Nicu lighting design handout

NICU Lighting: Copyright

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NICU LIGHTING: SUPPORTING HEALTH, COMFORT AND WELL-BEING FOR NEWBORNS, FAMILY AND

STAFF THROUGH LIGHTING DESIGN.

Lighting Design Content by Visa Lighting

www.visalighting.com

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NICU Lighting: Description

Course Description The growth and development of our children is extremely important at any age. At birth our eyes are still developing and will continue to change throughout our lives. Special care to lighting and the surrounding environment is an essential part of a NICU design. This course will go over the needs of an appropriate NICU lighting design as well as future design trends. We’ll review the body’s photo biological response to daylight and our 24 hour clocks as well as the visual lighting spectrum and how to apply it.

Learning Objectives At the end of this course participants will be able to: 1. Discuss the body’s biological and psychological

responses to light. 2. Analyze a neonate’s eye development and the

importance of a responsive lighting design. 3. Identify key lighting sources and how to apply them

when designing. 4. Review NICU lighting design trends, zones and

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NICU Lighting: Objectives

NICU LIGHTING: PHOTOBIOLOGY OVERVIEW

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Circadian Rhythm What is it and what does it mean to us? •24 Hour Cycle that is built in to any living being – plants & animals •The cycle can be modulated by external cues such as sunlight and temperature •Determines sleep and feeding patterns •Brain wave activity and Hormone production •Cell Regeneration and other Biological activities

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NICU Lighting: Photobiology Overview

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NICU Lighting: Photobiology Overview Circadian Rhythms & Lighting

How can lighting support a 24 hour routine? •Electric light should mimic the outdoors and a typical day •Brighter lighting during the day to keep us awake •Dimmer lighting at night that will promote normal sleep

Where this gets hard •Shift Workers •Nurse Stations •Seasonal Changes

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NICU Lighting: Photobiology Overview Circadian Rhythms & Lighting

NICU Lighting •Day/Night cycled lighting in NICUs - Increased weight gain, earlier initiation of oral feedings, decreased number of days on the ventilator and under phototherapy, and enhanced motor condition •Reducing light levels in NICUs – leads to lower respiratory rates, reduced time on mechanical ventilation and oxygen support and lower activity levels

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Daylighting •Rooms with windows when possible to have views to nature •Daylighting should be readily accessible to all patients, families and staff in a healthcare setting •Sunlight gives Vitamin D which supports our bodily functions and bone structure

•Glare and heat gain need to be considered •Reflections from windows or skylights can be uncomfortable and harmful if not designed correctly •Utilize shades and controls when possible

NICU LIGHTING: PHOTOBIOLOGY OVERVIEW

NICU LIGHTING: INFANT EYE DEVELOPMENT AND LIGHTING CONSIDERATIONS

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Parts of The Eye


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The Developing Eye •Pupil – Controls the amount of Light entering the eye

•It takes two weeks for the pupils to enlarge and start to see a range of light and dark images in a newborn

•Retina –Light sensitive tissue that converts light into electric impulses

•As this develops the ability to see and recognize pattern improves

•Macula– Area of the Retina used for central vision •Not fully developed until Age 4

•Eyelids – Can be thin in premature Infants •Decreased ability to constrict and control light exposure


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Eye Development Process A baby's First year of life

•0-3 Months •Babies can not focus more than 8-10 inches from their face, sensitive to bright light

•High Contrast Images like their mothers eyes/face begin to attract attention in the early weeks •Eyes may wander or look crossed as they learn how to coordinate and focus •Eye hand coordination begins and they start reaching out towards objects

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•5-8 Months

•Control of eye movement and eye-body coordination skills improve •Eyes begin to see depth and are working together •Begin to have good color vision, will see red first •Crawling begins, aids in eye-hand-foot body coordination

NICU Lighting: Infant Eye Development and

Lighting Considerations

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•9-12 Months

•Babies should be using their eyes and hands together •They will begin to pull themselves up to a standing position •Should be able to grasp objects with their thumb and forefinger •Crawling before walking encourages eye-hand coordination •Babies can now judge distances fairly well and throw

NICU Lighting: Infant Eye Development and

Lighting Considerations


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Damaging Effects of Bright Light •Excessive Stimulation – Amount and sudden change of light can be stressful •Bright light can increase heart and respiratory rates and decrease oxygen saturations •Eye exams with opthalmoscopes as well as pupil dilatation increases sensitivity to light •Retinopathy of Prematurity (ROP) – Occurs in premature infants when there is abnormal blood vessel development in the Retina

•Lighting should accommodate for sensitive eyes in this case, especially in ROP patients

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NICU Lighting: Lighting Overview

NICU LIGHTING: LIGHTING OVERVIEW

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Electromagnetic Spectrum Lighting • Surfaces are properly perceived only when they reflect specific

amounts of light of certain wavelengths • Correct color information will reach the observer only if the

illuminance is balanced (i.e. sufficient blue, green, and red components)

• It is important to use sources with adequate blue-to-yellow spectral power in spaces where patients are being observed

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Visual Spectrum

NICU Lighting: Lighting Overview


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Visual Spectrum How could this affect newborns? • Cyanosis – The appearance of blue or purple coloration of

the skin or mucous membranes due to the tissues near the skin surface having low oxygen saturation

• Jaundice – A yellowish pigmentaion of the skin and whites of the eyes caused by excess bilirubin in the blood. Occurs when bilirubin(breakdown of red blood cells) builds up faster than a newborn’s liver can break it down and pass through the body.


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CRI (Color Rendering Index) •A light sources ability to accurately render all colors of their spectrum, in a scale from 0-100. Daylight = CRI 100


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Color Temperature •A method of describing the color characteristics of light, usually either warm or cool and measuring in degrees of Kelvin (°K)


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Lamp types •Incandescent – Warm inviting quality. High CRI so complimenting to skin tones and is psychologically appealing. •Halogen – A variation of incandescent. More energy efficient, cooler light. Renders colors well •Fluorescent – Multiple color temperatures, good for lighting large spaces. Longer lasting than incandescent. Color rendering not as good as incandescent. •LED – Light Emitting Diode. Longest lamp life of any source. Energy efficient. Can come in multiple color temperatures and CRI levels.


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Amber/Red Wavelengths •Gives enough light to see and is comparable to incandescent lighting.


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Blue Light •Keeps us awake and alert by suppressing the production of melatonin, the hormone needed for sleep


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Phototherapy •The process of using light to eliminate bilirubin in the blood (in the case of Jaundice treatment). A baby’s skin and blood absorb the light waves. Then changes bilirubin into products instead of pigment, that can be eliminated. •Phototherapy light emits in the 430-490 nm spectrum


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Ultraviolet •Short-wave ultraviolet radiation can be used to kill bacteria and control the spread of infection in a healthcare environment.


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Finishes •Room finishes will absorb or impact light levels •An intended amount of light level in a room with darker finishes will not produce the same as a room with lighter/cooler finishes •Interior Designers and Lighting Designers need to work together to achieve the correct balance •Reduce glossiness when specifying finishes, pay close attention to room reflectance's and glare control

NICU LIGHTING: DESIGN

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NICU: Neonatal Intensive Care Unit Areas of a hospital specializing in the care of ill or premature newborn infants Lighting Zones “Three layers of lights”

• Patient • Family • Nurse/Caregiver


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Infant Patient Lighting •Separate procedure lighting of 200FC needed for exam •Indirect ambient lighting in patient area, dimmable (3500K) •1-60 FC as needed measured at bedside for general lighting •FLR or LED sources with CRI of 80+ •Controls that allow immediate darkening at any bed position for transillumination •Amber nightlight


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Family •Warm, comforting light that resembles home (3000K) •Task lighting for reading during the day or night •Dimmable lighting for night time and sleep •Amber room nightlight for night time observation and trips to the restroom •Shade and window controls can tie into lighting


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Nurse •Controls at room entry and bedside. Should allow for immediate on/off as needed •Separate procedure lighting of 200FC needed for exam •Task Lighting at 35FC< •Nurse Stations should have dimmable light to maintain circadian rhythms and help with adaptation


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Clean and Accessible Surfaces •Lighting Fixtures shall not promote dust collection •Materials should permit cleaning without the use of chemicals that may be hazardous, as it may not be possible to vacate the space during cleaning •Fixtures should be sealed with no areas for dust collection and be able to be easily wiped down •Ceiling/Lighting access from below the plenum •Hospital Acquired Infection is the greatest cause of death and sickness in the NICU


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Lighting Power Density and Codes ASHRAE 90.1 2010 •Building Area Method

•Hospitals – 1.21 W/SqFt •Space by Space Method

•Exam/Treatment – 1.66 W/SqFt •Nursery – .88 W/SqFt •Patient Room - .62 W/SqFt

•Exceptions •Patient care areas do not require an automatic control device or Procedure lighting to be accounted for in LPD

Questions:

Please contact Visa Lighting with questions.

Visa Lighting (201) 245-5500

Lauren Roberts, LC, IES Healthcare Development Manager [email protected]

Visa Lighting (801) 448-2126

Kathleen Packard, LC, EDAC Healthcare Development Manager [email protected]

