Academy of Architecture for Health

The following is a question from a NICU nurse. Please reply with your recommendations.              

In our new NICU addition (which will include single patient rooms), we would like to include an under-counter refrigerator in each room.  Can anyone recommend an attractive hospital-grade model, with a vent in the front, that is relatively quiet?  If so, it would be great to know what facility is currently using the model that you recommend and how they are working so far.
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Tammy Smith
Volunteer
Institute For Patient-centered Design, Inc.
Atlanta GA
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Quiet in a NICU is a beatiful thing. In my opinion you are doing the right thing with single patient rooms.

At 2:00 am in the morning there is no such thing as a "quiet refrigerator". I suggest you do not put a refrigerator in the room. No matter how quiet it is you will hear it. Also it will generate unwanted dust and become a magnet for dust just like the one in your kitchen does. The small inconvience of having to go out of the room for refreshment is offset by the benefits of not having the refrigerator in the room.

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Russell Redman AIA
Pope Architects, Inc.
Saint Paul MN
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Pamela Deatherage AIA
Kinslow, Keith & Todd, Inc.
Tulsa OK
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Neonatal ICU's need a refrigerator for medicinces and breast milk storage.
a small under-counter or smaller regrigerator is not for snacks and drinks.

I've had the same problem, though, on all my projects, finding an undercounter refrigerator that fits under the 34" high counter and doesn't cost 10 times a normal UC Ref.






Original Message:
Sent: 06-12-2012 09:56
From: Russell Redman
Subject: Refrigerators in Single Patient NICU Rooms

Quiet in a NICU is a beatiful thing. In my opinion you are doing the right thing with single patient rooms.

At 2:00 am in the morning there is no such thing as a "quiet refrigerator". I suggest you do not put a refrigerator in the room. No matter how quiet it is you will hear it. Also it will generate unwanted dust and become a magnet for dust just like the one in your kitchen does. The small inconvience of having to go out of the room for refreshment is offset by the benefits of not having the refrigerator in the room.

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Russell Redman AIA
Pope Architects, Inc.
Saint Paul MN
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I would ask the nurse in question what is the intended use for the frig?

Unless that frig is tied to a medication dispensing system in the patient room not sure that meds would be permitted in a stand alone frig in a patient room that was not controlled by pharmacy/nursing. Even then, you would not need anything as large as an undercounter frig. Additionally facility policy and procedures will most likely not permit the sharing the frig for any other use.

If the intended use is for holding breast milk for a single patient a cube frig shold be sufficent for that function.  If controlling sound as well as looks are legitimate concerns you may want to consider just placing the cube frig inside a cabinet behind a door in the room that family have access to.  You should be able to design a cabinet detail to deal with whatever venting situation you have.  Further when the frig needs to be replaced in the future you wont have to worry about somone in the purchasing department buying a different frig that conflicts with look, fucntion etc.  Limiting the size of the frig will also help prevent the frig for being used for other unintended purposes.

How many rooms are they doing? 
Each one of those refirgetators will need to be monitored daily for temps (BTW the nurse will need to do that), or they can get a self monitoring frig if budget is no option.

Additionally that frig will need to be cleaned and disinfected after each paitent stay which will add to room turnaround time.
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Americo Crincoli AIA
Director of Planning
Barnabas Health
West Orange NJ
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Original Message:
Sent: 06-13-2012 09:11
From: Pamela Deatherage
Subject: Refrigerators in Single Patient NICU Rooms



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Pamela Deatherage AIA
Kinslow, Keith & Todd, Inc.
Tulsa OK
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Neonatal ICU's need a refrigerator for medicinces and breast milk storage.
a small under-counter or smaller regrigerator is not for snacks and drinks.

I've had the same problem, though, on all my projects, finding an undercounter refrigerator that fits under the 34" high counter and doesn't cost 10 times a normal UC Ref.

Interesting discussion regarding NICU private rooms.  I would suggest that a neonatologist be consulted regarding ambient noise around preemies.  Since startle reflex is triggered by abrupt changes in sound levels, it would seem like a total quiet room without some level of white noise may not be the best acoustic environment.  A NICU patient room demands some level of sporadic activity 24/7 so perhaps some low level fan noise of a high quality but small refrigerator wouldn't be the worst problem in the room.   Having designed NICUs and also having been the parent of two NICU preemies myself, I've had a chance to observe activity levels all night long.  I realize not all the infants in a NICU are premature but they do account for a significant number of the patient population.  One thing that struck me is that they are coming from a relatively active acoustic environment (the mother's womb).

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Todd Hanson AIA
JSA Inc. Architects & Planners
Portsmouth NH
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Original Message:
Sent: 06-13-2012 09:11
From: Pamela Deatherage
Subject: Refrigerators in Single Patient NICU Rooms



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Pamela Deatherage AIA
Kinslow, Keith & Todd, Inc.
Tulsa OK
-------------------------------------------
Neonatal ICU's need a refrigerator for medicinces and breast milk storage.
a small under-counter or smaller regrigerator is not for snacks and drinks.

I've had the same problem, though, on all my projects, finding an undercounter refrigerator that fits under the 34" high counter and doesn't cost 10 times a normal UC Ref.