Premature infants are perhaps the most vulnerable patients in a hospital, and there are multiple factors at play in care provision in neonatal intensive care units (NICUs). There is a growing interest in how the design of the NICU environment can better support the complex care needs of these small patients. The Center for Health Design’s Knowledge Repository includes several papers on these topics, including the three featured here.

While family members are involved in care for all types of patients, they often have an especially active caregiving role in the NICU. In a recent study involving interviews and observation of family and staff members, Machry and colleagues explore how the design of NICU single-family rooms supports family members as they care for their babies. 

Researchers found that family behavior generally falls into three categories: home-like behaviors, educational and collaborative behavior, and infant care. They also noticed various design factors that seem to impact family engagement. For instance, the family couch could support daily activities but also foster better family-and-staff communication at eye-level; and the related proximities of furniture, privacy curtains and outlets supported infant care.

Another study focusing on how the environment impacts user behavior in the NICU looks at design concepts that may encourage better hand-hygiene compliance among staff. Jansen and colleagues started by exploring barriers to compliance and found that most noncompliant behavior happened around the incubator, which informed the development of five prototyped dynamic lighting prompts. The researchers observed and interviewed nurses as they performed simulated caregiving tasks with the mock-ups. They found that the lighting intervention that defined an “island zone” (the space surrounding the incubator) helped staff to actively think about hand hygiene, but that staff still struggled with many competing priorities that made compliance challenging. When there are so many things going on at once in the NICU, the environment can be very stressful, and this is only further complicated by noise. 

There are many studies showing the negative impact of noise, which is especially concerning in NICUs, where there are negative consequences for infant development. A study by Arnon and colleagues examines how music therapy might reduce noise and its negative consequences. The researchers collected data including noise levels and signal-to-noise ratios (SNRs) as a music therapist played or sang lullaby-style music in the open bay NICU. When compared to an open bay without music therapy, they found that the overall average continuous noise levels were lower in the room with music. They also found better SNRs in the room with music therapy, which can be beneficial to the neurodevelopment of preterm infants. 

These studies show a variety of ways that the design of NICU patient spaces can support better outcomes for these highly sensitive patients. 

If something as simple as furniture can improve communication, or design provisions for a music therapist can lead to better infant neurodevelopment, just think how many more opportunities there are to make a difference through health care design.

Research used for this column

The following research citations from The Center for Health Design’s Knowledge Repository of health care design resources were used by the author when writing this column:

  • H. Machry et al., “Designing for Family Engagement in Neonatal ICUs: How Is the Interior Design of Single-Family Rooms Supporting Family Behaviors, from Passive to Active?,” HERD: Health Environments Research & Design Journal, 2023, in press.
  • S. J. Jansen et al., “Developing a Design-Based Concept to Improve Hand Hygiene in the Neonatal Intensive Care Unit,” Pediatric Research, 2023, in press.
  • S. Arnon et al., “Music Therapy Intervention in an Open Bay Neonatal Intensive Care Unit Room Is Associated with Less Noise and Higher Signal to Noise Ratios: A Case-Control Study,” Children, vol. 9, no. 8 (2022): 1187.

About this column

“Design Discoveries” highlights research from The Center for Health Design’s Knowledge Repository, a user-friendly library of health care design resources. This research effort is supported by the American Society for Health Care Engineering, the American Institute of Architects, the Academy of Architecture for Health Foundation and the Facility Guidelines Institute.

Melissa Piatkowski research associate, The Center for Health Design.