as the detail of a visual task and its quality of lighting p e rt a i n s to the distribution of

immediate background, i n w h i c h case it is quantita­ l u m i n a n c e in a visual environment. The term is used

tively equal to the numerator i n the formula for l u rn i ­ i n a positive sense and i m p l i e s that all luminances

nance contrast. contribute favorably to visual performance, visual

comfort, ease of s e e i n g , safety, and esthetics for the

luminance ratio the ratio between the l u m i n a n c e s specific visual tasks involved.

of any two areas in the visual f i e l d .

quantity of light (luminous energy), Q = <I> d t the

l u m i n a n c e threshold the m i n i m u m perceptible dif­ product of the l u m i n o u s flux by the t i m e it is m a i n ­

ference in luminance for a given state of visual tained. lt is the time integral of l u m i n o u s flux (com­

adaptation. pare light and luminous flux).

luminous ceiling a ceiling area lighting system reflectance of a surface o r m e d i u m , p = <l>r/<1>1 the

comprising a contiguous surface of transmitting ratio of the reflected flux to the i n c i d e n t flux.

material of a d i ff u s i n g or l i g h t c o n t r o l l i n g character

with l i g h t sources mounted above it. See louvered reflected glare glare u s u a l l y from specular reflec­

ceiling. tions of h i g h luminances in polished ar glossy sur­

faces i n the field of view. lt u s u a l l y is associated with

luminous efficacy of a source of light the quo­ reflections from w i t h i n a visual task or areas i n close

tient of the total luminous flux by the total lamp proximity to the region being viewed. See veiling

power i n p u t . lt is expressed i n l u m e n s per watt. reflection.

luminous flux (<1>) the lnternational System (SI) reflection a general term for the process by w h i c h

u n i t of i l l u m i n a n c e . lt is the i l l u m i n a t i o n s on a sur­ the i n c i d e n t flux leaves a surface or m e d i u m from

face one square meter i n area on w h i c h there is a the incident s i d e .

u n i f o r m l y distributed flux of o n e l u m e n , or the i l l u m l ­

nation produced a t a surface of w h i c h a l l points are reflector a device used to redirect the l u m i n o u s flux

at a distance of one meter from a uniform point from a source by the process of reflection.

source of one candela.

refraction the process by which the direction of a

m a i n t e n a n c e factor (MF) a factor formerly used to light ray changes as it passes obliquely from one

denote the ratio of the i l l u m i n a t i o n on a given area m e d i u m to another in w h i c h its speed is different.

after a period of time to the i n i t i a l i l l u m i n a n c e on the

same areas. See light loss factor. regular (specular) reflectance the ratio of the flux

leaving a surface or m e d i u m by r e g u l a r (specular)

matte surface a surface from w h i c h the reflection reflection to the incident flux, See regular (specu­

is predominantly diffuses, with or without a n e g l i g i ­ lar) reflection.

ble specular c o m p o n e n t . See diffuse reflections.

regular (specular) reflection that process by

peripheral vision the seeing of objects displaced w h i ch incident flux is redirected at the specular

from the primary l i n e of sight and outside the central a n g l e . See specular angle.

visual field.

shielding angle (of a luminaire) the angle

photopic vision vrsion mediated essentially or between a horizontal line through the l i gh t center

exclusively by the eones. lt is generally associated and the l i n e of s i g h t at w h i c h the bare source first
2
with adaptation to a l u m i n a n c e of at least 3 . 4 cd/m becomes visible. See cut off angle (of a lumi­

3 2),
(2.2 • 10· cd/in. ( 1 . 0 fL). naire).

p o i n t of fixation a point or object i n the visual field specular angle the a n g l e between the perpendicu­

at which the eyes look and upon which they are lar to the surface and the reflected ray that is n u m e r ­

focused. ically e q u a l to the a n g l e of incidence and líes i n the

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same plane as the i n c i d e n t ray and the perpendicu­ visibility the quality or state of b e i n g perceivable

lar but on the opposite side of the p e r p e n d i c u l a r to by the eye. I n many outdoor applications, visibility is

the su rface. defined i n terms of the distance at which an object

can be just perceived by the eye. In indoor applica­

specular reflectance see regular reflectance. tions it u s u a l l y is defined in terms of the contrast or

size of a standard test object, observed u n d e r stan­

specular reflection see regular reflection. dardized viewing conditions, having the same

threshold as the given object.

specular surface a surface from w hi ch the reflec­

tion is predominantly regular. See regular (specu­ visual acuity a measure of the ability to d i s t i n g u i s h

lar) reflection. fine details. Quantitatively, it is the reciproca! of the

a n g u l a r size in m i n u t e s of the critica! detail that is

stray l i g h t light from a source that is scattered onto just large e n o u g h to be s ee n .

parts of the retina lying outside the retinal i m a g e of

the source. visual angle the a n g l e subtended by an object or

detail at the point of observation. lt u s u a l l y is mea ­

subjective brightness the subjective attribute of sured i n m i n u t e s of ar e .

any l i g h t sensation g i v i n g rise to the percept of l u m i ­

nous magnitude, i n c l u d i n g the w ho l e scale of q u a l i ­ visual field the locus of obj ects or points i n space

ties of being bright, light, brilliant, dim, or dark. that can be perceived when the head and eyes are

(Note: The term brightness often is used when kept fixed. The field may be monocular or bino c ular.

referring to the measurable /uminance. While the visual perception the interpretation of impressions

context u s u a l l y makes it clear as to which m e a n i n g transmi tt ed from the retina to the brain in terms of

is intended, the preferable term far the photometric information about a ph y sical world displayed bef a re

quantity is luminance, t h u s reserving brightness far the eye.

the subjective sensation.)

visual performance the quantitative assessme h t

supplementary lighting lighting used to provide of the performance of a task ta k ing into considera ­

an additional quantity and quality of i l l u m i n a t i o n that tion s p eed and accuracy.

cannot readily be obtained by a general l i g h t i n g sys­

tem and that s u p p l e m e n t s the general l i g h t i n g level, visual surround i n c l u d e s all portions of the v isual

u s u a l l y for specific work. field except the visual task.

task l i g h t i n g l i g h t i n g , which is directed a t a specif­ visual task conventionally , this designates t h o s e

ic surface or area providing i l l u m i n a t i o n far specific details and objects that must be seen far the perfor ­

visual tasks. See general l i g h t i n g far comparison. mance of a given activity, and i n c l u d e s the i m m e d i ­

ate background of the details or ob j ects.

transmission a general term far the process by

which i n c i d e n t flux leaves a surface or m e d i u m on work-plane the plane at which work usually is

the side other than the incident s i d e . do n e , and at which the i l l u m i n a n c e is s p ecified and

measured. Unless otherwise indicated, this is

transmittance, T = ct>t!<l>1 the ratio of the transmit­ assumed to be a horizontal plane 0.76 m (2.5 ft.)

ted flux to the incident flux. above the floor.

tube see l a m p .

12.0 Health Care (Hospital) Terms

tungsten-halogen lamp a gas-filled tungsten (Note: The following definitions come from a rn u l t i ­

incandescent lamp containing a certain proportion tude of sources such as medica ! dictionaries and

of halogens. Note: The tungsten-iodine lamp and commonly accepted practices r e lat ed to the hea l t h

the quartz-iodine lamp b e l o n g i n t h i s category. care industry and are far clarification onl y . )

v e i l i n g reflection regular reflections superimposed anesthesiology see medical specialties.

upan diffuse reflections from an object that partially

or totally obscure the details to be seen by reducing aphakia see eye.

the contrast. This is sometimes called reflected

glare. arthros.copy a m i n i m a l l y invasive operation u s i n g a

tube - like instrument into a j o i n t to ins p ec t and repa ir

tissues.

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ANSI/ I E S N A RP-29-06

bronchoscopy procedure in which an t ns tru rn e n t is examining light see l i g h t .

passed into the airway to l o o k at the l u n g structures

and/or o b t a i n s p e c i m e n s . extended care facilities see health care facili­

ties.

cannula a s m a l l tube made for i n s e rt i o n into a body

cavity or into a duct or vessel. eye: (1) aphakia absence of the lens of the eye

(this is the case after cataract s u r g e r y ) ; (2) cataract

cataract see eye. situation where the l e n s of the eye becomes g r a d u ­

a l l y opaque c a u s i n g loss of v i s i o n ; (3) presbyopia

cardiogram see electrocardiography u n d e r med­ defect' of v i s i o n in advancing age involving loss of

ical specialties. a b i l i t y to see clearly.

CCU see hospital departments. health care facilities: ( . 1 ) acute care hospital hos­

pital giving care to patients needing short-terrn or

cholecystectomy s u r g i c a l removal of the g a l l b l a d ­ emergency care ( s h o rt term applying to routine ill­

der. ness or s u r g i c a l services, either of w h i c h is expect­

ed to end prior to 30 d a y s ) ; (2) chronic care hospi­

culdoscopy examination of the interna! female tal hospital where patients are treated who are suf­

pelvic organs t h r o u g h an i n c i s i o n i n the v a g i n a . fering from i l l n e s s or disease that is l o n g and drawn

out; (3) extended care custodia! care refers to a

cyanosis a dusky b l u e or p u r p l i s h discoloration of n u r s i n g h o m e for those whose c o n d i t i o n is not l i k e l y

the skin or m u c o u s m e m b r a n e s d u e to deficient oxy­ to improve and is lon g -te r m ; (4) full nursing care

genation of the b l o o d , e i t h e r locally or systemically. refers to a n u r s i n g h o m e where the patients require

medication and care that s h o u l d be g i v e n by n u r s e s

cystoscopy a procedure by which the urinary blad­ or t h e i r a i d e s ; (5) intermediate care a type of con­

der is e x a m i n e d t h r o u g h a lensed telescopic instru­ valescent home where patients who cannot be

ment. given needed care at h o m e go from an acute care

hospital u n t i l they are able to return h o m e .

diagnostic radiology see medical specialties.

hospital departments: ( 1 ) C C U coronary care u n i t

dialysis the passage of a s o l u t i o n t h r o u g h a m e m ­ where patients with precarious heart c on d iti ons are

brane often for the purpose of p u r i fy i n g the s o l u t i o n . cared for u n t i l they are well e n o u g h for r e g u l a r nurs­

An example is hemodialysis a process that takes ing care; (2) ICU intensive care u n i t where critically

impurities from blood when the kidneys are non­ i l l or post-operative patients are cared for u n t i l they

functional. are w e l l e n o u g h far r e g u l a r n u r s i n g care; (3) outpa­

tient facility treatment area far patients who do not

endoscopy visual examination of the interior of a need o v e r n i g h t confined m e d i c a l care; (4) recovery

h o l l o w body organ by u s i n g a t h i n , l i g h t e d t u b e . room area where patients are brought from the

operating room ( h e r e , the condition of the patient is

electrical emergency power electrical power that carefully watched by the registered nurse until the

comes on within ten seconds of a general power anesthetic is sufficiently worn off to warrant return to

f a i l u r e . T h i s assures that the work of a hospital and the patient s room o r t o the i n t e n s i v e care u n i t ) ; (5)

at least a l l of the life-sustaining machines will con­ surgical holding area an area i n the s u r g i c a l suite

t i n u e without u n d u e i n t e r r u p t i o n . There may be sec­ where patients are brought on a wheeled stretcher

ondary emergency power to back up the original. (gurney) prior to being given an anesthetic or prior

This type is often battery powered. to g o i n g into the operating room.

electrocardiography see medical specialties. ICU see hospital departments.

electroencephalography see medical special­ jaundice yellowish pigmentation of the skin, tis­

ties. sues, and certain body f l u i d s caused by the deposi­

tion of b i l e p i g m e n t s (associated with liver disease)

electromyography see medical specialties. or excessive breakdown of red blood c e l l s (associ­

ated with hemorrhage or various hemolytic states).

endoscopy a g e n e r i c term used in the examination

of interna! organs by a lensed telescopic i n s t r u m e n t . laparoscopy the insertion of a thin lighted tube

The suffix oscopy is usually preceded by a prefix t h r o u g h the a b d o m i n a l wall to inspect the i n s i d e of

d e s i g n a t i n g the area u n d e r observation. the abdomen and remove tissue s a m p l e s .

78
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' ANSI/ I E S N A RP-29-06

light: (1) examination light a l i g h t directed to the monitor a m a c h i n e that indicates (to a trained per­

site of an examination so the physician or nurse can son) the condition of a patient. A cardiac monitor, for

examine the patient s condition adequately; (2) example, indicates the condition of the heart. Even

observation light a small lamp providing enough a person who is simply watching the condition or

l i g h t for attendants to see the patient, a watch, or a c h a n g e i n a situation m i g h t be considered a monitor.

thermometer, but e n o u g h to interfere with s l e e p ; (3)

reading light a lamp i n the patient s room to pro­ negatoscope a viewing device for x-ray f i l m (light­

vide adequate í l l u m i n a t i o n for r e a d i n g . box).

medical specialties: (1) anesthesiology the sci­ nephrology see medical specialties.

ence of administering medications that produce

i n s e n s i b i l i t y to pain; (2) electrocardiography the night light see light.

study of graphic records (electrocardiograms) w h i c h

are produced (recorded by machine) by electrical nursing homes see health care facilities -

currents originating in the heart; (3) electroen­ extended care.

cephalography the study of the graphic record of

the electrical activity of the b r a i n ; (4) microbiology pathology see medical specialties.

the laboratory science of identifícation of microscop­

ic life (bacteria, viruses and f u n g i ) ; (5) myography peritoneoscopy examination of the abdomen that

the study of the graphic record of muscle activity; contains the intestines, the stomach, and the liver.

(6) nephrology the study of the structure and func­

tion of the k i d n e y ; (7) nuclear medicine an area of presbyopia see eye.

m e d i c i n e d e a l i n g with the d i a g n o s t i c and therapeu­

tic uses of radiation; (8) pathology the laboratory radiology see medical specialties.

study of the nature and cause of disease;

(9) anatomical pathology the study of diseases reading light see light.

that deals with structural changes; ( 1 O) clinical

pathology the study of diseases that are accessi­ recovery room see hospital d e p a rt m e n t s .

ble to medical or s u r g i c a l treatment; ( 1 1 ) radiology

(a) diagnostic - the determining of the nature of a sialography r a d i o g r a p h i c examination of the sali­

disease by means of roentgen rays; (b) therapeutic - vary g l a n d s and ducts u s i n g a radiopaque medium

the treatment of disease states by i o n i z i n g r a d i a t i o n ; that is introduced into the salivary ducts.

(e) tomography - one of severa! techniques of

roentgenography that shows detail i m a g e s of struc­ surgical holding area see hospital departments.

tures of b o d i l y organs i n a selected p l a n e of t i s s u e s

w i t h i n a live subject. tomography see medical specialties.

microbiology see medical specialties.

79
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