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Report of the Eighth Census Conference on Newborn ICU Design
Committee to Establish Recommended Standards for Newborn ICU Design
Robert D. White, MD, Chair
January 26, 2012 Clearwater Beach, FL
 
   September 18, 2012
 
 
 
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.

Brominated Flame Retardants: bromide compounds that stop or diminish fire. Brominated flame retardants (BRFs) such as polybrominated diphenyl ethers (PBDEs) are used in many products including furniture, textiles, and electronic equipment to reduce the risk of fire. When heated, BRFs produce dioxins and furans (VOCs). BRFs are persistent bioaccumulative toxins and suspected endocrine disruptors.

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 that excludes other defined spaces (e.g., plumbing fixtures, anterooms, vestibules, toilet rooms, closets, lockers, wardrobes, fixed-based cabinets, and wall-hung counters).

Color rendering index (CRI)8: A measure of the degree of color shift that objects undergo when illuminated by a lamp, compared with those same objects when illuminated by a reference source of comparable correlated color temperature (CCT). A CRI of 100 represents the maximum value. A lower CRI value indicates that some colors may appear unnatural when illuminated by the lamp. Incandescent lamps have a CRI above 95. The cool white fluorescent lamp has a CRI of 62; fluorescent lamps containing rare-earth phosphors are available with CRI values of 80 and above.

Cubicle: Space enclosed on multiple sides with full height or partial partitions with at least one opening without a door.

External windows: Windows located on the exterior skin of a building, looking outside the building or into courtyards.

Flicker10: 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.

Gamut Area Index9: GAI represents the relative separation of object colors illuminated by a light source; the greater the GAI, the greater the apparent saturation or vividness of the object colors.

Hands-Free Handwashing Station: An area that provides a freestanding sink, meets all handwashing station requirements described in Standard 11, 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 and containing 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.)

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 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 17.

Perfluorochemicals: Perfluorochemicals (PFCs) are a family of man-made chemicals used to make products that resist heat, oil, stains, grease and water. Common uses include nonstick cookware, stain-resistant carpets and fabrics, as components of fire-fighting foam, and other industrial applications. Two chemicals in the PFC group are perfluorooctane sulfonate (PFOS; C8F17SO3) and perfluorooctanoic acid (PFOA; C8F15O2H). The chemical structures of PFOS and PFOA make them extremely resistant to breakdown in the environment and they are considered to be PBTs and VOCs.

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 to human health range from eye, nose, and throat irritation to organ and nervous system damage to cancer.

Phthalate Plasticizers: Phthalates currently are not listed as PBTs because there is some evidence that fish and mammals can break these down within 24 hours of entry; however, phthalates are often volatile organic compounds and are pervasive in our environments. Phthalates are a family of chemicals used to soften plastics such as children's toys, adhesives, and floor and wall covering. In healthcare, DEHP [Di(2-ethylhexyl) phthalate] is most often used to soften PVC medical devices including IV bags and tubing, catheters, and enteral nutrition feeding bags. Phthalates also are used as fixatives in perfumes, as time-release coatings on medications, and in nail polish, to make them more flexible. AKA "plasticizers," they may be absorbed through the skin, inhaled, or ingested. They are associated with reproductive and developmental harm, suppression of the immune system, and damage to organs and the nervous system.

Polychlorinated biphenyls (PCBs): Polychlorinated biphenyls (PCBs) are mixtures of organic chemicals that are non-flammable, chemically stable, and have high insulating qualities, making them ideal in industrial and commercial applications including paints, plastics, and rubber products. PCBs are considered to be PBT substances that build up in the food chain and accumulate to levels that are harmful to environmental health and carcinogenic to humans. PCBs also can be VOCs.

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 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 outdoor. Health effects are directly related to the amount of exposure, but range from allergies to nervous system disorders to cancer.

Acoustic Terms (Disclaimer: The following terms are defined in conceptually although not technically accurate language. Technically precise definitions can be found in official documents and professional textbooks.)

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 band widths. 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 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 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 noise refers to the continuous ambient sound in a 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 disturbance 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 E 413, 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 a low 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 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 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 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, 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 sound waves 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 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.


 
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last updated September 19, 2012  Kathleen Kolberg, University of Notre Dame