CIMIT FORUM AGENDA
Simulation and
November 27, 2007
4:00 – 6:00 PM
Technology requirements in the NICU of the Future: A First look at Light
and Sound
The physiological, sensory and
neurological systems of premature and ill neonates are particularly susceptible
to their environment. Designing the “NICU of the Future” (NICUF) as a state of
the art neonatal intensive care unit will need to combine cutting edge
technology, noninvasive monitoring and testing and include a living laboratory
in which to further the understanding and treatment of newborn diseases
processes. Join in a discussion on light and sound, a first in a series of
discussions on technology requirements in the NICU.
Moderator:
Janice Crosby, RN, MBA,
Director, Business Development, CIMIT, jecrosby@partners.org
NICU of the
Future Project, Children’s Hospital Boston: Current Challenges and Future Goals
Stella
Kourembanas, MD, Chief, Division of Newborn Medicine, Children’s
Hospital Boston; Clement A. Smith Associate Professor of Pediatrics, Harvard
Medical School, Stella.Kourembanas@childrens.harvard.edu
With
the help of CIMIT, Children’s Hospital Boston is in the process of creating a
neonatal intensive care unit (NICU) of the future that will employ cutting-edge
technology, that will use non-invasive monitoring systems, and that will be a
living laboratory in which doctors can simultaneously study and treat
disease. Children’s Hospital Boston is
already a major research and training center, and it is positioned to continue
to be a leader in the field of neonatal care.
The
NICU of the future must be specially designed to deal with the needs of
premature infants. Currently, 12.5% of
infants are born pre-term (before 37 weeks), and for reasons that are unclear,
this percentage is rising. The annual
cost of prematurity in the United States, considering hospital costs and lost
parental productivity, is estimated to be about $26 billion, and it is clear
that prematurity places infants at high risk for infection, malnutrition, and
long-term neurological injury. Future research will hopefully lead to improved
long-term outcomes for premature infants and to a lower rate of prematurity.
The NICU of the future must care for a
unique population that will present many challenges. Both premature and full-term infants will
receive care in the NICU, meaning that the space must be equipped to meet a
variety of needs. Patients and families
must have privacy, and the architectural layout of the NICU must be designed to
minimize infection. The lighting must be
acceptable to staff while being healthy for infants, and noise from beepers and
alarms must be carefully controlled.
Hopefully, the NICU of the future will be family-oriented yet
staff-friendly and will be streamlined yet able to evolve with new technology.
NICU of the
Future, Sound and Light
Anne Hansen, MD, MPH, Director, Neonatal Intensive Care Unit,
Children’s Hospital Boston; Assistant Professor of Pediatrics, Harvard Medical
School, Anne.Hansen@childrens.harvard.edu
Sound
and light must be carefully considered when designing any hospital space, and
these factors are particularly important to the design of a NICU. The architecture of any inpatient area must
allow patients or family members to have private conversations without being
overheard by those nearby. Disruptive
and potentially worrisome noises from beepers, phones, and alarms should be
kept to a minimum so that patients can relax, rest, and recuperate. Light should be cycled in a natural manner to
prevent patients from developing disturbances in their day-night rhythms, for
such disturbances are inimical to sleep, growth, and healing.
In
the NICU, sound and light are especially important. At the beginning of the third trimester,
infants gain the ability to respond to sound and light. In the womb, sound is damped, but in the
NICU, infants are routinely exposed to significant noise. Loud noises have been shown to lead to
decreased oxygen saturation in babies, and premature infants are very
susceptible to hearing loss. In the
NICU, it is recommended that ambient noise be kept below 50 decibels (dB), but
in practice, the noise level is almost always much higher. To solve this problem, incubators should be
made out of sound-muffling material, and other equipment in the NICU should be
made quieter. Most NICU’s across the country
are also much brighter than is recommended.
Bright lights cause lowered oxygen saturation and poor weight gain for
infants. Premature babies should ideally
be exposed to as little light as possible, to mimic the environment of the
womb. In the NICU of the future, sound
and light will be controlled so that the environment is as healthy as possible
for infants.
Noise in the
Clinical Environment: Sources, Effects, and Solutions
Jonathan D Kemp, PhD, Director of Engineering, Cambridge Sound
Management, LLC, jdkemp@csmqt.com
Noise
levels in hospitals have doubled in the last thirty years, and although the
recommended noise level for a NICU is 45 to 50 dB, the actual noise level
inside an incubator usually ranges from 56 to 72 dB. In addition to high levels of background
noise, intermittent noises are also a serious problem because these noises
cause an infant to show signs of stress such as an increased heart rate,
increased blood pressure, and decreased oxygen saturation. A loud environment in the NICU also harms
infants indirectly by causing caregivers to lose focus and to become fatigued
and irritable.
Noise
in the NICU can be reduced in a variety of ways. In terms of architecture, it is helpful to
think about the ABC’s – “absorbing,
blocking, and covering.” The materials
used in the walls, floors, and ceilings influence how sound propagates in a
space. Physical barriers such as walls
can block sound while providing privacy to patients, and background building
noise can be used to cover, or mask, disruptive noises and conversations. Equipment changes could also reduce noise
levels. Using light-based or remote
alarms in place of more traditional alarms would help babies sleep more
peacefully and would help reduce the anxiety of families. Changing the material of incubators could
help muffle sound inside them. Finally,
changing patterns of staff-to-staff communication, either in terms of location
or equipment, could reduce noise.
As
one thinks about the NICU of the future, it is important to remember that the
noise level should be not be greater than 50 dB, that wearable noise-blocking
devices are not the answer, and that the noise-related needs of infants change
with age.
5:00PM Panel
Discussion to include participants above and Paula Buick,
RN MBA, Medical Planner, Payette, Boston, pbuick@payette.com, and Patricia
Hickey, RN, MS, MBA, CNAA, Children’s
Hospital, Patricia.Hickey@childrens.harvard.edu
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