Technology & Services
Efficient hospital lighting
a report by
Richard Forster
Lighting Consultant and Editor, Society of Light and Lighting Newsletter
Introduction
Any hospital complex encompasses a broad range
of functional elements and is almost a self-
supporting community. The occupancy is both
complex and dynamic and, therefore, any lighting
has to meet the separate, and even conflicting,
visual needs of staff, patients and visitors.
Furthermore, many areas are in use 24 hours a day,
seven days per week. Extending the natural
working day is possible by electric lighting, but for
hospitals the use of artificial lighting occurs to a
much greater extent than in normal commercial
and industrial premises.
Recommended illuminations vary from one lux for
night-lighting to 100,000 lux in operating theatres.
The first objective is the provision of adequate
illumination. Attempts to save energy by under-
lighting are a false economy, as without sufficient
light errors and mistakes increase and visual fatigue
reduces the rate of work.
It is impossible to deal with all the lighting issues in
a single article, so a small number of aspects have
been selected. Their relative importance will vary
from site-to-site, but hopefully it will be possible to
audit local conditions either by a walk-through
survey or by asking a few key questions of facilities
management and procurement.
Daylight
This is a good starting point and immediately
recognisable. Daylighting is an important element in
building design, as it provides variety, a link with the
outside world and a temporal scale. These aspects are
particularly important for visitors and patients who
are in an unfamiliar environment. Well-designed
daylighting of a space can reduce the reliance on
electric lighting, thus saving electricity. The
inconsistency of natural light, however, often results
in electric lighting being left switched on when it is
not needed. In fairness to the occupants of a space
there is no clear indication of the relative
contribution from electric light and daylight by
which a decision can be made to switch off electric
BUSINESS BRIEFING: HOSPITAL ENGINEERING & FACILITIES MANAGEMENT 2005
lighting. The potential for daylighting to save energy
is thus rarely realised.
Lighting Controls
There are various options available for the automated
control of lighting based on presence detection,
photo-sensors that can measure the amount of
natural light, timers and building management
systems. Which is deemed to be the most suitable
will depend on the type of location and its usage
pattern. There are two basic rules in providing
automated switching. Firstly, there should always be
safety of movement so occupants are never deprived
of all lighting in a space and secondly there should
always be a convenient local manual override so that
the function of a space can continue.
Lighting controls are called for in Part L of the
Building Regulations for England and Wales, either
automated or by local manual switching. For the
latter, it is important that the switching circuitry
relates to a sensible sub-division of the space. Large
open spaces can be reorganised and it is important
that the switching is changed to match the current
arrangement. Manual switching does not have to be
hard-wired and where change is likely switching by
infrared handsets, similar to the domestic TV remote
control, can be considered. Other options include
switching via telephones or PCs.
Sudden abrupt changes in lighting levels can be
disturbing and even construed as a fault condition, so
dimming is becoming more popular. With modern
light sources, such as fluorescent tubes, the
relationship between light output and power
consumed is almost linear – dimming saves electricity
consumption. With filament lamps, however, the
light output decreases much more rapidly than the
power consumption, so the potential for energy
saving is less significant. Simple resistive dimmers do
not save energy but merely transfer consumption
from the lamp to the dimmer itself.
Greatest Cost
It is not normally appreciated that the greatest cost
Richard Forster worked for Atlas
Lighting from 1957 to 1961, as
commercial trainee, Lighting
Engineer and Senior Lighting
Engineer. He then worked as
Lighting Designer for Isora
Integrated Ceilings in 1969 and
won the Illuminating Engineering
Society (IES) National Floodlighting
competition for Coventry Cathedral
in 1972. From 1972 to 1991 Mr
Forster worked for Thorn Benham
Environmental Engineering and in
1974 as Marketing Manager for
Thorn Lighting. He was an
Independent Lighting Consultant in
1991, specialising in light sources,
providing technical articles,
education and industrial training.
From 1993 to 2000 Mr Forster was
Editor of the Chartered Institution
of Building Services Engineers
(CIBSE) Lighting Division Newsletter
and was also Editor of the Society
of Light and Lighting Newsletter in
2000. He has also written various
technical articles in Building
Services Journal, Light Magazine
and other lighting trade journals as
well as papers given to IES and
CIBSE National Lighting Conferences.
Mr Forster has a City and Guild
Full Technological Certificate in
Illuminating Engineering, is a
Diploma Member of the IES and is
a Member Institution of Lighting
Engineers. He also has a lighting
diploma from the CIBSE.
1
 Technology & Services
Figure 1: Typical Through-life Costs. Fluorescent Luminaire Over 10 Years
Figure 2: Typical Luminous Performance Comparison
associated with lighting is the energy consumed.
Typical through-life costs are shown in Figure 1.
Changing from a normal nine-to-five, five-day
week, to 12 hours per day every day doubles the
hours of use and thus the energy consumed. For
many situations in a hospital complex this may be a
conservative estimate. Energy costs are currently
predicted to rise after a period of stable, and even
falling, prices. This is partially due to market forces,
but concern about global warming and increasing
environmental pollution is applying additional
pressure to reduce energy consumption. It is,
therefore, important that hospital lighting is based on
only the most efficient light sources.
Fluorescent Tube Lighting
Probably the most common lamp in use today is the
fluorescent tube. Developed just before WWII, its
availability was restricted during the years of the
conflict and became part of the post-war building
programme. Significant technical progress was made
in the 1950s with the introduction of improved
phosphor coatings generically called ‘halophos-
2 phates’. There were two groups of white lamps for
BUSINESS BRIEFING: HOSPITAL ENGINEERING & FACILITIES MANAGEMENT 2005
general lighting called white, warm white and cool
white. Better colour rendering was possible if
required, but only with approximately two-thirds of
the light output. This group was given names such as
Natural and Northlight. With this choice, good
colour rendering was restricted to situations where it
was important, such as retail premises and industrial
colour matching.
In the 1970s, new phosphors were introduced that
created white light by the addition of red, green and
blue colours and became known as ‘triphosphors’.
These had three main advantages:
• increased light output – typically +10% initially,
35% at end of life;
• good colour rendering – no longer was it
necessary to compromise efficiency for colour
rendering or vice versa. Colour rendering is
explained in more detail below;
• good lumen maintenance (see Figure 2); and
• longer life.
This extra performance carried a cost penalty with
triphosphor lamps at approximately twice that of their
halophosphate versions. The construction industry
has been traditionally structured so that through-life
cost benefits are not properly recognised. The
installing contractor is only interested in initial costs
and not operating costs. The purchasing department
compares component costs and favours low-cost
replacement lamps. Facilities management can
identify energy consumption, but have little
opportunity to influence equipment specification.
Higher lamp costs can be easily justified (see Figure
1). More light emitted means less luminaires to
purchase, fewer lighting points to install, lower
installed load and less equipment to maintain.
The better durability of ‘triphosphors’ results in the
light output being maintained at a higher level for a
longer period.
The reduction in light output with time from the
triphosphor lamp is only approximately 5%, which is
not readily detectable by the naked eye.
Consequently, if one lamp fails its replacement will
not appear at different brightness.
With halophosphate lamps there is a much greater
fall-off in light output, which, after 9,000 hours, is
approximately 20%. A single replacement lamp
would be 25% brighter and would be apparent. This
is why the curve for the halophosphate lamp is only
 Efficient hospital lighting

shown to 9,000 hours – after that time group Table 1: Power Reduction
replacement becomes necessary in order to maintain
a uniform appearance from an array of lamps. Length T12 T8
1,800mm 85W 75W
Recommended illumination levels are more 1,500mm 65W 58W
accurately described as maintained or service 1,200mm 40W 36W
illuminance, which does not refer to the initial 600mm 20W 18W
performance, but the minimum average. This
means lighting designers do not have to consider
the initial light output from the lamps, but the Figure 3: Fluorescent Tube Identification
lowest value when the lamp is replaced. The
difference in light output, therefore, is not 10% but
approximately 35%.

Tube Diameter

In addition to the phosphor efficiency the gas filling

of the tube was altered so that approximately the
same light output was possible with a reduction in
power consumed.
This can be identified by the change from 1 1/2 inch
diameter to one inch. Lamp producers know this
internationally as the change from T12 to T8. Many
standard light bulb shapes are designated a letter – in
this case T = tube – and its diameter is expressed in
eighths of an inch.
If any T12 lamps are found then it is likely that
energy savings are possible. The only exception to
this simple rule is 2,400mm (8ft) lamps, which are
only available as T12.
T8 and T12 tubes are physically interchangeable as
they use the same bi-pin cap and are of the
same length.
In the 1990s, T5 fluorescent tubes were introduced.
These use only triphosphor coatings and are designed
specifically for high-frequency electronic operation.
They will not retrofit into lighting designed for T8
or T12 lamps.
Electronic Control Gear
Operating fluorescent tubes at high frequency (circa
50kHz) will increase light output by approximately
10% compared with a standard 50Hz supply.
Electronic circuits adjust the lamp power to give the
same light output as conventional control gear, so the
value branded on the lamp can be misleading. The
use of T12 lamps and electronic gear is rare as
availability started during the era of T8 lamps. The
36W lamp listed above would operate at
approximately 33W.
Electronic control gear has several significant
additional advantages. The light is ‘flicker-free’
whereas lighting at 50Hz can cause discomfort to a
Tube diameter
T5 T8 T12
1/2 inch 1 inch 1 1/2 inch
16 mm 26 mm 38 mm
small section of the population. It is also silent in
operation and this can be important for certain
hospital areas. Due to the fact that the starting process
is controlled, the lamp life is extended to
approximately 20,000 hours.
Colour Rendering
This is a key performance characteristic of
fluorescent tubes. It is the ability of a light source to
accurately represent the colours of an object, which
it is illuminating. Colour is a complex subject but a
colour rendering index (CRI) as a numerical scale
1–100 has been developed to provide an
approximate indication. There are several versions
but that commonly quoted by lamp manufacturers is
Ra8, which is based on the average results from
eight pastel shades across the spectrum, typical of
normal interior surroundings. There are specific
indices, of which one is based on skin colours, thus
relating to medical visual environments. There is a
European standard for surgical lighting, which
suggests that the ideal colour temperature is
4,000–4,500 Kelvin.
For tungsten halogen lamps, colour temperature and
colour rendering are interrelated. For fluorescent
tubes the characteristics are separate and a colour
temperature of 4,000K should be specified in
association with an appropriate CRI.
Standard and deluxe triphosphor fluorescent tubes are
normally acceptable for general lighting with CRI 80+
and for medical areas with CRI 90+. This aligns with
the international and European standards for lighting of 3

BUSINESS BRIEFING: HOSPITAL ENGINEERING & FACILITIES MANAGEMENT 2005

 Technology & Services

Table 2: Light Output Comparison

Length Diameter Rating Lumens Efficiency Phosphor

Lumens/Watt
1,200mm T12 40W 2,850 71 Halophosphate
1,200mm T8 36W 2,600 72 Halophosphate
1,200mm T8 36W 3,200 89 Triphosphor
1,200mm T5 28W 2,750 98 Triphosphor

the workplace, which call for lamps with a minimum then energy saving measures can be applied.
CRI of 80 for general areas and 90 for clinical areas. It
is worth noting that compact fluorescent lamps are • Where there is adequate daylight can the electric
only available with triphosphor coating. lighting be switched off?

Standard halophosphate lamps have a CRI of 50–75
so cannot meet these colour rendering criteria.
Identifying which lamps are triphosphors is not simple,
as manufacturers use individual brand techniques rather
than generic descriptions. This has some justification as
two lamps from different manufacturers may have the
same CRI, but colours will not appear the same under
both. As CRI is an average performance measure, so
individual colours can differ, which is a limitation of
presenting colour performance by a single number.
To ascertain that the correct lamps are being used, it is
necessary to determine that they are triphosphor and
with a minimum CRI of 80 or 90 according to the
location and that the lamps are provided by one
manufacturer. Where colour is important there is no
substitution for visual assessment of lamps in situ, which
is not normally difficult to arrange.
Disposal
• Have automated lighting controls been considered?
• Are the fluorescent lamps T8 or T5 diameter?
• Are ‘triphosphor’ lamps being used, with deluxe
versions for examination areas?
• Is electronic gear being used?
For most building services, efficient operation can
only be confirmed by interrogating records and visits
to plant rooms. For lighting the answers to the above
questions are there for all to see. ■
References
BS EN 12464-1:2002
Light and Lighting - Lighting of Workplaces
Part 1: indoor workplaces

Fluorescent lamps are now classified as hazardous waste BS EN 6061-2-41:2000

and require appropriate disposal. The European Medical Electrical Equipment
Directives 2002/96/EC for Waste Electrical and
Electronic Equipment and 2002/95/EC Restriction of SLL/CIBSE Code for Lighting 2004
the Use of Certain Hazardous Substances in Electrical
and Electronic Equipment were due to be CIBSE Lighting Guide No.2 1989
implemented in UK legislation at the time of press. Hospitals and Healthcare Buildings
Lamps with high light output and a long life will help
to offset the additional operating costs from these Lighting and Colour for Hospital Design
forthcoming regulations. Dalke H, Littlefair P, Loe D L
NHT Estates 2004
Summary

If the answer is no to any of the following questions,

BUSINESS BRIEFING: HOSPITAL ENGINEERING & FACILITIES MANAGEMENT 2005