NICU Standard 16: Support Space for Ancillary Services

Distinct support space shall be provided for all clinical services that are routinely performed in the NICU.

Counseling Space:  A minimum of one dedicated space shall be provided within the NICU to support counseling services for families and staff.  Rooms shall be sized to accommodate a minimum of three adults and an infant bed. This space shall have access from family and staff areas and provide acoustic and visual privacy.  Furnishings shall include comfortable seating.

Interpretation:  The emotional and psychological challenges for families and staff in the NICU setting are extensive.  Space should be provided for the counseling support of these populations; in larger units, this may require the designation of two or more rooms.  This space can be used for related counseling needs such as private space for interaction between families and social workers, and grieving spaces.  Additional space for more family members might be appropriate. Consider the provision of oxygen and vacuum outlets if the presence of the baby in the room is desired.  If the space is used frequently, consider separate rooms for staff and families. Staff should be aware that this space is dedicated to counseling and not to be used for other purposes such as staff meetings and storage. A visual system to indicate when the room is in use is recommended, as well as adequate soundproofing to ensure conversations are private and the impact of outside noise is minimized.  Each unit should provide a sufficient number of counseling rooms to meet the needs for counseling and private conversations away from the bedside.

Milk Preparation:  Space for preparation and storage of human milk, formula, and additives shall be provided within the unit or other location that is away from the bedside8. When a separate room for infant feeding preparation is not merited due to infrequency of need, commercial preparation off premises or other reasons, a separate area in the food services area or in the patient unit shall be designated for infant feeding preparation.  Hospital food preparation design guidelines shall be followed.

When the functional program requires a separate room, the room shall include the following areas that can be separated in individual rooms or combined: 

(a) Ante area

(b) Preparation area

(c) Storage space for supplies, formula, and both refrigerated and frozen breast milk.

(d) Clean-up area

To minimize contamination, the ventilation system should have a minimum filtration of 90% based on the American Society of Heating, Ventilation and Air Conditioning Engineers standards or have a HEPA forced air filtration system.  

Provisions shall be included for human milk storage. Human milk may be stored in a designated space in the infant feeding preparation room, and in designated spaces on the patient unit. If the refrigerator or freezer is located in the infant space or a hallway, the condenser noise shall not exceed 40 dBA. 

Interpretation:  Ancillary services such as (but not necessarily limited to) respiratory therapy, laboratory, pharmacy, radiology, developmental therapy, and specialized feeding preparation are common in the NICU. Distance, size, and access are important considerations when designing space for each of these functions. Satellite facilities may be required to provide these services in a timely manner.

Unless performed elsewhere in the hospital, a specialized feedings preparation area or room should be provided in the NICU, away from the bedside, to permit mixing of additives to breast milk or formula.  The cleanliness of the floor surface, walls and ceilings should be easily maintained. Floor drains are not recommended unless required by local code. Adequate sinks, electrical outlets and storage should be provided based on the individual hospital facility needs. The use of a laminar flow hood is a decision that each hospital should make. Pharmacies are not required to use laminar flow hoods to prepare oral medications. Powdered formulas are not sterile, and preparing them under a laminar flow hood may not improve the sterility of the product. All water supplied for feeding preparation should meet Federal Standards for drinking water and be commercially sterile.  Commercially sterile water is preferred because it has eliminated pathogenic and other organisms, that if present, could grow in the product and produce spoilage under normal conditions of handling and storage.

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