The single most important aspect of an extractor fan is, of course how much air it sucks out of the bathroom. Known as the ‘extraction rate’ the amount of air actually moved is described using two units of measure: metres cubed an hour (m3/hr) or Litres per second (L/s).
Now I’m not saying manufacturers deliberately make it difficult for end users to assess the relative power of different extractor fans, but they certainly don’t make it easy either! Some quote extraction rates using m3/hr while others uses L/s. Very rarely, unfortunately, do they quote both, making it difficult to compare models.
In order to convert the numbers, simply multiply m3/hr x 0.277.
There is a fairly complex calculation using the volumetric capacity of a room and number of ‘air changes per hour’ which will give you the exact ‘required’ extraction rate. However, in the real world this is rarely necessary and as a pretty good rule of thumb, for an average sized domestic bathroom you should be looking for an extractor fan offering at least 21L/s or 75m3/hr.
However, the better extractor fans now available offer 26L/s or 95m3/hr. For the small premium that these fans attract, the higher extraction rate is definitely worth it, clearing steam from the bathroom much more quickly. If a manufacturer or reseller does not make the extraction rate readily available don’t buy it – it’s being hidden for a reason.
Install the correct bathroom fan for the situation
This may sound obvious but it is amazing how often an extractor fan is asked to do a job it wasn’t designed to do. The most common problem is that of the fan being ducted over too long a distance. Long duct runs are a problem for extractor fans, as air pressure increases with every centimetre of ducting. Air pressure acts as an invisible barrier to the air being pushed along the duct – the longer the duct run, the greater the air pressure, the greater the resistance.
Standard axial fans should be ducted no further than four or five metres and the duct run should be kept as straight as possible because bends and kinks increase the air pressure and resistance. Any further than 5m – and a lot less if the fan is not particularly powerful (80m3/hr) in the first place, then the extractor fan will simply cease to work – the vented air will back up in the ducting and steam will remain in the bathroom.
If your installation requires a longer duct run you must use a centrifugal fan. The impeller design of centrifugal fans is such that they generate much greater air pressure. They also tend to be more powerful – the average four inch centrifugal fan vents at around 110m3/hr (compared to 95m3/hr for a top end axial fan). It may be said that centrifugal fans blow as hard as they suck!
Always, always have your bathroom fan installed by a Fully Qualified Electrician
This doesn’t need too much explanation, but it’s worth elaborating a little. We found that in 97% of cases where an extractor fan was deemed to be faulty or not working correctly it had been installed by the home owner (or friend/father/son etc etc) and not by a qualified professional.
In my humble opinion this is fairly conclusive but let’s consider something way more important – Electricity, whether delivered at 240v or 110v is potentially lethal – it can kill you. Incorrectly installing an electrical item is extremely dangerous both for the unqualified installer and *anybody* who thereafter uses the device. Any danger is multiplied ten-fold in the bathroom where water is present.
In short: always, always have your bathroom extractor fan installed by a Fully Qualified Electrician.
Grout that gets dirty, grimy, or has any build-up of black, brown or gray mildew or mold can be very unsightly and embarrassing. It can be very hard to clean between tiles properly because grout is porous and it’s hard to get into the small spaces to scrub it clean.
Standard bathroom and kitchen sprays often won’t clean it properly, despite a lot of scrubbing. White and gray-colored grout with dark tiles can be a nightmare, as any discoloration really shows. It makes the entire bathroom, shower recess, or kitchen look grimly and neglected.
This article reviews your options — including natural and relatively mild home remedies using natural ingredients. It also includes bleach cleaners for stubborn stains, heavy mold and mildew build-up, and resistant black marks.
Your tiles may be dirty and stained for a whole host of reasons and it pays to have some alternative weapons in your arsenal for fighting against dirty and discolored grout.
Once it has been cleaned, it pays to clean it regularly as a preventative measure. Regular spraying with lemon juice, vinegar, or alcohol keeps mold and mildew at bay. Always quickly clean up any spillages of liquids and foods that can stain — such as curry, coffee and red wines. Treating the areas when wet makes the stain much easier to remove.
This article provides tips for routine regular cleaning to keep your lines clean and sparkling.
Baking Soda and Water
Add a little baking soda to some water and make a thick paste.
Use the toothbrush to apply the baking soda paste to the grout, and rub vigorously.
For deep stains, leave the paste on and scrub again.
Redo areas that remain stained, and use a little lemon juice to remove the last residues.
Vinegar, and Baking Soda and Vinegar
This is the best way if you want to avoid using harsh chemicals.
Add some white vinegar to a spray bottle.
Sprinkle the baking soda along the grout lines.
Spray with vinegar and while the baking soda is fizzing scrub with an old toothbrush. The alkaline baking soda reacts strongly with the acid vinegar to produce a powerful fizzing bleach action.
Wipe the grout with a damp sponge.
Mix about a cup of hydrogen peroxide with two cups of warm water. Add to a spray bottle.
Thoroughly spray the stained areas to wet with the peroxide and leave on for about 5-10 minutes.
Use an old toothbrush dipped in the peroxide mixture to scrub along the grout lines to remove the last remnants.
Fresh lemon juice is a strong acid and bleach.
Simply squeeze some fresh lemon juice and pour along the grout lines. Leave for about ten minutes.
This will clean any dark marks or stains in the grout line. Citric acid works in a similar fashion.
Stained grout caused by mildew and be cleaned with rubbing alcohol added to a spray bottle.
Simply spray the shower tiles with alcohol. The alcohol kills the mildew and removes the stain.
Bleach and Baking Soda
This combines two powerful cleaning actions.
Make a paste by combining half a cup of bleach with one and a half cups of baking soda.
Scrub with an old toothbrush.
Let it sit on the grout for about ten minutes, then remove it with a cloth and hot water.
Dilute following the manufacturers instructions.
Add to a spray bottle and soak the grout lines.
Leave on for 5 -10 minutes and then rinse off.
Oxygen Bleach (Powdered version of OxiClean)
This bleach is non-toxic, does not produce any fumes, and is safe for fabrics and colors, unlike many stringer bleaches.
To clean floor tile grout, mix the recommended amount of oxygen bleach with some warm water and mix to dissolve.
Pour the solution onto the floor tile and spread out so that the lines are filled with the bleach solution. Leave the solution on the grout for least 15 minutes (30 minutes or longer for bad stains).
Scrub the stained areas lightly get rid of any residue, adding more solution as required.
Once the grout is clean you can add a little bleach to the mop water every time you clean.
Always clean any food, wine or coffee spillages up quickly before it has time to satin the grout.
Grout Cleaning Machines, High Pressure Sprays, Steam Cleaners
For badly stained floor tiles, you may need to hire a special purpose grout cleaning machine that using high pressure sprays of steam cleaning. Special chemicals enhance the power of the machines to remove stains.
Smoking detectors are a significant part of your family’s first line of protection against fires. Research has shown that chances of evading and success are greater if you identify flame at its first levels before it grows out of control.
By successfully setting up smoke detectors you can put out a fireplace before it grows to a disaster-scale flame that needs the involvement of your local flame division.
Investments in Alarm techniques, CCTV, improved fortifications and impressive methods such as forensic tagging are vital to modern protection techniques, but the fact still continues to be that your products are being taken. You may get them back and the criminals may be captured. Surely it would be easier to stop them taking anything in the first place.
This is where protection smoke comes into its own – the fast inundation of a place with synthetic fog meant to wrap your products from vision and get rid of criminals off your property. Not only is it a proven loss protection method, the existence of such a process also serves as a highly effective obstruction.
Smoke Displays are meant to be fully appropriate for standard protection techniques, whether you require incorporation into a preexisting home protection program, a stand-alone solution or a transportable unit for immediate implementation and protection.
Placing your detectors or maximum recognition Smoke generator should be placed on the roof as close to the center of the space as possible, and no nearer than One foot wide from surfaces. If the sensor must be placed on a surfaces the top of the sensor should be 6 inches wide down from the roof. On a steep roof, they should be 3 feet from the biggest point calculated side to side.
Do not set up Fog generator near heat resources as they may set off incorrect alert techniques. While the kitchen has many flame risks, setting up a smoke sensor could cause incorrect alert techniques due to smoke produced by food preparation or food preparation. Try not to set up smoke detectors within six inches wide of where surfaces and roofs be a part of as the detectors may not receive the smoke flow required to stimulate the alert.
Smoke detectors also have an effective range of detection; most are ranked to cover a 30′ x 30′ place. If space is larger than that two detectors will be needed and spread successfully.
It is important that your smoke detectors are set up successfully and managed frequently so they can function successfully to give you with safety. The proper position of your smoke detectors is a key factor in their ability to give efficient caution of fires.
When it comes to safety, a strong recommendation would be not to settle for any kind of compromise and that is why installing a security gate is a must. Assuming that you have decided to acquire a kit for your home, the first step entails shopping for one and to this effect the number of options available under this niche is likely to leave you overwhelmed. Variations are mostly based on designs, models and material and a particularly popular option is that of sliding gates kit. In terms of price, a security system for gates need not be exorbitant or beyond reach because these are no longer considered as luxury but as a necessity in every home.
Unlike a decade back when security gate was available in a few selected designs, today there is plenty of choice available under this niche. This is the reason as to why you must bear in mind certain factors that will help you to identify a perfect system for your requirements. So before you venture out to buy a security system, you must first determine the purpose for which you need it. Is it for the sake of home improvement, for ensuring protection for your children or for providing safety to your home and premises when you are away? If it is home improvement, then the look of the sliding gate will match the colour and style of your home.
Next you would need to decide the kind of sliding gate kits that you would need in terms of complexities and extent. For example, a comprehensive system will ensure that you will be able to control your gates through a remote and will also be able to check who enters your property in your absence. An intercom will ensure that you can communicate with the visitor before you let anyone in and then decide whether the person is safe to be let in. This is also the stage when you decide on the material and this is not as straightforward as you think. Wood is a common choice but if you want something stronger, then steel and aluminium are suitable options.
Whichever security gate you choose, some of the points that you must consider are the material’s corrosion quotient, durability, its reaction to weather changes and its effectiveness in daily usage. Ideally your chosen sliding gate should not corrode easily, should be durable and effective not to mention immune to weather changes and extreme climatic conditions. Then it is just a question of finding a store that offers a variety of sliding gate options like folding, pair folding, aisle folding and so on and purchasing it.
On your part as the home owner, you need to practice safe habits in order to make the most of the sliding gate kits which you might have purchased. Even though sliding gates are too high and too low to allow anyone to jump over, you must always check who might be at the gate by making use of the camera and speak to them via the intercom before assuming that they might be safe. Ultimately, sliding gates are secure enough for you and your family and you must make optimum use of them.
As the climate is rapidly changing: the summers are hotter longer while the winters are becoming warmer and shorter than normal. Scientific publications show the reduction of the ozone layer and melting of the glaciers are the cause of the sudden changes in the climate. This along with other factors is why people are turning to green products. Genuine green products that cause no or little harm to the planet.
Green products are made from natural ingredients and renewable materials and also contain no carbon compound. They provide full protection and save the human race from the sudden change in climate, and this product has little or no negative effect.
However, the demand for green products is rapidly increasing There is variety of green product in the market eitheronline, or stores and they all contribute in saving the earth environment from this temperature. Recently release by scientist, 85% of the world percentages are turning toward buying this product as a key tool in saving their environment from this climate.
Some of the most promising products that are widely demanded in the market are listed below. Green Cleaning Products: Increasingly, there are more options to clean your home effectively with products that do not contain harmful chemicals. In most cases, these products work as effectively as more conventional and less natural solutions These products are eco-friendly and do not contain fossil fuel components. Therefore, by buying this harmless free chemical product, your home environment is safer and the planet is safer too.
Green Home Décor Items: Everyone loves beautiful and attracting homes and many companies are creating several eco-friendly products that will make your home appealing and attractive in green and clean ways that was not imaginable even a few years ago. These products include linens, pillows, mattress, candles, etc.
Green Shopping Bags: A big reason why there is a reduction in the ozone layer, can only be traced to pollutions such as hydro-carbon, polythene bags, these two amidst other contribute immensely to the reduction. Therefore, to reduce this problem, the eco-friendly green grocery bags are popular now. We have numerous options and it is a habit that is changing. People are now brining their own reusable bags to the store or using low impact paper bags as preferred options.
Green Household Items: these particular categories contain different varieties of item such as flooring items to kitchen items, cooking tools, bamboo spoons, and more There are made from plants in most cases and don’t contain any toxic carbon component that can be harmful to one’s environment.
Green products can benefit our homes and our planet. Reducing toxins in our daily life is good for our families and good for the environment. Our planet will become a healthy place to live and will also help in reducing the global warning and pollution.
If you had to choose between investing in a moderate and affordable home or a high class luxury sports car like a Ferrari, which would you go for?
My guess is that your answer would be based on a few determining factors:
Are you male or female – males tend to like cars more than women do
How old are you – young people like to impress their friends, so cars are good to do this
Are you married or single – once again the car factor for singles without kids is going to be pretty high on the agenda
So if you are determined to splash out on something exotic like an imported sports car from Italy, then you are going to need the services of a good online supplier of car detailing goods.
Companies that service the online sector for enthusiasts level car detailing supplies that are worth a look, are Detail Central, who can be found at www.detailcentral.com.au
So make up your mind and stick to your guns, if it is the luxury import, get your cash ready, as these things tend to suck your spare coin away at a rapid rate. Equally however, should you choose the wiser option of buying a suitable
In just about any home the most significant room or spot is the kitchen. This is the area that cannot be neglected as it is the only real spot where meals are made. A person’s lots of time is used up in the kitchen for cooking meals for himself and his family. It’s thought that the family relationship is generated within the kitchen by aiding each other. This function can be useful for obtaining a fine comprehension of each other’s needs and wants.
The entire look and feel of the kitchen totally is dependent upon the wood ware and decorations included in the surroundings. The very first thing spotted in the kitchen area each time an individual shows up is the kitchen cabinets. The cabinetry of the kitchen are the major thing which is the first thing anyone sees. Changing or setting up the fresh cabinets certainly is a hard task. If you are planning to obtain a new set of kitchen cupboards then you might look into making full homework on the prices and the marketplace surveys to ensure that you’ll be able to go for the best material to build these. With all of this it’s also advisable to take into consideration the finances you’ve for having the cabinets built.
If you have already kitchen cupboards set up in your kitchen area then you shouldn’t be that much fearful. But should your cabinetry are a bit older and they also need a little bit of service then you can surely opt for some sort of adjustments that suit your kitchen’s look and feel. Using this method you can spend less money as you’ll not ought to purchase fresh kitchen cabinets, the only thing you will need to execute is make modifications in the cabinetry the way in which you wish by having in thinking your price range. Renovating the existing cupboards will let you sustain your kitchen and also assist you to save a decent money rather than selecting new cabinets.
In case the kitchen cabinets installed in your kitchen are manufactured from metal then redesigning them won’t be a good plan. The same holds true for those kitchen cabinets whose materials standard has been worsened. They might not be worthy of renovating so you will be required to obtain brand new ones. It’s possible to use additional options for instance painting or spot removing to make them appear new and fresh. In case you are prepared to get a new look and feel of your kitchen area then you certainly also try to find a skilled to supply you with suggestions or make it easier to perform the work that’s mandatory. In case you opt for some professional to perform this task then you will accomplish it in one or two days.
You will discover a couple of solutions in relation to updating the look of your kitchen area. You may either remodel your kitchen or you could simply fix those areas that have to be sorted out. If you find yourself deciding on improvements, you’ll really have to opt for those changes that fit your kitchen’s nearby.
You can of course decide on the cabinets that’re custom-made or even the ones that’re all set to sale. The custom-made kitchen cabinets can be somewhat more costly to obtain whilst the off the shelf cabinets are cheaper on the other hand. It is advisable to locate most of the choices available. You can even search for online kitchen cabinets to determine the assortment accessible out there.
Solar hot water heating systems are a great way to effectively conserve energy and reduce the overall electricity bill. It can also cut down on your gas, wood or coal bills depending on your current water heating system. Solar water heating systems have been used commercially for over a century now. Solar water heating can be used in any climate.
Sound unbelievable? Check it out on the U.S. Department of Energy website. They say so too. Moreover, the fuel used to run a solar water heater is sunshine. And, at the time of writing this article, sunshine is free – no tax has been added yet. A solar hot water heater can reduce your water heating bill by more than sixty percent. But with energy prices going up, the amount of savings will soon turn to be even higher. So using a solar water heater will help save fossil fuels. Solar water heating will significantly reduce your carbon footprint, and reduce the demand for fossil fuels which pollute the environment.
A company from Jaipur provides such systems that are easy to maintain, rather maintenance free and long life too. There heaters are made using the thermosyphon effect. Based on the evacuated tube water heating technology, systems by SolarMaxx Solar Water Heating are brought to you by the illusions4real group. Rajasthan which seems more that 300 sunny days in a year also haappens to get very cold in winter months. People generally require hot water for over 6 months in a year.
The state is also a popular tourist spot, and cities like Jodhpur, Udaipur, Jaipur, Sawaimadhopur, Sikar, Bharatpur, Ajmer, Jaisalmer, Barmer etc have many hotels. Hotels need a lot of hot water and the government have made the use of solar water heaters compulsory for all hotels in the state having any more than 20 rooms.
Recently some popular hotels have chosen SolarMaxx as their service provider, such as Park Prime by Dangayach group in jaipur, Rang niwas in hotels, Shiv Vilas in Jaipur are few amongst the list. Solar Maxx is also very popular in the budget hotel segment, not only is it for hotels but also hospitals and home owners. Domestic users benefit a lot by the use of solar water heaters as they are extremly safe and there are no hassles of high bills, accidents caused due to water heating rods and so on.
It shouldn’t take long now to make a decision and go green for you, save energy, save money, go solar with SolarMaxx.
In keeping with most districts of healthcare, the marketplace has seen a boom in the construction of Behavioral Healthcare facilities. Contributing to this increase is the paradigm shift in the way society views mental illness. Society is placing a heavier value on the need to treat people with serious addictions such as alcohol, prescription and elicit drugs. A large percentage of people suffering from behavioral disorders are afflicted with both mental and addictive behaviors, and most will re-enter communities and either become contributors or violators.
These very specialized facilities do not typically yield the attention from today’s top healthcare designers and their quantity accounts for a small fraction of healthcare construction. However, Behavioral Healthcare projects are increasing in number and are being designed by some very prominent architectural firms such as Cannon Design and Architecture Plus. Many are creating state-of-the-art, award-winning contemporary facilities that defy what most of us believe Behavioral Healthcare design to be.
Changing the Way We Design Behavioral Healthcare Facilities
As with all good planners and designers, A+D (along with facility experts) are reviewing the direct needs of patient and staff while reflecting on how new medicine and modern design can foster patient healing rates, reduce environmental stress, and increase safety. This is changing the face of treatment and outcome by giving the practitioner more time to treat because they require less time and resources to “manage” disruptive patient populations.
The face of Behavioral Healthcare is quickly changing. No longer are these facilities designed to warehouse patients indefinitely. And society’s expectations have changed. Patients are often treated with the belief that they can return to their community and be a contributor to society. According to the National Association of Psychiatric Health Systems (NAPHS), depending on the severity of illness, the average length of stay in a Behavioral Healthcare facility is only 9.6 days.
What has changed?
Jaques Laurence Black, AIA, president and principal of New York City-based daSILVA Architects, states that there are two primary reasons for the shortened admission period:
1. Introduction of modern psychotropic drugs that greatly speed recovery
2. Pressures from insurance companies to get patients out of expensive modes of care
To meet these challenges, healthcare professionals are finding it very difficult to effectively treat patients within the walls of antiquated, rapidly deteriorating mental facilities. A great percentage of these facilities were built between 1908 and 1928 and were designed for psychiatric needs that were principled in the belief to “store” not to “rehabilitate.”
Also impacting the need for Behavioral Healthcare construction is the reluctance of acute-care facilities to provide mental health level services for psychiatric or addiction patients. They recognize that patient groups suffering from behavioral disorders have unique health needs, all of which need to be handled and treated only by very experienced healthcare professionals. This patient population also requires a heightened level of security. Self-harm and injuring staff and other patients are major concerns.
The Report of the Surgeon General: “Epidemiology of Mental Illness” also reports that within a given year about 20% of Americans suffer from a diagnosable mental disorder and 5.4% suffer from a serious mental illness (SMI ) – defined as bipolar, panic, obsessive-compulsive, personality, and depression disorders and schizophrenia. It is also believed 6% of Americans suffer from addiction disorders, a statistic that is separate from individuals who suffer from both mental and addiction disorders. Within a given year it is believed that over one-quarter of America’s population warrants levels of mental clinical care. Even if these statistics were cut in half, it cannot be denied as a serious societal issue.
With a growing population, effectively designing in accordance with such measures is at the heart of public health.
Understanding the Complexity of Behavioral Healthcare Design
Therefore, like Corrections, leading planners and designers specializing in Behavioral Healthcare are delving deeper to better understand the complexity of issues and to be the activist to design facilities that promote treatment and healing – and a safer community.
The following is a list of key design variables that are being studied and implemented:
1. Right Sizing
2. Humanizing Materials and Color
3. Staff-Focused Amenities and Happiness
4. Security and Safety
5. Therapeutic Design Tenants
Today’s Behavioral Healthcare facilities are often one-story single buildings within a campus size. Often debated by Clients due to costs, this design preference is driven by the demand for natural light, window views to nature for all patient areas, and outdoor open-air gardens “wrapped” within. All of this provides soothing qualities to the patient, reduces their anxieties, counteracts disruptive conduct and helps to reduce staff stress.
“When you look at the program mix in these buildings, there’s a high demand for perimeter because there are a lot of rooms that need natural light. Offices, classrooms, dining areas, community rooms, and patient rooms all demand natural light, so you end up with a tremendous amount of exterior wall, and it forces the building to have a very large footprint.” – James Kent Muirhead, AIA, associate principal at Cannon Design in Baltimore
These design principles are also believed to improve staff work conditions. Unlike a multi-story complex, at any moment staff can walk outdoors and access nature, free from visual barriers, and within a building that more accurately reflects building types that both patients and staff would encounter in their communities.
In addition to right-sizing for the overall building footprint, is right-sizing for internal patient and staff support area. Similar to the move we have seen in Corrections to de-centralize support spaces, Behavioral Healthcare is moving to decentralized nursing/patient units called “neighborhoods.” With mental health facilities there is a large concern with distances and space adjacencies in relation to the patient room and patient support areas such as treatment and social spaces. Frank Pitts, AIA, FACHA, OAA president of Architecture Plus, Troy, NY, advocates neighborhoods that average 24-30 beds arranged in sub-clusters, called “houses”, of 8-10 beds. Thus, each neighborhood consists of three houses. Often these layouts will include a common area where patients congregate and socialize, with a separate quiet room so patients can elect to avoid active, crowded areas. In addition Pitts states, “There’s a move away from central dining facilities. So, while facilities will still have a central kitchen, it’s a whole lot easier moving food than it is patients.” However, it is important for the facility to mimic normal outside daily life routines, so patients are encouraged to frequently leave their neighborhoods to attend treatment sessions, and outdoor courtyards.
Humanizing Materials & Color
In all facilities that play a role in rehabilitation, design strives to create spaces that humanize, calm, and relax. Behavioral Healthcare patients need to feel that they are in familiar surroundings; therefore, the architectural vocabulary should feel comfortable and normal. Since these facilities are about rehabilitation (when possible) and encouraging patients to merge back into society, the facility should feel like an extension of the community. Their spaces should reflect the nature and architecture of the surrounding region and thus so, no two facilities should look too much alike.
“Our approach to designing these facilities is to view the facility as an extension of the community where patients will end up when they’re released. Interior finishes also depend on geography because you want to replicate the environment patients are used to. You want to de-stigmatize the facility as much as possible.” – Tim Rommel, AIA, ACHA, OAA, principal with Cannon Design in Buffalo, NY.
Therefore, materials and colors within these spaces want to feel familiar to one’s region and everyday life. To soothe the psyche and rehabilitate, they want to feel soft and comfortable, yet visually stimulating. An interior that is overly neutral or hard in appearance is not appropriate. Materials should reduce noise, and colors should lift the spirit. This can help to create an environment in which the patient can learn, socialize, and be productive while easing anxieties, delivering dignity, and modifying behavior. As stated previously, behavioral studies advise the use of softer interior materials-like carpeting, wood doors and tile. Doing so translates directly to both patient and staff well-being, particularly staff safety, and makes for a nicer place to work. In addition, staff have more resources to “treat” instead of manage heated situations. When staff experiences are eased and satisfied, morale is boosted and life-saving rules and policies are more likely to be enforced.
Staff-Focused Amenities & Happiness
While reducing staff stress and fatigue through a healing supportive environment seems like an obvious goal, there are relatively few studies that have dealt with this issue in any detail. More attention has been given to patient outcomes. However, many leading hospitals that have adopted therapeutic tenants into their newly built environments have seen vast improvement through their “business matrixes” and financial reporting.
In one example, the Mayo Clinic, a national leader in implementing healing design in its facilities, has reported a reduction of nursing turnover from a national annual average of 20% to an annual 3%-4%. In another example, when Bronson Methodist Hospital incorporated evidence-based design into its new 343-bed hospital, they cited their 19%-20% nurse turnover rate dramatically dropped to 5%.
Now, both the Mayo Clinic and Bronson Methodist Hospital have had to initiate a waiting list for nursing staff seeking positions. This converts to better-trained and qualified staff, and a reduced error rate. Therefore, more health facilities are investing in staff support areas such as lounges, changing rooms, and temporary sleep rooms. Within these staff spaces and in the hospital throughout, facilities are also recognizing the need for upgrade materials, better day lighting, and an interesting use of color: One soon realizes that the need of patients and staff are interwoven, each impacting positively or negatively the other.
Security & Safety
Without debate, self harm and harm to staff is one of the biggest concerns mental health facilities manage. Often the biggest safety and security concern is the damage patients can do to themselves. “There are three rules I had drummed in me,” says Mark Hanchar; Director of Preconstruction Services for Gilbane Building Company, Providence, R.I. “First, there can’t be any way for people to hang themselves. Second, there can be no way for them to create weapons. Third, you must eliminate things that can be thrown.” Hanchar says that the typical facility is, “a hospital with medium-security prison construction.” This means shatter proof glass, solid surface countertops (laminate can be peeled apart), stainless steel toilets and sinks (porcelain can shatter), push pull door latches and furniture that cannot be pulled apart and used as a weapon. These are just to name a few.
Additionally, removing barriers between patients and nursing staff is a safety consideration. Frank Pitts, AIA, FACHA, OAA president of Architecture Plus, says what may be counter-intuitive for safety precautions, “Glass walls around nursing stations just aggravate the patients.” Removing glass or lowering it at nursing stations so patients can feel a more human connection to nurses often calms patients. There is also discussion of removing nursing stations altogether; decentralizing and placing these care needs directly into the clinical neighborhoods and community spaces. Pitt says, “The view is that [nursing staff] need to be out there treating their patients.”
Therapeutic Design Tenants
As medicine is increasingly moving towards “evidence-based” medicine, where clinical choices are informed by research, healthcare design is increasingly guided by research linking the physical environment directly to patient and staff outcomes. Research teams from Texas A&M and Georgia Tech sifted through thousands of scientific articles and identified more than 600 – most from top peer-reviewed journals – to quantify how hospital design can play a direct role in clinical outcomes.
The research teams uncovered a large body of evidence that demonstrates design features such as increased day-lighting, access to nature, reduced noise and increased patient control helped reduce stress, improve sleep, and increase staff effectiveness – all of which promote healing rates and save facilities cost. Therefore, improving physical settings can be a critical tool in making hospitals more safe, more healing, and better places to work.
Today’s therapeutic spaces have been defined to excel in 3 categories:
1. Provide clinical excellence in the treatment of the body
2. Meet the psycho-social needs of patients, families, and staff
3. Produce measurable positive patient outcomes and staff effectiveness
Considering the cost of treating mental illness, which is exceedingly high, and wanting facilities to have effective outcomes, a further practice of incorporating therapeutic design is increasing. The National Institute of Mental Health (NIM H) approximated in 2008 that serious mental illnesses (SMI ), costs the nation $193 billion annually in lost wages. The indirect costs are impossible to estimate.
The estimated direct cost to clinically treat is approximately $70 billion annually and another $12 billion spent towards substance abuse disorders. In addition to the increased need of care and the boom in Behavioral Healthcare construction, it becomes an obligation to make certain that we as facility managers, architects, designers and manufacturers therapeutically plan and design these facilities.
Notably, in 2004, “The Role of the Physical Environment in the Hospital for the 21st Century: A Once-in-a-Lifetime Opportunity,” published by Roger Ulrich P.H.D., of Texas A&M University, was released. In a culmination of evidence-based research, research teams found five design principles that contributed significantly to achieving therapeutic design goals.
The report indicates five key factors that are essential for the psychological well-being of patients, families and staff, including:
1. Access to Nature
2. Provide Positive Distractions
3. Provide Social Support Spaces
4. Give a Sense of Control
5. Reduce or eliminate environmental stress
Access to Nature
Studies indicate that nature might have the most powerful impact to help patient outcomes and staff effectiveness. Nature can be literal or figurative – natural light, water walls, views to nature, large prints of botanicals and geography, materials that indicate nature and most importantly, stimulating color that evokes nature. Several studies strongly support that access to nature such as day-lighting and appropriate colorations can improve health outcomes such as depression, agitation, sleep, circadian rest-activity rhythms, as well as length of stay in demented patients and persons with seasonal affective disorders (SAD).
These and related studies continue to affirm the powerful impact of natural elements on patient recovery and stress reduction. Thus, it is clear that interior designs which integrate natural elements can create a more relaxing, therapeutic environment that benefits both patients and staff.
These are a small set of environmental features that provide the patient and family a positive diversion from “the difficult” and, in doing so, also negate an institutional feel. These can be views to nature, water walls, artwork, super imposed graphics, sculpture, music – and ideally all of these want to be focused on nature and, when applicable, an interesting use of color. Therapeutic environments that provide such patient-centered features can empower patients and families, but also increase their confidence in the facility and staff. This helps with open lines of communication between patient and caregiver.
Social Support Spaces
These are spaces designed partially for the patient but mainly for the comfort and socialization of family members and friends of the patient; therefore, family lounges, resource libraries, chapels, sleep rooms and consult rooms all play a role. When family and friends play a key role in a patient’s healing, these spaces encourage families to play an active role in the rehabilitation process.
Sense of Control
In times when patients and family feel out of control, it is very healing for the facility design and staff to provide it back when appropriate. Although, this cannot always be done suitably in mental healthcare facilities. However, when applicable, these design features include optional lighting choices, architectural way-finding, resource libraries, enhanced food menus, private patient rooms and
optional areas to reside in. A few well-appointed studies in psychiatric wards and nursing homes have found that optional choices of moveable seating in dining areas enhanced social interaction and improved eating disorders. When patients feel partially in control of their healing program and that the building features are focused to them, an increased confidence of the quality of care enters and tensions lower.
As with all therapeutic design, this allows the caregiver to use their resources healing in lieu of “managing” patient populations.
Reduce or Eliminate Environmental Stress
Noise level measurements show that hospital wards can be excessively noisy places resulting in negative effects on patient outcomes. The continuous background noise produced by medical equipment and staff voices often exceeds the level of a busy restaurant. Peak noise periods (shift changes, equipment alarms, paging systems, telephones, bedrails, trolleys, and certain medical equipment like portable xray machines are comparable to walking next to a busy highway when a motorcycle or large truck passes.
Several studies have focused on infants in NIC Us, finding that higher noise levels, for example, decrease oxygen saturation (increasing need for oxygen support therapy), elevate blood pressure, increase heart and respiration rate, and worsen sleep. Research on adults and children show that noise is a major cause of awakening and sleep loss.
Architectural design can assist in overcoming these types of obstacle. Whether you are designing a luxury home or care facility, there are certain design aspects that need to be considered. Overall comfort and a sense of peace, are able to be enhanced by a well designed environment. Considering Melbourne designed homes and prestige premises, one could draw the conclusion that choosing the right home builder is going to make all the difference.
In addition to worsening sleep, there is strong evidence that noise increases stress in adult patients, for example, heightening blood pressure and heart rate. Environmental surfaces in hospitals are usually hard and sound-reflecting, not sound-absorbing causing noise to travel down corridors and into patient rooms. Sounds tend to echo, overlap and linger longer.
Interventions that reduce noise have been found to improve sleep and reduce patient stress. Of these, the environmental or design interventions such as changing to sound-absorbing ceiling tiles, are more successful than organizational interventions like establishing “quiet hours.” White noise or noise reducing electronic devices can also help quieten a noisy environment.
Conclusion and Additional Information
The information contained in this excerpted report is intended as a guide for architects, specifiers, designers, facility planners, medical directors, procurers, psychologists and social workers which have a stake in providing improved facilities for behavioral healthcare patients. It is a portion of a report entitled “The Contributions of Color” authored by Tara Hill, of Little Fish Think Tank. Ms. Hill was commissioned by Norix Group Inc., in 2010 to research the role color plays in the safe operation of correctional facilities and behavioral health centers. More in-depth information specifically about the psychological influence of color and behavioral healthcare facility design can be found by reading the full report.
About the Author
Tara Hill is a full-scope, state registered interior designer, and the founder and principle of Little Fish Think Tank. Before founding Little Fish, Ms. Hill was an Associate + Senior Designer at HOK, and the Director of Interiors at Stanley, Beaman & Sears. She has implemented award-winning, innovative design solutions for commercial and institutional interiors.
Ms. Hill also has significant experience regarding the science and theory of color, both as a design tool and a promoter of healing. She has conducted extensive research in evidence-based design regarding color and its profound impact on the human spirit.
Prior to her work with Norix, Ms. Hill developed the Healing Colors Collection for Corian® solid surfaces, by Dupont®, for the healthcare environment. http://www.golittlefish.net
About Norix Group Inc.
For over 25 years, Norix has offered the most complete line of correctional furniture, for use throughout correctional facilities. With their extensive experience in providing secure furniture for prisons and jails, Norix is a trusted resource for every corrections application.
Norix also offers a vast array of furniture for several industries including behavioral healthcare, commercial, higher education, public safety, GSA and shelters. All furniture is designed for safety, security and extreme durability. Norix intensive-use furniture is extraordinary by design, surpassing industry standards for strength, safety and long-term performance.