Intensive Care Unit Built Environments: A Comprehensive Literature Review (2005–2020)

Abstract

Background: The intensive care environment in hospitals has been the subject of significant empirical and qualitative research in the 2005–2020 period. Particular attention has been devoted to the role of infection control, family engagement, staff performance, and the built environment ramifications of the recent COVID-19 global pandemic. A comprehensive review of this literature is reported summarizing recent advancements in this rapidly expanding body of knowledge. Purpose and Aim: This comprehensive review conceptually structures the recent medical intensive care literature to provide conceptual clarity and identify current priorities and future evidence-based research and design priorities. Method and Result: Each source reviewed was classified as one of the five types—opinion pieces/essays, cross-sectional empirical investigations, nonrandomized comparative investigations, randomized studies, and policy review essays—and into nine content categories: nature engagement and outdoor views; family accommodations; intensive care unit (ICU), neonatal ICU, and pediatric ICU spatial configuration and amenity; noise considerations; artificial and natural lighting; patient safety and infection control; portable critical care field hospitals and disaster mitigation facilities including COVID-19; ecological sustainability; and recent planning and design trends and prognostications. Conclusions: Among the findings embodied in the 135 literature sources reviewed, single-bed ICU rooms have increasingly become the norm; family engagement in the ICU experience has increased; acknowledgment of the therapeutic role of staff amenities; exposure to nature, view, and natural daylight has increased; the importance of ecological sustainability; and pandemic concerns have increased significantly in the wake of the coronavirus pandemic. Discussion of the results of this comprehensive review includes topics noticeably overlooked or underinvestigated in the 2005–2020 period and priorities for future research.

Newborn Incubators Do Not Protect from High Noise Levels in the Neonatal Intensive Care Unit and Are Relevant Noise Sources by Themselves

“…Since familycentered care increases interaction between parents and staff, the communication has to be properly dosed in order to provide rest and recreation for neighboring families. A recent review of intensive care unit built environments addresses this problem [15]. Studies suggest that parental vocal qualities are commonly adapted to their infants' behavioral state [66], which is why an attenuation of either the infants' state and/or the parental voice by the noisy environment and/or incubator possibly impairs proper interaction.…”

“…From a structured literature research using the databases Pubmed, EMBASE, and Web of Science in July 2021, 500 reports on "noise and NICU" could be retrieved (Appendix A). These publications demonstrate that noise impacts on newborns, parents and the staff [13][14][15][16][17]. They often either focus on the reduction of noise [13,18] or at the enrichment of the acoustic environment [19,20].…”

The role of the built environment in updating design requirements in the post-pandemic scenario: a case study of selected diagnostic facilities in Brazil

“…Figure 4 highlights the most frequently contaminated surfaces (considering the frequency of related results, not the number of contaminated surfaces). Other high contamination rates were related to electronic equipment (mobile phones, personal computers, tablets and other personal items) (Jerry, O'Regan, O'Sullivan, Lynch, & Brady, 2020;Noorimotlagh, Jaafarzadeh, Martínez, & Mirzaee, 2021;Peyrony et al, 2020;Santarpia et al, 2020;Vicente et al, 2021), medical equipment surfaces (such as ventilators, monitors, and X-ray devices) (6; 13%) (Gordon et al, 2021;Liu et al, 2020;Santarpia et al, 2020;Verderber, Gray, Suresh-Kumar, Kercz, & Parshuram, 2021;Wu et al, 2020), patient bed rails (5; 11%) (Chan et al, 2020;Jerry et al, 2020;Santarpia et al, 2020;Vicente et al, 2021;Wu et al, 2020) and floors (5; 11%) (Dargahi et al, 2021;Jerry et al, 2020;Passos et al, 2021;Peyrony et al, 2020;Redmond et al, 2021).…”

“…We also verified the importance of promoting wellness for patients and medical staff to reduce stress and anxiety. Considering that, the most frequent recommendations were engaging with nature (4; 37%) (Brambilla, Rebecchi, & Capolongo, 2019;Gola et al, 2020;Verderber et al, 2021;Wang, 2021), providing daylight and quality views to the outdoors (3; 27%) (Capolongo et al, 2020;Verderber et al, 2021;Wang, 2021), acoustic comfort (Capolongo et al, 2020;Gola et al, 2020;Verderber et al, 2021) and spacial configurations that promote privacy and family engagement (Verderber et al, 2021) (Figure 7).…”

“…As design requisites, HBEs incorporate several concepts of biophilia (Abdelaal & Soebarto, 2018;Mazuch, 2017) by providing nature environment stimuli in the built environment. Some of the design strategies may include sensorial richness, specification of natural finishes, offering contact with nature (gardens, plants, view windows, and water fountains) (Brambilla et al, 2019;Verderber et al, 2021;Wang, 2021). In addition, interpersonal distance (Redmond et al, 2021;Zhou & Ji, 2021).…”