Design Considerations of the Intensive Care Nursery

Robert D. White and Michele C. Walsh

When the neonatal intensive care unit (NICU) is appreciated as a place where crucial brain growth and development occur over a period of weeks or months, it becomes apparent that the sensory environment has comparable importance to the provision of direct medical care. This is even more evident when one realizes that the physical environment can affect the physical and mental health and performance of the caregivers, as well as parental involvement and satisfaction. Thus proper design should provide the best technological and environmental support possible to all three constituencies—infants, families, and caregivers. This goal is difficult to achieve, not only because of space and financial limitations common to almost all construction projects, but also because some of these needs are in conflict with one another, as illustrated briefly in the previous discussion on circadian biology.

Certain basic standards for NICU design have been defined with these scientific and practical considerations in mind.1,2,12 In this chapter, we review some of these standards (Box 38-1) and add practical suggestions for those who are considering alterations in the physical environment of their NICU.

Box 38-1 Key Factors in Designing the Intensive Care Nursery

Location

• Close proximity or controlled access to delivery and transport areas

• Controlled access and egress for patient and staff safety

Space Allocation

• Minimum of 120 square feet per bed space, excluding sinks and aisles (165 square feet minimum for single-patient rooms)

• Adequate and easily accessible storage (30 square feet per bed) for supplies and equipment

Access

• At least 4-foot aisles in multi-bed rooms

• At least 8-foot corridors outside private rooms

Privacy

• Minimum of 8 feet between beds, with provisions for family and speech privacy

Headwall

• Twenty simultaneously accessible electrical outlets, divided between normal and emergency power circuits

• Three each of compressed air, oxygen, and vacuum outlets, all simultaneously accessible

• Data transmission port

Hand Hygiene

• Large sinks with hands-free controls within 20 feet of every bed

• Sinks designed to accommodate children and persons in wheelchairs

• Appropriate provision for soap, towel dispensers, and receptacles for trash, recyclables, and biohazardous waste

Surfaces

• Floors ¹³—easily cleanable, durable, glare free, and cushioned in patient care areas

• Walls—easily cleanable and durable; attractive visual accents and sound-absorbent materials can be used where they can be protected from damage

• Ceilings—washable, highly sound-absorbent acoustical tile wherever feasible

Lighting¹⁴

• Ambient lighting levels adjustable through a range of 10 to 600 lux

• No direct ambient lighting in patient care areas

• Light sources with suitable spectrum to permit accurate color rendering ⁵

• Procedure lighting capable of providing at least 2000 lux at the bed surface, and adjustable in both location and intensity

• Daylighting for adult work areas, with appropriate shading and insulation

Acoustics⁹

• Noise control measures to maintain the combination of background and operation sound below a mean level of 45 dB ¹⁰

Heating, Ventilation, and Air Conditioning

• Ambient temperature of 22° to 26° C (72° to 78° F)

• Relative humidity of 30% to 60%

• Minimum of six air exchanges per hour with appropriate filtering; two changes should be with outside air

• Exhaust vents situated to minimize drafts near patient beds, and appropriately sized and constructed to minimize noise from airflow

Family Support

• Adequate and welcoming directional and informational signage

• Lounge, refreshments, restrooms, storage, library, telephones

• Overnight rooms—at least one per four patient beds

• Consultation/grieving room

• Lactation area (if sufficient privacy is not available at the bedside)

• Dedicated area at the bedside for infant care, work, and rest

Staff Support

• Lockers, lounge, restrooms, on-call rooms

• Adequate and comfortable charting/work area at each bedside

• Clerical/work areas away from, but easily accessible to, each bedside

• Office/desk space for all disciplines that routinely provide care

Sustainable Design

• Use of materials that are free of substances known to be teratogenic, mutagenic, carcinogenic, or otherwise harmful to human health ⁷

• Designs and materials that reduce consumption of energy, cleaning fluids, and nonrenewable resources ⁶

Adjacencies

In an ideal setting, the NICU is located in close proximity to the high-risk delivery rooms—in some NICUs, close enough to use a pass-through window. In hospitals with large maternity services or children’s hospitals, however, the NICU may be on a separate floor or in a different building. In this case, a stabilization area must be provided within or adjacent to the high-risk delivery area where the infant can be stabilized before transfer to the NICU. Transfer should occur in a neonatal transport device with appropriate monitoring and respiratory support, proceed through nonpublic areas as much as possible, and use dedicated or controlled-access elevators.

Adjacencies to other support services in the hospital, including operating rooms, imaging, laboratory, and pharmacy, should be carefully considered, as should the traffic patterns for families to reach the NICU and the areas they may need to use for eating, sleeping, personal needs, and interacting with other families. While making access convenient for families, good design also minimizes the traffic of non-NICU visitors or staff for both safety and aesthetic reasons.

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Jun 6, 2017 | Posted by admin in PEDIATRICS | Comments Off

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Fastest Obstetric, Gynecology and Pediatric Insight Engine

Design Considerations of the Intensive Care Nursery

Design Considerations of the Intensive Care Nursery

Adjacencies

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