Sick Building Syndrome: Healing Health Facilities

Innovative strategies improve air quality inside health-care facilities so that patients don't end up sicker than when they arrived

When we think of Sick Building Syndrome, the first context that comes to mind for most of us as the cause of the coughing, discomfort, and irritation usually associated with it is a hermetically sealed, over-air-conditioned high-rise office building. The last place you would expect to encounter it is in a building meant for healing. Yet hospital occupants, patients and staff included, are just as likely to fall victim to building-related illness as office workers. In fact, a recent study by the National Institute for Occupational Safety and Health shows that, outside of the manufacturing sector, work-related asthma rates are higher among those employed in the health care industry than in any other group of workers.

When it comes to the indoor environment of health care facilities, the chief concern doctors have for their patients remains infection control, especially since weakened immune systems are more susceptible to contagions. Estimates from the Institute of Medicine indicate that nosocomial infections—those contracted by a patient while under medical care—account for more deaths annually in the United States than motor vehicle accidents. While there is little design professionals can do to prevent hospital-acquired infection that results from human error—improper sterilization, for instance—architects and engineers are putting into practice inventive measures to improve the indoor air quality (IAQ) of health care facilities and reduce the risk of airborne ailments.

There are a number of indoor air pollutants that contribute to poor IAQ and the spread of airborne disease. These include biological contaminants such as molds and bacteria, and combustion pollutants like carbon monoxide and toxic particles. Even the building itself is a factor, since toxic substances emitted from building materials and furnishings degrade IAQ. This off-gassing, as it is known, is a by-product of such pervasive materials as paint, varnishes, carpet, flooring, insulation, adhesives, and particleboard. The harmful volatile organic compounds (VOCs) that are emitted from these materials can have adverse short- and long-term health effects. One of the easiest and most cost-effective approaches to improving IAQ is eliminating individual sources of pollution. It has become common practice today in the design of health care facilities to utilize natural materials—linoleum flooring, cotton insulation, undyed wool carpet, among others—as well as products with low or no VOCs. Additionally, more and more hospitals are switching to nontoxic cleaning products.

The need to vent

While source control is a straightforward first step toward improving IAQ, ensuring proper ventilation is an obvious, if not more formidable, task. Several recent health care projects make enhanced ventilation a design priority. At Dell Children's Medical Center of Central Texas in Austin, Ohio-based architecture firm Karlsberger brought the outside in by incorporating six courtyards—all open to the sky, and all but one enclosed on all sides by building walls—that serve as air intakes for the hospital's innovative mechanical system.

Replete with flora representing the various ecosystems found within central Texas, as well as numerous water features, the courtyards—referred to as the "lungs" of the building—provide the interiors with clean, oxygenated air from an extremely controlled environment. "In the old children's hospital, they complained that they could detect a faint smell of lawn-mower exhaust in the operating room when the lawn was being mowed," recalls Joe Kuspan, AIA, principal at Karlsberger. The new arrangement avoids such scenarios: Within the courtyards, a couple of which are inaccessible, there is no lawn maintenance (the few small patches of grass are artificial), or trucks pulling into a loading dock spewing fumes. Throughout the hospital campus—located on a former municipal airport site—smoking is prohibited, and this is strictly enforced in the courtyards that are open to patients, visitors, and staff for physical therapy activities and outdoor dining.