Neonatal intensive care unit design and healthcare-associated infections: a scoping review
Pavan V. Thakkar, Natalia Josiah, Elizabeth R. Blackwood, Ganga S. Moorthy, Lakshmi Katakam, Melissa Campbell, Deverick J. Anderson, Ibukunoluwa C. KaluAbstract
Background:
Healthcare-associated infections (HAIs) contribute substantially to morbidity and mortality among hospitalized neonates. Many hospitals have transitioned from the traditional open-bay NICU layout to single-family room (SFR) designs. However, evidence regarding the association between unit design and neonatal HAI incidence or microbial colonization remains limited and inconclusive.
Objective:
We conducted a scoping review to evaluate the association between NICU design (SFR versus open-bay) and HAIs, to inform evidence-based design and infection prevention strategies.
Methods:
In February 2025, we searched MEDLINE via PubMed for studies on neonatal unit designs. We included English-language studies that directly compared HAI or colonization outcome measures between open and SFR room designs in neonatal units. We excluded studies that did not assess neonates, were based on outpatient settings or non-neonatal wards, used animal models, only focused on impact on families and/or healthcare workers or were summary statements or reviews.
Results:
Our search yielded 610 studies, of which 45 progressed to full-text review; we ultimately included 10 studies in this review all of which utilized observational designs. Eight compared outcomes before and after moving to a new ward while two compared units within the same hospital. All but three included studies were from the United States. Studies assessed a variety of infection and colonization measures, including but not limited to sepsis, catheter-associated infections, and multidrug resistant organisms, with widely varying results.
Conclusions:
The current evidence regarding the association between NICU design and HAIs is mixed and context dependent.