Design drought - Water features fall out of favor over germ concern
Like dogs and cats or the Hatfields and McCoys, you're likely to start a skirmish these days if you put infection-prevention specialists and hospital designers in the same room.
Arguments over what constitutes a healing environment may have erupted into a full-blown feud with the end result being you may start seeing less greenery and flowing water inside hospital lobbies and atriums.
Kevin Lynch, an associate vice president and director of interior architecture for the Dallas-based architectural firm HDR, says infection-control and prevention specialists have become “almost rabid” in their attitudes against fountains, plants and other decorative features that they say may harbor germs.
“If we listened to them, there'd be nothing,” he says. “Just a big empty box.”
Linda Dickey, director of epidemiology and infection prevention at University of California Irvine Healthcare and a spokeswoman for the Association for Professionals in Infection Control and Epidemiology, says otherwise.
“I hope that we're seen as the patients' advocate,” she says. “We're not bringing this forward to be hard-headed. Everyone should have their eyes open about what we're about to spend money on.”
Plant soil can be a source of aspergillus mold, and fountains or other water features can breed Legionella bacteria, which leads to Legionnaires' disease, Dickey says.
But Bruce Komiske, chief of design and construction at the new Ann & Robert H. Lurie Children's Hospital of Chicago, cites studies that says decorative elements such as indoor vegetation and water features have positive impacts on blood pressure, muscle tension and both heart and brain activity. They can also help increase employee productivity and reduce staff turnover.
At the new 23-story facility, which is scheduled to open in about a year as the replacement for Children's Memorial Hospital, the 11th floor will house a two-story indoor “sky garden” with two “pocket” outdoor green spaces on the sides. “Every step of the way, we've had infectious-disease doctors and nurses looking over our shoulders,” Komiske says. “You can't just give in and say ‘Let's not do it.' ”
Komiske adds that designers received input from a “Kids' Advisory Board” patient panel, and one of it members told him: “When I'm at the hospital confined for weeks on end, I need fresh air.” He says this is what led to the decision to add the two, small outdoor spaces on either side of the sky garden. “There were lots of obstacles and lots of people saying ‘You can't do that,' ” Komiske recalls. “Thirty years ago, art in healthcare was new and different; now gardens are the new art,”
One item that was scaled back was a plan to have an open stream of water running through the garden, but Komiske says that—after several options for keeping the water free of bacteria were examined and rejected—it was decided to go with an enclosed water feature instead. Plans are also going forward for a 2,000-gallon saltwater aquarium in a waiting area, he says.
The garden will consist mostly of bamboo trees contained in large curving concrete planters. It was designed by Mikyoung Kim, head of the landscape architecture department at the Rhode Island School of Design, and funded with a donation by the Crown family whose patriarch, Lester Crown, is 66th on the Forbes list of the wealthiest Americans.
Though not commenting on the garden at Lurie Children's, Dickey says donations can be problematic.
“A lot of times, you have a donor who says they want to put a fountain in XYZ location and that's what they have their heart set on,” Dickey says, adding that, if they have concerns, an infection-prevention specialist will have to tactfully ask the hospital benefactor, “Could we honor your donation in a different way?”
Even though there had been no evidence of it causing problems, Dickey says a “sheet” waterfall feature at UC Irvine was dismantled because of dissatisfaction with the maintenance service.
At Aurora St. Luke's South Shore hospital, the Cudahy, Wis., campus of the system's 730-bed St. Luke's Medical Center in Milwaukee, the facility's “water wall” feature was identified as the source of Legionella that led to eight people being treated for Legionnaires' disease last year.
Aurora spokesman Adam Beeson says the hospital was following recommended maintenance including weekly cleanings and monthly water changes. The system went on to shut off all its water features and will no longer add new ones. Some existing fountains “have become planters or sculptures,” Beeson says.
At North Shore-Long Island Jewish Health System's Monter Cancer Center in Lake Success, N.Y., there were some initial concerns about what could breed in soil for the extensive indoor tree plantings there, but spokesman Brian Mulligan says no problems have been reported at the facility that won an honorable mention in Modern Healthcare's 2007 Design Awards.
Mulligan says the trees' soil and irrigation system are 2 feet below floor level and that everything is covered with decorative rocks. “There is no exposed dirt or water,” he says. “They looked at everything possible, and everything is working out as planned.”
Sue Wieland, national sales representative for the hospitality and healthcare sector at Ambius, a Buffalo Grove, Ill.-based interior landscaping business, says healthcare has become her company's “No. 1 customer.”
“Healthcare has been one of our largest sectors this past year,” she says. “It's one sector that's still doing well financially.”
Because they produce oxygen and improve people's moods, Wieland says “Everyone loves plants.”
Lynch at HDR says artificial replacements—such as showing a fireplace video on a television—are no substitute for the real thing, and exposing patients to nature has more healing benefits than trying to keep them absolutely safe in a sterile environment.
“I feel like that's where we're headed,” he says. “It's almost like ‘Stark Trek' with the holodeck.”
But Dickey says that for patients who have recovered from an illness or injury, having their hospital stay extended because of an infection can be more than just frustrating.
“For some, it can be devastating or life threatening,” she says.
This article first appeared in ModernHealthcare.com