NICU Standard 23: Ambient Lighting in Infant Care Areas

Ambient lighting levels in infant spaces shall be adjustable through a range of at least 10 to no more than 600 lux (approximately 1 to 60 foot candles), as measured on any plane at each bedside. Both natural and electric light sources shall have controls that allow immediate darkening of any bed position sufficient for transillumination when necessary.

Accurate color rendering is essential to NICU care. Luminaires used for ambient lighting shall conform to recommended fidelity (Rf) and color saturation (Rg) values as published for Medical Facilities by the Unified Facilities Criteria UFC 4-510-0113. The optical reflectors in the luminaires (light fixture) shall have a neutral finish so that the color rendering properties of the light source are maintained. The sources shall avoid unnecessary ultraviolet or infrared radiation by the use of appropriate lamps, lens, or filters9. Flicker index (FI) values for luminaires used for ambient lighting shall not exceed 0.114. Lighting fixtures shall be easily cleaned.

No direct view of the electric light source or sun shall be permitted in the infant space as described in Standard 6: this does not exclude direct procedure lighting, as described in Standard 24. Any lighting used outside the infant care area shall be located so as to avoid any infant's direct line of sight to the fixture.

Interpretation: Substantial flexibility in lighting levels is required by this standard so that the disparate needs of infants at various stages of development and at various times of day can be accommodated, as well as the needs of caregivers. In very preterm infants, there has been no demonstrable benefit to exposure to light. After 28 weeks gestation, there is some evidence that diurnally-cycled lighting has potential benefit to the infant15. Caregivers benefit from moderate levels of ambient light in order to perform tasks and maintain wakefulness.

Control of illumination should be accessible to staff and families, and capable of adjustment across the recommended range of lighting levels. Use of multiple light switches to allow different levels of illumination is one method helpful in this regard, but can pose serious difficulties when rapid darkening of the room is required to permit transillumination, so a master switch should also be provided.

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