This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Change history
25 March 2024
A Correction to this paper has been published: https://doi.org/10.1038/s41372-024-01908-4
References
Committee on Perinatal Health. Toward improving the outcome of pregnancy. recommendations for the regional development of maternal and perinatal services. White Plains, NY: The National Foundation—March of Dimes; 1976.
American Academy of Pediatrics/American College of Obstetricians and Gynecologists. Guidelines for perinatal care, 8th ed. Elk Grove Village, IL/Washington, DC: American Academy of Pediatrics/American College of Obstetricians and Gynecologists; 2017.
Facilities Guidelines Institute. Guidelines for design and construction of hospital and health care facilities. Dallas, TX: Facilities Guidelines Institute; 2022.
Klemming S, Lilliesköld S, Arwehed S, Jonas W, Lehtonen L, Westrup, B. Mother-newborn couplet care: nordic experiences of organization, models and practice. J Perinatol. 2023; 43 (in press).
American National Standards Institute. Lighting for hospitals and health care facilities, RP29-16. New York: American National Standards Institute; 2016.
AST guideline for best practices in laser safety 2019. Available from http://www.ast.org/uploadedFiles/Main_Site/Content/About_Us/Standard%20Laser%20Safety.pdf.
National Fire Protection Association. NFPA 99: Health Care Facilities Code, 2018 ed. National Fire Protection Association; 2018.
ADA Pediatric Nutrition Practice Group. Infant feedings: guidelines for preparation of human milk and formula in health care facilities, 3rd ed. Academy of Nutrition and Dietetics; 2018.
DiLaura DL, Houser KW, Mistrick RG, eds. The lighting handbook. 10th ed. 2011, New York, NY: Illuminating Engineering Society; 2011.
Harris D. Surface finish materials: considerations for the Neonatal Intensive Care Unit (NICU). Newborn Infant Nurs Rev. 2016;16:203–7.
Sehulster L, Chinn RYW. Guidelines for environmental infection control in health-care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). United States: American Society for Healthcare Engineering/American Hospital Association; 2003. Updated 2019.
Harris DD, Shepley MM, White RD, Kolberg KJS, Harrell J. The impact of single family room design on patients and caregivers: executive summary. J Perinatol. 2006;26:S38–48.
Unified Facilities Criteria (UFC). Design: military medical facilities. UFC 4-510-01 Change 2, 2017. Department of Defense, Washington, DC, USA: US Army Corps of Engineers; 2017.
National Electrical Manufacturers Association. Temporal light artifacts: test methods and guidance for acceptance criteria. NEMA77-2017. Washington DC: National Electrical Manufacturers Association; 2017 .
Morag I, Ohlsson A. Cycled lighting in the intensive care unit for preterm and low birth weight infants. Cochrane Database Syst Rev. 2016;10:CD00682.
US Green Building Council. LEED 2009 for healthcare, new construction and major renovations. Washington DC: US Green Building Council; 2009. updated 2016.
Evans JB, Philbin MK. Facility and operations planning for quiet hospital nurseries. J Perinatol. 2000;20:S105–12.
Morris BH, Philbin MK, Bose C. Physiologic effects of sound on the newborn. J Perinatol. 2000;20:S55–60.
Gray L, Philbin MK. Effects of the neonatal intensive care unit on auditory attention and distraction. Clin Perinatol. 2004;31:243–60.
Health Quality Council of Alberta. Healthcare facility mock-up evaluation guidelines: Using simulation to optimize return on investment for quality and patient safety. Calgary, Alberta, Canada: Health Quality Council of Alberta; October 2020. Available from: https://hqca.ca/wp-content/uploads/2020/10/Healthcare-facility-mock-up-evaluation-guidelines-FINAL.pdf.
Funding
The acoustic terms defined in the Glossary are defined in conceptually although not technically accurate language. Technically precise definitions can be found in official documents and professional textbooks.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Valuable technical assistance to the committee was also provided by Mark Rea, PhD and Jack Evans, PE.
The original online version of this article was revised: The author group has been corrected.
Glossary
- Adult sleep areas
-
Rooms designated for parent or staff sleep or rest.
- Ambient lighting
-
The continuous “background” illumination for a specified area.
- Ambient temperature
-
Thermal measurement of the generalized space around the neonate. Usually refers to room temperature.
- Backsplash
-
A vertical, protective surface located behind a sink or counter.
- Biohazardous
-
Refers to human tissue, cells, body fluids, or culture materials that may contain infectious or other hazardous materials.
- Cabinetry
-
Box-like furniture constructed for storage; could consist of drawers, counters, or shelves.
- Casework
-
The components that make up a cabinet.
- Clear floor space
-
The space available for functional use excludes other defined spaces (e.g., plumbing fixtures, anterooms, vestibules, toilet rooms, closets, lockers, wardrobes, fixed-based cabinets, and wall-hung counters).
- Cubicle
-
Space enclosed on multiple sides with full height or partial partitions with at least one opening without a door.
- External windows
-
Windows are located on the exterior skin of a building, looking outside the building or into courtyards.
- Flicker
-
A relative measure of the cyclic variation in output of a light source (percent modulation). It is given by the expression 100% x [(A – B)/(A + B)] where A is the maximum and B is the minimum output during a single cycle.
- Hands-free handwashing station
-
An area that provides a free-standing sink, meets all handwashing station requirements described in Standard 10, such as space for cleaning agents and drying capability, and in addition, is operable without the use of hands.
- Infant bed
-
Furniture or equipment used to hold an infant.
- Infant room
-
Contains the infant space.
- Infant space
-
The area surrounding the infant bed contains all support equipment and furniture.
- Luminaire
-
A complete lighting unit consisting of a lamp or lamps and the parts designed to distribute the light, to position and protect the lamp(s), and to connect the lamp(s) to the power supply. (Also referred to as fixture.)
- Noise
-
Noise is unwanted, interfering, and/or harmful sound.
- Non-public service corridors
-
Designated traffic pathways that are restricted to staff use for staff access and patient or material transport.
- Parent–infant rooms
-
Separate rooms in or adjacent to the NICU are designed for parents to room in with their infants during some portion of the NICU stay. These rooms include infant care space, parent sleeping space, and facilities as described in Standard 16.
- Persistent bioaccumulative toxins
-
Persistent bioaccumulative toxins (PBTs) are substances that transfer easily among air, water, and land and are stored in fatty tissue. As a consequence, they accumulate or magnify in the food chain, and also span generations. Effects on human health range from eye, nose, and throat irritation to organ and nervous system damage to cancer.
- Positive distractions
-
Sensory experiences which enable an individual to focus on psychologically supportive and compelling stimuli. These stimuli are intended to divert attention from negative experiences. Positive distractions should be culturally- and age-appropriate and could range from nature and art to video games and music.
- Room
-
Space enclosed with full-height partitions or walls equipped with a door.
- Single-family rooms
-
Rooms within the NICU are analogous to private patient rooms elsewhere in the hospital that are designed to provide for the care of one or more infants from a single family. These rooms have the usual provisions for infant care as well as space for family members to stay at the bedside or in the room for extended periods of time. A sleeping area for family members is often provided within these rooms, but may also be situated immediately adjacent to them, or elsewhere in the NICU or hospital.
- Volatile organic compounds
-
Volatile organic compounds (VOCs) are the primary source of indoor air pollution and are measured as organic gases. VOCs such as formaldehyde and urethane are released from products during use and often are found in pressed wood products and household products including paint and wood preservatives. Importantly, the EPA reports that levels of VOCs average 2–5 times higher in indoor environments than outdoors. Health effects are directly related to the amount of exposure, but range from allergies to nervous system disorders to cancer.
- Allowable sound level criteria, noise criteria (NC), and room criteria (RC)
-
Sound levels can be measured over the entire spectrum of audible frequencies. For some technical purposes (e.g., spaces in which verbal communication is important) the spectrum can be divided into smaller frequency spans, such as octaves or specific narrow bandwidths. Background noise within a room is often measured in octave bands for comparison with a family of smooth, balanced curves, called noise criteria (NC) or room criteria (RC). This criteria system is used for the design and validation of building spaces because it is more descriptive than a single number such as dB or dBA, which does not carry enough information to distinguish between a pure tone, a balanced spectrum, or a sound dominated by lower or higher frequencies.
- Areas in open acoustic communication
-
Areas without a barrier wall or an operable door between them or areas separated by a door that is intended to remain open most of the time.
- Background or facility noise
-
Background or facility noise: Background noise refers to the continuous ambient sound in space due to the mechanical and electrical systems of the facility or building itself and to permanent equipment. Background noise is produced by sources outside the building and by the building’s own heating, ventilation, and air-conditioning systems, vacuum tube systems, elevators, plumbing, automatic doors, etc. Because occupant-generated noise will add to the “noise floor” or background noise of the building, allowable background level criteria are set low enough to prevent annoyance, reduced speech intelligibility, sleep disturbance, or other disturbances after the building is occupied.
- CAC (ceiling articulation class)
-
Rates a ceiling’s efficiency as a barrier to airborne sound transmission between adjacent closed offices [rooms]. Shown as a minimum value, previously expressed as CSTC (ceiling sound transmission class). A single-figure rating derived from the normalized ceiling attenuation values in accordance with classification ASTM E413, except that the resultant rating shall be a designated ceiling attenuation class. (Defined in ASTM E 1414). An acoustical unit with a high CAC may have allowed NRC. (cited from www.armstrong.com).
- Ceiling plenum
-
The area between the finished ceiling and the underside of the structure above, often used for ductwork, electrical wiring, plumbing pipes, etc. as well as for recessed ceiling lights.
- Demising partitions
-
A “demising” assembly, partition, floor, ceiling, etc. is one that separates the space of one occupant or department from that of another, or from a corridor. Partitions within an occupant or department space are non-demising partitions. For example, the wall between two patient rooms is demising, but the partition within a patient room that encloses the bathroom for that room is non-demising. Likewise, the wall between one office suite and another is a demising wall, but the walls within the suite itself are non-demising. The wall between a mechanical or electrical equipment room and any occupied space is a demising wall. In a residential apartment building, the partition between the two units is demising, but the partitions between rooms within the same apartment are not demising.
- Facility vs. operational noise
-
Exterior sources (e.g., street traffic and outdoor building mechanical equipment) and interior sources (e.g., air conditioning and exhaust systems) generate facility noise. It exists in the empty building as it is constructed. The people and equipment that occupy the building generate operational noise.
- Operational noise
-
Operational noise is generated by people and equipment that occupy the building and are separable from the building. A general rule of thumb states that occupants and their equipment will add about 10 dBA to background noise. However, this generalization does not apply to all room uses. For example, two or three people in an office environment with a 45–55 dBA background might add about 10 dBA, but the same group in a quiet conference room with a 35–45 dBA background might add 20 dBA. A large group of people might add 40 dBA. In intensive care units with hard surfaces, close spacing of patient beds, and large amounts of staff and equipment the occupied room noise may be 20 dBA or more above the background with brief excursions well above that.
- Occupant-produced noise
-
Occupant noise is not under the control of architects and engineers but can be incorporated as a design parameter through the use of a matching architectural requirement (e.g., wall and ceiling absorption criteria). Control of occupant-produced noise lies primarily in the realm of quality assurance programs and hospital management.
- Permanent equipment
-
Large equipment that is necessary for essential functions of the NICU and that is rarely replaced. Such equipment includes refrigerators, freezers, ice machines, and mechanical/electrical storage systems for supplies and medication. Permanent equipment is distinct from medical equipment used for direct patient care.
- Reflective and absorptive surfaces: Noise reduction coefficient (NRC)
-
Within any closed space, sound levels are affected by reflections of soundwaves from surfaces. When the surfaces are predominantly hard, sound pressure builds up in the space, increasing the original level with reverberation. Conversely, when the surfaces are soft or acoustically absorptive, reflected energy is reduced and sound pressure does not build up. Acoustically absorptive surface materials are rated by a noise reduction coefficient (NRC), which is an average of absorption coefficients in the middle range of the audible spectrum of sound frequencies. Although an oversimplification, the NRC rating of a material can be thought of as the percentage of sound energy absorbed. If the NRC of a wall panel, for example, is 0.65, about 65% of the sound energy of a source is absorbed and about 35% reflected back into the room.
- Speech privacy
-
“Methods used to render speech unintelligible to the casual listener.” This definition embodies two key concepts: (a) the measurement of intelligibility/unintelligibility, which is a practice familiar to five generations of acoustics professionals since the first work done on the Articulation Index in the 1940’s by Leo Beranek and others; and (b) the viewpoint of the “casual listener.” That is, this definition of speech privacy does not cover intentional or assisted listening (quoted from the webpage of the American National Standards Institute (ANSI), and the Glossary of American National Standard T.1–523–2001, a standard maintained by the U.S. Department of Commerce, National Telecommunications and Information Administration, Information Security program (INFOSEC).)
- Vibration
-
Vibration is perceptible to humans at a certain magnitude or level and can cause discomfort or annoyance. Larger magnitudes of vibration can cause the rattling of lightweight building elements, superficial cracking in partitions, or even structural damage. Very small magnitudes of vibration not perceptible to humans can disturb high-magnification optical microscopes or very sensitive electronic equipment. Sources of vibration common in hospitals are helicopter flyovers and landings/take-offs, magnetic resonance imagers, sound systems, and heavy trucks. Buildings can be constructed to prevent the propagation of vibration through the building.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Altimier, L., Barton, S.A., Bender, J. et al. Recommended standards for newborn ICU design. J Perinatol 43 (Suppl 1), 2–16 (2023). https://doi.org/10.1038/s41372-023-01784-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41372-023-01784-4
This article is cited by
-
Mother-newborn couplet care: Nordic country experiences of organization, models and practice
Journal of Perinatology (2023)
