The architectural design of the Continuum Center for Health and Healing enhances the patients physical, emotional and spiritual resources through responsive planning, selection of environmentally friendly materials, and the creation of a distinctive, non-traditional healing environment.
In 2001 The Continuum Center for Health and Healing received an architectural design award from the Boston Society of Architects. The Center was selected for its design and the choice and use of interesting materials. The materials were selected and integrated with a feng-shui sensibility that resulted in a non-institutional atmosphere that captures the idea of a healing environment. You are invited to tour the Center and find out more about the clinical services by contacting the Director of Community Education and Outreach at (646) 935-2250.
The ancient principles of feng shui were utilized in the initial planning of the Center. The well-known (architecturally trained) Feng Shui master Alex Stark worked closely with the architectural firm of Guenther Petrarca, a leader in green design and the use of eco-sensitive materials. This collaboration ensured that construction and design principles optimized the use of the spaces potential.
The totality of the Centers interior reflects the principles of Feng Shui, an ancient Chinese art built on the belief that Qi the vital life force pervasive throughout the universe and existing in all living things can be affected by our external environment. A positive arrangement of our environment promotes better health because Qi is allowed to flow freely. Likewise, any environment blocking the flow of Qi negatively impacts both our physical and mental health.
The Center based its interior layout on the art of placement specific to ancient Chinese beliefs to improve energy flow through the interior. The consultation, examination and therapy rooms have been placed north to promote patient healing and tranquility while staff areas located south will benefit from harmonious internal communication. East placement provides the waiting room pleasure and connectivity while OB/GYN rooms situated to the west represent new beginnings. Rooms and areas placed south west and southeast as well as north west and northeast also symbolize and foster inner growth and outer potential.
Feng Shui also suggests that living beings should live harmoniously with each other as well as with elements in nature. Therefore, the elements used in decorating the interior space have been chosen to reflect this idea. Soft, functional lighting with soothing sounds play integral parts in the Centers organic composition. The auditory and visual input also work towards a calming effect on all those who enter the Center.
The Centers overall space and internal structures have been constructed to be the antithesis of the mainstream waiting room: interactive and relaxing. Unlike traditional waiting rooms the Centers waiting area serves as a multi-functional space for patients to learn and interact with one another. A large meeting table for group-learning, a resource area, individual lounge seats, and web-ready computer stations are among the amenities available to patients to optimize their time before an appointment. In addition, the reception area is clearly separated from the patients waiting area in a circular room that is easily accessible but out of direct view.
Natural and earth-friendly materials that are also non-toxic have been used throughout the Center. Building elements, including paints, finishes, floor and wall materials, used in The Centers Design and Construction were carefully chosen with consistent attention to environmental responsibility. Furniture materials, upholstery, and other fabrics also further reflect the Centers commitment to environmentally conscious choices.
The Centers Design and Construction
The architecture team examined prevailing health care planning models with a view toward de-institutionalizing the experience of receiving care. Contrary to conventional planning models, for example, the waiting space is remote and not visible from the elevator lobby arrival zone. It is reached only after travelling through a complex spatial sequence intended to relax and envelop the patient. The Reception function is not located in the Waiting Room, further enhancing patient privacy and reducing the clinical supervision aspect of the waiting experience. The Waiting area accommodates a wide range of activities: group education at a large conference table, individual lounge seats with computers providing Internet access to a wide range of health-related sites, and a patient library.
Conceptually, the team sought to define a healing environment that is recognizable and distinct from residential, hospital or corporate health care interior design. This distinction is manifested through careful consideration of scale, spatial and sensory experience and the rigorous selection of environmentally sound building materials and construction methodologies.
The selection of building materials and installation methods was made to optimize indoor air quality and environmental responsibility. Material selections (flooring, paint, adhesives, and cabinet substrates) eliminate use of formaldehyde and volatile organic compounds. Carpet is minimized; major flooring materials are cork and linoleum (natural, biodegradable products). Fabric selection focuses on the use of recycled and compostable materials. Materials were selected to be easily maintained with natural cleaning products in order to preserve a high level of indoor air quality.
It is the intent that the Continuum Center for Health and Healing serves as an educational model for the design of healing environments in the future, and informs an important and continuing dialogue about the relationship between man and the physical structures within which we live, learn and heal.
Please read on for a more detailed description of our building materials and installation techniques.
A volatile organic compound (VOC) is a potentially hazardous chemical compound that easily evaporates and contains one or more carbon atoms. Formaldehyde used in construction adhesives and mastics, for example, is one of the most common VOCs found in the home and work place. Other VOCs are present in paint (particularly alkyd paints), caulking, and carpet backing. While the quantity of any single compound has a relatively limited impact on indoor air quality, there is increasing concern about the cumulative effect of all the compounds added together. There are a wide range of health issues associated with exposure to VOCs, ranging from relatively minor complaints such as eye, nose and respiratory irritation to more serious medical concerns, depending on the particular compound and the concentration. VOCs also contribute to air pollution in general; the emission level of VOCs is increasingly regulated under federal air quality legislation.
Durable, premium quality, fast-curing paints and stains were used that have low VOC content. They produce almost no odor during application and are odor free once cured. These kinds of products are well suited for areas in which the health of occupants is a concern. They meet or exceed all federal and state air quality regulations (including California), and contain no formaldehyde, ammonia, crystalline silica or ethylene glycol.
Construction Adhesives, Caulking Compound, Sealers, Cleaners
All products used are low odor, non-toxic, water-based products that have very low VOC content and are safely applied by the installer. These products are recommended for indoor air environments for the chemically sensitive. They meet or exceed all federal and state air quality regulations (including California). None of the products contain formaldehyde.
Medium Density Fiberboard (Cabinet substrates) used for our custom cabinetry. All Green Medium Density Fiberboard (MDF) is made from 100% recovered wood from old pallets, construction waste and manufacturers outfall which preserves natural resources and habitats. The recycled wood is sorted, chipped to uniform size and screened. The fiber is then washed and fed through state of the art refiners and is steam pressed to create homogenous panels, free from contamination. Unlike other panelboards, no urea formaldehyde resin is used in the binding agent. Since there are zero incremental formaldehyde emissions, it meets the rigid European E-1 and HUD-24 low emission standards.
The MDF is clear finished with a high quality water-based clear finish that is very low odor and very low VOC. It is comparable to conventional solvent and water-based polyurethanes in performance without the toxicity.
Formaldehyde Free Fiberglass Insulation (Sound and thermal)
Typical fiberglass batt insulation contains about 5 % resin binder that is capable of outgassing formaldehyde fumes into the air. Products without formaldehyde were used which improves indoor air quality as well as outdoor through reduced emissions during manufacturing. These fiberglass batts contain a minimum of 25 %-recycled glass that reduces pollution resulting from fuel burning, and reduces waste through the utilization of recycled materials.
The suspended ceilings acoustic panels are composed of aspen wood fibers bonded with an inorganic cement which is then formed under heat and pressure to create uniquely textured, extremely durable, flat panels.
All of the raw materials used are sustainable. The wood excelsior is from managed new growth trees that reach maturity in 25-30 years. The primary source of magnesium oxide used in the binder is seawater, and the silicate used in the secondary binder is made from sand. In the production of these materials waste magnesium is recovered and reused to reduce the magnesium requirement. Water is also recycled during the manufacturing process to reduce water consumption.
Recycled Glass Tiles (Restrooms)
An alternative wall and floor solution can be found in the dumpster. Old wine and beer bottles are finding a second life as glass tiles. There are a number of companies, producing decorative tiles for walls, floors and mosaic accents. These tiles characteristically have bubbles and cracks that add to their beauty. Glass tiles are easy to clean and maintain. We used appropriate adhesive and grout to make this a green toilet wall finish solution.
Antique Heart Pine (Yoga Room Floor and Wood Slat Wall)
Heart Pine wood comes from the Longleaf Pine tree, which has long been extinct in North America. It was the wood of choice for colonial builders because of its size, strength and resistance to rot and insects. Today, Heart Pine is reclaimed from outmoded factories, textile mills and warehouses as they are demolished. The magnificent beams are re-sawn and re-milled into solid planks for flooring and lumber. Antique Heart Pine is a 100% recycled product.
The wood finish is a natural oil product and is 100% biodegradable and made without harmful synthetic chemicals. It contains only biologically and environmentally responsible ingredients, grown without pesticides, which are tested for human and environmental health and safety. Since only certified organic products are used, the finishes tend not to cause any allergies, asthma, or skin irritations, not to mention the nausea, headaches and nervous system disorders often caused by fumes of synthetic ingredients in many conventional products. These types of products can also be safely disposed of with regular household garbage, without harming groundwater or soil.
Linoleum (Exam Room Flooring)
Linoleum is a natural flooring product made from renewable raw materials linseed from the flax plant, natural resins, wood and cork floors, crushed limestone, and non-toxic pigments. The backing is of jute fibers. Linoleum has been manufactured and in use for the last 100 years. It requires less energy to manufacture than most other flooring products and is known for being inherently anti-bacterial and naturally anti-static, yet it is without harmful VOC emissions. It is easy to clean and maintain. It is a soft-walking surface that provides acoustic dampening. The adhesive used for installation is a 100% solvent free adhesive.
Limestone (Entry Flooring and Wall)
Limestone is a stone comprised of mainly calcium carbonate old fossilized organic matter sandwiched and compressed between layers of earth. Limestone can be anywhere from creamy white to cadet blue. The refined French variety comes from organic beds laid down during the Jurassic period some 90 million years ago. The stone is clear finished with a high quality water based seal that is very low in odor and very low VOC.
Cork (Treatment Rooms & Circulation Area Flooring)
Cork is a flooring material with a long history of use. Cork is the bark of the Cork Oak tree, which is harvested every 9-14 years. The tree is never cut and the habitat remains undisturbed. The bark protects the tree during its average 500-year life span. These trees grow in the forests of Mediterranean countries, with the largest concentration of plantations located in Spain and Portugal. Not only is the bark inherently fire resistant to protect the tree from forest fires, but it is also resistant to the extreme temperature changes prevailing in those regions. It is resistant to more than 38 species of insects including the termite, and to the development of microbes (one of the reasons it is so invaluable to the storage of wine).
Because 90% of the tissue consists of gaseous matter, the density of cork is extremely low, giving the material wonderful thermal and acoustical insulating properties. Cork flooring is often found in libraries, such as the US Library of Congress, to dampen the sound. The gaseous quality of the cork also provides a cushion effect- a soft walking surface to the building environment. Cork does not absorb dust; with proper cleaning, it is naturally hypoallergenic. Cork is inherently fire resistant; it does not spread flames and does not release toxic gases during combustion.
The presence of Suberin in cork, a natural waxy substance produced by the tree, renders cork impervious to both liquids and gases. As a result, cork does not rot and only requires a light sealant such as beeswax; a natural wood oil or a water based low VOC sealer to complete the finish.
Recycled Carpet Tile (Office Area)
Carpet is one of the most polluting architectural finishes used in todays building industry. Most commercial carpet is produced from toxic synthetic materials; it consumes enormous energy in manufacturing; it generally requires solvent based, off gassing glues for installation; it is not biodegradable and generates substantial landfill volume. In response to environmental issues, the carpet industry has introduced more environmentally responsive product lines and instituted recycling processes to reuse waste carpet product.
The carpet used at the Continuum Center for Health and Healing has the highest recycled content available in the industry at 72%. Estimates by the producers of this type of carpet state that recycling saves 50,000 BTUs of energy per pound of carpet in comparison to a standard nylon carpet (this is about the same energy used for one laundry wash and dry cycle per each carpet tile!). The backing for this product is made from 100% recycled carpet, drastically reducing waste in our landfills.
Commercial carpet is also very difficult to reclaim or re-use because the nylon thread of the carpet is difficult to separate from the vinyl backing. The carpeting used at the Center has been constructed to be separated for recycling and therefore closes the loop of the manufacturing process. The price of reclamation is included in the price of the carpet tile. Also, this or any carpet tile can be installed using a dry bond adhesive system (used like tape). Unlike typical carpet adhesives, these materials have no harmful VOCs and no formaldehyde.
Wool Carpet (Area Rugs in Waiting Room)
Because all carpeting is a nest for dust, mites and other allergens and biological pollutants, it is preferable to limit its use by using area carpets over a smooth surface floor. Natural fiber rugs are easier to keep clean and will wear longer. They can be removed for cleaning which takes the dusty, disruptive cleaning process off site. Often vacuuming just lifts to the surface and makes ambient the irritable debris embedded in the carpet.
In selecting wool carpets, the following green considerations have informed the selection. First, the wool is harvested from organically raised sheep. After harvesting, it is important that the wool not be bleached (bleach is toxic and enters the environment through wastewater) and not moth proofed (a process that contains formaldehyde). The dyeing process employs vegetable dyes and other non-tetratogenic chemicals (often wool dyes for carpet and fabrics use chromium, which is a toxic heavy metal). The carpets will not be backed in latex, which is a volatile organic compound.
In the manufacturing of furniture used at the Center sustainable woods are used and water intensive manufacturing processes have been eliminated. No chloroflorocarbons are used (which reduce the ozone layer) and paint solvents were also reduced. In the distribution of the furniture products reusable pallets have been developed for shipping, disposable packing materials have been diminished, and the packing weight has been minimized to reduce fuel costs and energy consumption.
As an alternate to chrome finishes, which generate residual heavy metal particulate from the manufacturing process, a type of finish was used on the furniture, which eliminates VOCs hazardous cleaners and is nonflammable for factory safety.
Waste Management in Health Care: A Public Health Issue
In the past health care waste never received much attention -- it only accounts for about 1% of the total waste stream. The beach wash ups in the 1980s, however, led to over-regulation of medical waste due to fear of disease transmission. With Fresh Kills Landfill closure, more and more waste is exported out of state, leading to increased costs. Now the Environmental Protection Agency has reported that medical waste incinerators are a major source of mercury and dioxin in the environment. Dioxin, a group of extremely toxic compounds, is produced when poly vinyl chloride (PVC) is incinerated. Many medical devices are made of PVC. Since the 1950s, the amount of waste in health care has more than doubled, due to the dramatic increase in the use of disposable products.
We now better understand that health care environmental management is a public health issue. And as providers of health care, it only makes sense that we would do whatever we can to make less garbage and make it less toxic to the environment and human health. We are ethically obligated to deal with this issue or our mission statements are in question. The good news is that better management of materials is good business and has many positive outcomes including cost savings, improved regulatory compliance, a safer work environment and improved relationships with our communities. Our patients and our staff deserve a healthier environment in which to live and work. Waste Management is a respect issue. By taking responsibility for the proper segregation of the material we generate, we show respect for our housekeeping staff, our patients, the communities we serve, the environment, and ultimately, ourselves.
Health care institutions should be leaders in the field of proper waste management and recognize the link between human health and the environment. The irony in place is that while providing health care, we can make a coworker sick by exposure to a contaminated needle. We can add dioxin into the atmosphere through burning PVC plastic. We can release mercury into the environment through mismanagement of mercury-containing products and clog incinerators and landfills with unnecessary volumes of solid waste.
Health care environmental management programs require long-term commitment with ongoing monitoring and education. Beth Israels programs focus on reducing the amount and toxicity of waste generated through improved segregation of materials, recycling, reuse, purchase and change of work practices. Beth Israel Petrie Campus (First Avenue @16th street) employees have reduced their generation of red bagged waste by over 1,400,000 pounds per year, saving over $ 800,000 per year in waste haulage fees. The savings paved the way to Beth Israels overall commitment to improved waste management for all Beth Israel sites.
Beth Israels Singer Division (88th and East End Avenue) saved $135,000 per year through the same practices of red bag reduction, switching to reusable sharps container and recycling. Beth Israel employees recycle office paper, corrugated boxes, newspaper and magazines, fluorescent light bulbs and some batteries.
Waste Management programs at Beth Israels Kings Highway Division in Brooklyn were implemented in August of 1996. Annual savings are $130,000. The program included reducing the red bags by 2/3 through improved segregation by staff members, renegotiating an over-priced waste contract, switching to a reusable sharps collection system and implementing office paper recycling.
In our effort to phase-out mercury containing products, staff purchase aneroid sphygmomanometers and look for alternatives to mercury products wherever possible. Our battery collection program will be expanded in 2001 to include collection bins in all soiled utility rooms. Broadlane, our purchasing group, is committed to reducing the volume and toxicity of our waste stream through smart purchasing practices.
Beth Israel has received numerous awards for our waste initiatives including The Community Environmental Health Award February 1998 from the Health Care without Harm Campaign; the 1998 Annual Activist Award from Citizens Environmental Coalition; Honors for Contribution to Mercury Free Medicine spring 1999 from Health Care Without Harm Campaign and Janet Brown, Beth Israels Waste Manager is receiving a Citizens Award from the EPA in April 2001.
Health care practitioners can learn of waste management/cost saving opportunities for their practices by reading the Greening Your Practice column in the bimonthly publication Holistic Primary Care. Practitioners can receive this publication for free by faxing a request to 212/406-8959. Janet Brown can be reached at 212/420-2442 or e-mail email@example.com Learn more about health care environmental management issues by checking out the Health Care Without Harm web site at www.noharm.org.