Single-patient Rooms Research Articles

Use of portable air cleaners to reduce aerosol transmission on a hospital coronavirus disease 2019 (COVID-19) ward.

To study the airflow, transmission, and clearance of aerosols in the clinical spaces of a hospital ward that had been used to care for patients with coronavirus disease 2019 (COVID-19) and to examine the impact of portable air cleaners on aerosol clearance. Observational study. A single ward of a tertiary-care public hospital in Melbourne, Australia. Glycerin-based aerosol was used as a surrogate for respiratory aerosols. The transmission of aerosols from a single patient room into corridors and a nurses' station in the ward was measured. The rate of clearance of aerosols was measured over time from the patient room, nurses' station and ward corridors with and without air cleaners [ie, portable high-efficiency particulate air (HEPA) filters]. Aerosols rapidly travelled from the patient room into other parts of the ward. Air cleaners were effective in increasing the clearance of aerosols from the air in clinical spaces and reducing their spread to other areas. With 2 small domestic air cleaners in a single patient room of a hospital ward, 99% of aerosols could be cleared within 5.5 minutes. Air cleaners may be useful in clinical spaces to help reduce the risk of acquisition of respiratory viruses that are transmitted via aerosols. They are easy to deploy and are likely to be cost-effective in a variety of healthcare settings.

Reducing Morbidity and Mortality Rates from COVID-19, Influenza and Pneumococcal Illness in Nursing Homes and Long-Term Care Facilities by Vaccination and Comprehensive Infection Control Interventions.

The COVID-19 pandemic identifies the problems of preventing respiratory illnesses in seniors, especially frail multimorbidity seniors in nursing homes and Long-Term Care Facilities (LCTFs). Medline and Embase were searched for nursing homes, long-term care facilities, respiratory tract infections, disease transmission, infection control, mortality, systematic reviews and meta-analyses. For seniors, there is strong evidence to vaccinate against influenza, SARS-CoV-2 and pneumococcal disease, and evidence is awaited for effectiveness against COVID-19 variants and when to revaccinate. There is strong evidence to promptly introduce comprehensive infection control interventions in LCFTs: no admissions from inpatient wards with COVID-19 patients; quarantine and monitor new admissions in single-patient rooms; screen residents, staff and visitors daily for temperature and symptoms; and staff work in only one home. Depending on the vaccination situation and the current risk situation, visiting restrictions and meals in the residents’ own rooms may be necessary, and reduce crowding with individual patient rooms. Regional LTCF administrators should closely monitor and provide staff and PPE resources. The CDC COVID-19 tool measures 33 infection control indicators. Hand washing, social distancing, PPE (gowns, gloves, masks, eye protection), enhanced cleaning of rooms and high-touch surfaces need comprehensive implementation while awaiting more studies at low risk of bias. Individual ventilation with HEPA filters for all patient and common rooms and hallways is needed.

Sustained Reduction of Nasal Pressure Injuries in the Neonatal Intensive Care Unit With the Use of Bubble Continuous Positive Airway Pressure: A Quality Improvement Project.

The purpose of this interprofessional team-driven quality improvement project was to implement a Bubble continuous positive airway pressure (CPAP) Skincare Protocol proactively to prevent potential device-related pressure injuries. The setting was a level 3, 60-bed single patient room neonatal intensive care unit (NICU) located within a Midwest urban academic medical center with more than 200 healthcare providers. Prior to the beginning of this project, the NICU had been using the CPAP apparatus that had documented 6 nasal pressure injuries over a 6-month period. Because of ease of use, the NICU moved to using Bubble CPAP (BCPAP), which is known to place patients at a higher risk of nasal pressure injuries due to the way the apparatus sits inside the nares. An evidence-based practice model provided the guiding framework for the development of our BCPAP Skincare Protocol. Knowing that the unit had already documented nasal pressure injuries, the interprofessional-devised protocol was developed to decrease the risk of nasal injuries with the use of BCPAP in premature infants. The protocol was disseminated via an all-healthcare provider educational program. During the first 3 months postprotocol implementation period, one stage 2 nasal injury was noted and immediately treated and healed without incident. During the next 24-month, postimplementation period, there were zero nasal pressure injuries reported. The healthcare providers found that using an interprofessional team approach in developing and implementing an evidence-based BCPAP Skincare Protocol reduced the incidence of nasal pressure injuries associated with the use of BCPAP in the NICU.

Isolation of coronavirus disease 2019 (COVID-19) patients in cohorted wards or single-patient rooms? Advantages and disadvantages.

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Candida auris Outbreak Control in Critical Care Units in a Tertiary-Care Hospital in Nairobi, Kenya

Background:Candida auris is an emerging pathogen associated with nosocomial outbreaks. During January to May 2019, 11 invasive cases of C. auris were identified in the intensive care unit (ICU) and high-dependency unit (HDU) at a hospital in Nairobi, Kenya. We report on the interventions implemented to control the outbreak. Methods: Intensified infection prevention and control (IPC) interventions were implemented. All patients infected or colonized with C. auris were placed in single-patient rooms with strict contact precautions. Cleaning of the patient care environment was enhanced by instituting a 3-step procedure of cleaning with soap and water, disinfecting with 0.5% chlorine, and rinsing with water. Glo-Germ gel was used to evaluate the cleaning processes, and percentage of missed surfaces was calculated. Hand hygiene training and compliance observations were conducted to enforce adherence to hand hygiene. The IPC team provided training and observational feedback of IPC to staff, patients, and their families. The IPC interventions were guided by screening activities. To monitor ongoing transmission, a biweekly point-prevalence survey (PPS) was performed to screen all previously negative ICU and HDU patients for C. auris. Furthermore, admission and contact screening were added to guide patient placement. Screening was conducted by collecting a composite swab from the bilateral axilla and groin. Samples were incubated in salt dulcitol broth for 5 days at 40°C then subcultured onto Sabouraud dextrose agar. Colony identification was performed using a Vitek 2 system (bioMérieux). Results: In total, 177 patients were placed in single-patient rooms under contact precautions during May–August 2019. We conducted 123 environmental cleaning observations, and the percentage of missed surfaces decreased from 71% (10 of 14) in June to 7% (1 of 16) in August. Hand hygiene compliance among ICU and HDU staff was 79% (204 of 257) in May, 71% (159 of 223) in June, 73% (170 of 233) in July, and 81% (534 of 657) in August. In total, 283 screening swabs from 234 patients were processed during May–August 2019. Overall, 18 of 88 PPS swabs (20%), 13 of 180 admission screening swabs (7%), and 0 of 15 contact screening swabs (0%) were positive for C. auris. The PPS results showed a rapid decrease in colonization: 6 of 14 (43%) in May, 12 of 54 (22%) in June, 9 of 98 (9%) in July, and 1 of 70 (2%) in August. No new C. auris infections were identified from June to October 2019. Conclusions: The control of C. auris in a hospital outbreak requires multimodal interventions, including enhanced IPC interventions, PPS, admission and contact screening for colonization, rigorous monitoring, and team effort.Funding: NoneDisclosures: None

Cohorting KPC+ Klebsiella pneumoniae (KPC-Kp)–Positive Patients—A Genomic Exposé of Cross-Colonization Hazards

Background: Long-term acute-care hospitals (LTACHs) are disproportionately burdened by multidrug-resistant organisms (MDROs) like KPC-Kp. Although cohorting KPC-Kp+ patients into rooms with other carriers can be an outbreak-control strategy and may protect negative patients from colonization, it is unclear whether cohorted patients are at unintended increased risk of cross colonization with additional KPC-Kp strains. Methods: Cohorting KPC-Kp+ patients at admission into rooms with other positive patients was part of a bundled intervention that reduced transmission in a high-prevalence LTACH. Rectal surveillance culturing for KPC-Kp was performed at the start of the study, upon admission, and biweekly thereafter, capturing 94% of patients. We evaluated whole-genome sequencing (WGS) evidence of acquisition of distinct KPC-Kp strains in a convenience sample of patients positive for KPC-Kp at study start or admission to identify plausible secondary KPC-Kp acquisitions. Results: WGS multilocus sequence type (MLST) strain variability was observed among the 452 isolates from the 254 patients colonized by KPC-Kp (Fig. 1). Among the 32 patients who were positive at the beginning of the study or admission and had a secondary isolate collected at a later date (median, 89 days apart, range, 2–310 days), 17 (53%) had secondary isolates differing by MLST from their admission isolate. Although 60% of the KPC-Kp in the study was ST258, there was substantial genomic variation within ST258 isolates from the same patient (range, 0–102 genetic variants), suggesting multiple acquisitions of distinct ST258 isolates. Among the 17 patients who imported ST258 and had ST258 isolated again later, 11 (65%) carried secondary isolates genetically closer to isolates from other importing patients than to their own ST258 (Fig. 2). Examination of spatiotemporal exposures among patients with evidence of multiple acquisitions revealed that 11 (65%) patients with multiple MLSTs shared a room with a patient who was colonized with an isolate matching the secondary MLST, and 6 (35%) patients who carried multiple distinct ST258 isolates shared a room with a patient who imported these closely related isolates prior to secondary acquisition. Conclusions: Half of patients who imported KPC-Kp and had multiple isolates available had genomically supported secondary acquisitions linked to roommates who carried the acquired strains. Although cohorting is intended to protect negative patients from acquiring MDROs, this practice may promote multiple strain acquisitions by colonized patients in the cohort, potentially prolonging the period of MDRO carriage and increasing time at risk of infection. Our findings add to the debate about single-patient rooms, which may be preferred to cohorts to minimize potential harms by reducing MDRO transmission.Funding: NoneDisclosures: None

100% Single-Patient Rooms and Environmental Contamination With Highly Resistant Microorganisms: The MOVE Study

Background: Studies have shown that patients colonized with highly resistant microorganisms (HRMO) contaminate the hospital environment, and that transmission from contaminated environments to patients occurs. In May 2018, the Erasmus MC University Medical Center, Rotterdam, moved from a hospital with mostly multiple-occupancy rooms to a new hospital with 100% single-patient rooms with private bathrooms. This move provided the unique opportunity to determine environmental contamination before the new hospital was open for admissions and thereafter and to compare the environmental contamination to the number of patients colonized with HRMO. Method: Environmental sampling took place twice in the old building and 12 times in the new building, from 2 weeks before to 15 months after relocating patients. At each moment, ~306 samples were taken from 13 locations (eg, nightstands, sinks) in 40 patient rooms. Samples were screened for Staphylococcus aureus (methicillin-susceptible [MSSA] and methicillin resistant [MRSA]) and highly resistant Pseudomonas aeruginosa, Acinetobacter baumannii, Enterococcus faecium, and Enterobacteriales. During the study period, January 1, 2018, until August 31, 2019, all clinical samples positive for HRMO were included. Results: Environmental sampling revealed that 29 of 724 (4.0%) locations were positive for HRMO in the old building, whereas 4 of 3,358 (0.1%) samples in the new building were positive for HRMO (P < .001). In the old building, 14 of 29 locations were positive for extended-spectrum β-lactamase (ESBL)–producing bacteria and 15 were positive for carbapenemase-producing bacteria. In the new building, 3 of 4 positive samples were positive for vancomycin-resistant E. faecium (VRE), 1 was positive for ESBL-producing K. pneumoniae. For both HRMO, no carriers were detected. In the old building, 145 of 12,256 adult patients (1.2%) had clinical samples positive for HRMO, compared to 561 of 38,397 (1.5%) in the new building, a small but significant increase (P = .02). Conclusions: The transition from mainly 2- and 4-person rooms to 100% single-patient rooms resulted in a significant decrease in environmental contamination, even though the number of patients colonized with HRMO slightly increased. No molecular typing to determine transfer from environment to patients and vice versa has yet been performed. Future sampling is needed to determine whether the low environmental contamination is a long-term effect of the transition to single rooms.Funding: NoneDisclosures: None

Effective Utilization of Limited Isolation Rooms to Provide Safe Patient Care and Staff Safety in a Low- and Middle-Income Country

Background: My tertiary-care hospital is a 750-bed hospital with only 17 airborne infection isolation room (AIIR) and negative-pressure rooms to isolate patients who have been diagnosed or are suspected with prevalent diseases like tuberculosis, measles, and chickenpox. On the other hand, only 14 single-patient isolation rooms are available to isolate patients with multidrug-resistant organisms (MDROs) such as CRE (carbapenum-resistant Enterobacter) or colistin-resistant MDROs. Due to the limited number of isolation rooms, the average number of hours to isolate infected patients was ~20 hours, which ultimately directly placed healthcare workers (HCWs) at risk of exposure to infected patients. Methods: Plan-Do-Study-Act (PDSA) quality improvement methodology was utilized to decrease the average number of hours to isolate infected patients and to reduce the exposure of HCWs to communicable diseases. A detailed analysis were performed to identify root causes and their effects at multiple levels. A multidisciplinary team implemented several strategies: coordination with information and technology team to place isolation alerts in the charting system; screening flyers and questions at emergency department triage; close coordination with admission and bed management office; daily morning and evening rounds by infection preventionists in the emergency department; daily morning meeting with microbiology and bed management office to intervene immediately to isolate patients in a timely way; infection preventionist on-call system (24 hours per day, 7 days per week) to provide recommendations for patient placement and cohorting of infected patients wherever possible. Results: In 1 year, a significant reduction was achieved in the number of hours to isolate infected patients, from 20 hours to 4 hours. As a result, HCW exposures to communicable diseases also decreased from 6.7 to 1.5; HCW exposures to TB decreased from 6.0 to 1.9; exposures measles decreased from 4.75 to 1.5; and exposures chickenpox decreased from 7.3 to 1.0. Significant reductions in cost incurred by the organization for the employees who were exposed to these diseases for postexposure prophylaxis also decreased, from ~Rs. 290,000 (~US$3,000) to ~Rs. 59,520 (~US$600). Conclusions: This multidisciplinary approach achieved infection prevention improvements and enhanced patient and HCW safety in a limited-resource setting.Funding: NoneDisclosures: None

Point of Care Stations: A Novel Way to Improve Stethoscope Hygiene

Background: Stethoscopes are known to be highly contaminated by a multitude of bacteria and therefore carry the potential to transmit pathogens within hospitals. North American infection prevention groups recommend low-level disinfection of stethoscopes for bioburden reduction between patients; however, adherence remains low in inpatient settings. Given that the lack of access to disinfection materials is the most commonly reported barrier to stethoscope hygiene, we studied an intervention using a point-of-care approach to increase stethoscope hygiene compliance among healthcare workers in critical care units. Methods: This quality improvement study was conducted in 2 critical-care units of a quaternary-care, academic, health sciences center in Toronto, Canada. We designed novel stethoscope hygiene stations consisting of a wall-mounted board with alcohol wipes, hooks for drying, and hand sanitizer dispensers to combine stethoscope and hand hygiene. Observations of stethoscope disinfection events per opportunity were collected by trained human auditors before and after the multimodal intervention, which consisted of the installation of 14 stations at the entrances of single-patient ICU rooms, accompanied by educational lectures and infographic dissemination. Anonymous feedback forms were used to gather information on healthcare workers’ stethoscope hygiene knowledge and behavior before and after the intervention. Results: In total, 124 observations were collected using convenience sampling between February and July 2019. Overall stethoscope hygiene compliance increased significantly from a baseline of 38% to 62% (P = .0316) (Fig. 1). Physician adherence to stethoscope disinfection increased by 22%. During the study period, hand hygiene compliance remained unchanged at 75%. Also, 74 healthcare providers completed feedback forms; they revealed an increase in awareness of stethoscope hygiene policies and/or recommendations (9% to 41%) and self reports of stethoscope hygiene compliance (28% to 44%). Conclusions: The implementation of stethoscope hygiene stations, coupled with an educational initiative, lead to a significant increase in overall stethoscope hygiene compliance among healthcare workers. Future quality improvement initiatives can adapt this strategy to promote disinfection and reduce pathogen burden of other personal and multiuse medical equipment.Funding: NoneDisclosures: Susy Hota reports contract research for Finch Therapeutics.

New York University Grossman School of Medicine.

New York University Grossman School of Medicine.

Nurses' Participation in the Design of an Intensive Care Unit: The Use of Virtual Mock-Ups.

Co-design with multiple tools is useful when end users' knowledge is important, especially when designers work with people unfamiliar with design. Many studies have highlighted the importance of nurses' participation in design, and such participation requires the development of techniques and tools to facilitate collaboration. This article analyzes how nurses participated in designing a general intensive care unit in a walk-in virtual environment (VE) and examines how their work-related knowledge can be transferred to the design process of spaces. In this action research study, the design process was conducted by using virtual mock-ups, which were evaluated by multi-occupational groups in a walk-in VE. Nurses were the largest occupational group. Their work processes were under modification, since existing multi-patient rooms were being redesigned as single-patient rooms. The design of single-patient rooms was performed in three iterative cycles in the walk-in VE. The nurses could specify their requirements in the walk-in VE, and their suggestions were incorporated into the architectural design process. The nurses were satisfied with their role in the design process. Co-design with virtual mock-ups in walk-in VE is appropriate when designing new healthcare facilities and when the opinions of workers are important. Virtual mock-ups in walk-in VE can be used collaboratively, facilitating simultaneous feedback from multiple users. Virtual reality (VR) technology has evolved, and changes can be made rapidly and at a lower cost. Another advantage of VR is that it allows one to design larger spaces, thus providing larger layouts of facilities for evaluation.

Design Models for Single Patient Rooms Tested for Patient Preferences.

Using 3D design models, this study aims to better involve patients in the design of hospitals by investigating what physical environmental characteristics in hospital patient rooms are valued by patients. There is a plea for shared-decision-making and collaborative design processes with representatives from healthcare and the construction sector based on evidence and end users’ perspectives. Existing research is hampered by poor conceptualization of environmental design factors, as these are differently operationalized between medical and technological sciences. Architects communicate through visuals, whereas medical professionals and researchers tend to communicate in words. By using 3D-modeling to research the relationship between health and well-being on the one hand, and the affordances the built environment offers, this knowledge gap can be better addressed. Two hundred four respondents, 60% patients and 40% medical professionals, engaged in discrete choice experiments visualizing a single patient room. A main finding is that patients and medical professionals consistently choose for hospital rooms with the highest amount of daylight access. What this study adds is that the orientation of the windows matters as well. Horizontal windows, allowing for a panoramic view, were twice as much chosen than were vertical windows. Another important finding concerns patients’ preferences for an open door, suggesting patients prefer to stay “connected” to the outside world. This study is important as it shows, empirically, that patients may make different choices if in research the rooms are better conceptualized and thus visualized and if multiple design features are assessed as configuration rather than using a sequential, “one-design-characteristic-after-another” approach.

Do established infection prevention and control measures prevent spread of SARS-CoV-2 to the hospital environment beyond the patient room?

SummaryThe role of the hospital environment in the transmission of infection is well described. With an emerging infection whose mode of transmission is under investigation, strict infection prevention and control measures, including patient isolation, hand hygiene, personal protective equipment that is doffed on exiting the patient room, and environmental cleaning should be implemented to prevent spread. Environmental testing demonstrated that COVID-19 patients contaminated the patient area (11/26, 42.3% of tests) but contamination of general ward areas was minimal (1/30, 3%) and the virus was detected after cleaning on one item only (1/25, 4%) which was noted to be in disrepair.

Adult cardiac surgery and the COVID-19 pandemic: Aggressive infection mitigation strategies are necessary in the operating room and surgical recovery

The COVID-19 pandemic necessitates aggressive infection mitigation strategies to reduce the risk to patients and healthcare providers. This document is intended to provide a framework for the adult cardiac surgeon to consider in this rapidly changing environment. Preoperative, intraoperative, and postoperative detailed protective measures are outlined. These are guidance recommendations during a pandemic surge to be used for all patients while local COVID-19 disease burden remains elevated.

Occupational Heterogeneity in Healthcare Workers’ Misgivings about Organizational Change

Past research on organizational change has explored how workers embrace change in some scenarios, resist it in others, and in some cases, subtly circumvent change efforts by feigning conformity. What remains unclear is the role of occupations in explaining workers’ responses to change. Using survey data ( N = 226) and in-depth interviews with workers ( N = 33) in a neonatal intensive care unit as it transitioned from a multiple-occupancy ward design to single-patient rooms, this study examines occupational discrepancies in reactions to the change. Findings reveal that misgivings about the move vary considerably across groups and illustrate the enduring significance of occupational identity.

Ethical and Legal Aspects of Ambient Intelligence in Hospitals

Ambient intelligence in hospitals is an emerging form of technology characterized by a constant awareness of activity in designated physical spaces and of the use of that awareness to assist health care workers such as physicians and nurses in delivering quality care. Recently, advances in artificial intelligence (AI) and, in particular, computer vision, the domain of AI focused on machine interpretation of visual data, have propelled broad classes of ambient intelligence applications based on continuous video capture. One important goal is for computer vision-driven ambient intelligence to serve as a constant and fatigue-free observer at the patient bedside, monitoring for deviations from intended bedside practices, such as reliable hand hygiene and central line insertions. While early studies took place in single patient rooms, more recent work has demonstrated ambient intelligence systems that can detect patient mobilization activities across 7 rooms in an ICU ward and detect hand hygiene activity across 2 wards in 2 hospitals. As computer vision–driven ambient intelligence accelerates toward a future when its capabilities will most likely be widely adopted in hospitals, it also raises new ethical and legal questions. Although some of these concerns are familiar from other health surveillance technologies, what is distinct about ambient intelligence is that the technology not only captures video data as many surveillance systems do but does so by targeting the physical spaces where sensitive patient care activities take place, and furthermore interprets the video such that the behaviors of patients, health care workers, and visitors may be constantly analyzed. This Viewpoint focuses on 3 specific concerns: (1) privacy and reidentification risk, (2) consent, and (3) liability.

Environmental contamination by carbapenem-resistant Acinetobacter baumannii: The effects of room type and cleaning methods.

We evaluated environmental contamination by carbapenem-resistant Acinetobacter baumannii (CRAB), the effectiveness of cleaning practices, the performance of aerosolized hydrogen-peroxide (aHP) technology, and the correlation between measures of cleaning and environmental contamination. Serial testing of environmental contamination during a 7-month period. Single-patient rooms in intensive care units (ICUs) and multipatient step-up and regular rooms in internal medicine wards in a tertiary-care hospital with endemic CRAB. CRAB environmental contamination was determined semiquantitatively using sponge sampling. In step-up rooms, 91% of patient units (56% of objects) were contaminated, and half of them were heavily contaminated. In regular rooms, only 21% of patient units (3% of objects) were contaminated. In ICUs, 76% of single-patient rooms (24% of objects) were contaminated. Cleaning did not reduce the number of contaminated objects or patient units in step-up rooms. After refresher training, cleaning reduced the proportion of contaminated objects by 2-fold (P = .001), but almost all patient units remained contaminated. Using aerosolized hydrogen peroxide (aHP) disinfection after discharge of a known CRAB-carrier decreased room contamination by 78%, similar to the reduction achieved by manual hypochloride cleaning. Measuring cleaning efficacy using fluorescent gel did not correlate with recovery of CRAB by sponge cultures. In step-up rooms, the high number of objects contaminated combined with poor efficacy of cleaning resulted in failure to eliminate CRAB in patient units. Fluorescent gel is a poor detector of CRAB contamination. The role of aHP is still unclear. However, its use in multipatient rooms is limited because it can only be used in unoccupied rooms.

The Effects of Private Rooms on Hospital-Associated Infections.

According to this study: Switching to single-patient rooms led to a notable and sustained decrease in the rates of new methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) colonization and VRE infection, but not of Clostridioides difficile or MRSA infections.

Infection prevention and control in patients with cystic fibrosis (CF): Results from a survey in 35 German CF treatment centers

This survey evaluates whether the Cystic Fibrosis (CF)-specific infection prevention and control (IPC) recommendations released by the Commission for Hospital Hygiene and Infection Prevention (KRINKO) in 2012 have been implemented in specialized German CF facilities. Of 35 participating centers (response rate 32.7%), 37% care for more than 100 patients and 44% treat mainly adults. Clinics for adult CF patients report a shortage of qualified personnel for intensified environmental cleaning. Some hospitals struggle to provide single patient rooms with an adjacent sanitary area to segregate CF patients strictly. Most centers offer at least one decolonization cycle (including systemic and inhalative antibiotics) to patients colonized with MRSA.In CF centers in Germany, the KRINKO IPC recommendations are considered helpful by the attending physicians and thoroughly implemented. There is room for improvement concerning strict segregation of inpatients with CF in single patient rooms, in particular in large CF centers mainly caring for adults.

Effects of two non-invasive continuous positive pressure devices on the acoustic environment of preterm infants

BackgroundTwo non-invasive ventilation strategies, Bubble Continuous Positive Airway Pressure (Bubble CPAP) and standard nasal Continuous Positive Airway Pressure (nasal-CPAP), are commonly used to treat preterm infants in the NICU, differentially impacting their auditory environment and contributing to noise exposure above recommended safe levels. AimTo compare differences in sound exposure for preterm infants receiving two types of non-invasive CPAP. MethodProspective observational study of 108 preterm infants, receiving either Bubble-CPAP or nasal-CPAP, using repeated measures of sound exposure in single-patient rooms and semi-private bays. ResultsAnalyses with repeated measures demonstrated that both types of CPAP increase noise levels above the background of the NICU, and that non-invasive nasal-CPAP produces higher noise pollution compared to Bubble CPAP, regardless of the room type. ConclusionWhile CPAP is a necessary treatment for many preterm infants, cumulative noise exposure in extremely preterm infants may also be a care consideration.