Creating Safe and Healthy NICUs for the Littlest Patients

By Nicole DeFazio, Basel Jurdy and Lauren MacLeod

Designing a neonatal intensive care unit requires addressing the medical, developmental, emotional, and social needs of not only the infants but the families and staff as well. Due to the level of care that the patients in these units require, the guidelines and recommendations for interior design are some of the most complex in the healthcare industry. Many studies have concluded that the built environment has a tangible effect on not only the infants being treated, but the family members and caregivers as well.

The first step to take when designing a NICU is deciding whether to pursue the single-family room model, open-bay unit, or a hybrid of both. That choice will have a direct impact on the privacy, both social and acoustical, of a family during their stay in the unit. Parents and caregivers have found healthcare spaces with a significant number of amenities reduce their stress and anxiety.

Finding Child-Friendly Finishes

The selection of finishes within these units should be carefully considered to meet the “recommended standards for newborn ICU design.” These guidelines state that wall and floor finishes shall be easily cleanable, prevent growth of microorganisms, and have a low gloss value to reduce glare risk on the infant or medical professional. Indoor air quality is a growing concern within all built environments that humans are occupying but becomes crucial for a newborn ICU as the baby’s organs are still developing. Wall and floor products as well as furnishings need to be researched fully to ensure that they are free of VOCs and PVCs that would off-gas and pollute the air. Manufacturers of surface products have increasingly become more sustainable and transparent about the contents of their goods due to the growth of programs such as Cradle-to-Cradle Product Innovation, LEED, and WELL standards. To create an environment free of respiratory irritants for infants with under-developed immune systems, cleaner and more natural products like rubber or linoleum sheet flooring could be utilized.

Although the genetic makeup and physical appearance of the finishes selected should be carefully studied, designers must also think about the imagery being provided in the unit. Often designers will create a child-friendly concept for infant spaces, including bright colors and graphics of animals or flora. Before specifying, we should be discussing any symbols that the care team may use to signify loss. For example, many hospitals will use a purple butterfly at the entrance to a patient space that was part of a multiples birth, but sadly one or more of the siblings did not survive. To prevent confusion for staff or emotional distress for parents, it would be best to stay away from those graphics for decorative art.

When selecting finishes for an infant care space, it is imperative to remember that the lighting will reflect any color tones that are on the walls or flooring to the adjacent surfaces. This includes the baby itself, which can be of concern since perception of skin tones like yellow can often be evidence of conditions such as jaundice. Finishes that are blue, purple, or pink can often help family members with positive distraction and keep care teams energized, but the colorful materials should be kept away from any indirect lighting that’s designed to bounce off of the vertical surfaces to illuminate the room.

Keeping Quiet

Acoustic control in the patient zone is of utmost importance to the health of the infant patients and staff. Quieter environments are supports fewer errors and more sustained attention for better decision-making. Less noise also reduces staff stress, burnout, and turn-over which yields greater well-being for professionals.

While hospital noises of beeping equipment, rolling carts, and breast milk refrigerators whirring are challenging to get around, acoustics within the infant care space need to be carefully studied. Privacy for staff-parent conversations, freedom from distracting sounds, and the ability to achieve uninterrupted sleep should be attainable goals for that space. Since the ceiling is the largest available area for sound absorption, it is pertinent to specifying a product that has a noise reduction coefficient of 0.90 for 80% of the surface to overall acoustical liveliness and propagation of sound between spaces.

Sound travels between rooms through one or more paths. When we evaluate sound’s the source, path, and receiver, the emphasis of the acoustical design can focus on the path of noise. While some sources of noise like human activity can be reduced by adjusting behaviors in the suite, but other sources of noise – like medical equipment — are out of our control. Further, locating sensitive rooms away from active areas or entry ways to the NICU suite helps in separating some of the sources away from the room by allowing for longer paths of noise.

24/7 Lighting

Lighting and lighting controls are other elements of intense scrutiny in the design of NICU’s. There is nothing new about the importance of getting newborns on the solar clock from birth or the benefits babies receive from a dynamic system. It has been established that newborns sleep better, have a faster rate of weight gain, begin oral feeding earlier, spend less time on a ventilator and exhibit enhanced motor functions (‘The NICU Lighted Environment’ by Mark Rea and Mariana Figueiro) when exposed to a cycling lighting system that mimics the sun.

The lighting industry has been designing NICU rooms with color-changing and dimmable lighting solutions for decades — long before LEDs were anything more than an indicator light on a clock radio or car dashboard. While today’s color-changing or tunable white LED lighting systems simplify the lighting product, there are still many considerations for an effective system that supports all users, functions, and budgets. As a 24/7 space, the lighting and lighting controls must be in sync and work seamlessly from the moment of installation. COVID-19 has added another level of complexity with the discussion of UV sterilizing systems that can only occur when the room is not occupied.

Products that meet all requirements remain limited, but there are a handful of lighting fixtures that solve many of the issues when paired with strategic design and coordination. Our lighting experts are continually working with manufacturers to create an installation that is one system and completely turnkey.

Evolving NICU

The ever-changing market of interior products is widening the spectrum of what a neonatal care space can look and feel like. By utilizing healthy products that have high acoustic properties and lighting that embraces the newest technologies, these care spaces can lead to quicker development of infants, less stress for families and easier working conditions for care teams.

Nicole DeFazio is an interior designer based in Stantec’s Pittsburgh, Pa., office. She implements creative ideas, provides guidance, and offers sustainable designs to healthcare clients resulting in spaces that inspire and comfort patients, visitors, and the care team.

Basel Jurdy is the discipline lead for acoustics & vibration based in Stantec’s Seattle office. He educates the client and project team on the art and science behind acoustics to find the right acoustical solution for each individual project.

Lauren MacLeod is a lighting designer based in Stantec’s Seattle office. She knows light can affect well-being (good and bad) and combines research findings, technical knowledge, and sensitive design techniques to create lighting scenarios that benefit occupants.