International guidelines developed with contributions from a Texas A&M University College of Nursing researcher confirm the importance of thoughtful intensive care unit (ICU) design and encourage the involvement of nurses in the process to improve workflow, safety and staff well-being.
As a co-lead of the guideline development panel, Jodie Gary , an associate professor in the College of Nursing, worked alongside clinicians, architects, engineers and other researchers from around the world to identify evidence-based design strategies for ICUs.
The guidelines, published in 2025 in Critical Care Medicine with follow-up analysis released recently in Critical Care Nursing Clinics of North America, were developed by addressing 15 key questions related to ICU layout, patient rooms, infection prevention, infrastructure and staff spaces.
Gary said the effort was designed to bring more structure to decisions that have traditionally relied on experience and institutional practice.
“Before this work, ICU design was largely guided by expert opinion and practical experience,” she said. “This guideline brings a systematic evidence-based approach to how these spaces should be built and organized.”
One of the central findings was that ICU design can influence both workflow and patient safety in practical, day-to-day ways.
“Even small design features can change how care is delivered minute to minute,” Gary said. “Things like visibility into patient rooms or how equipment is positioned can either support clinicians or create unnecessary barriers.”
The guidelines recommend single-patient rooms, strong visibility between staff and patients, infection prevention features, flexible layouts for patient surges and greater access to natural light. Natural light emerged as a particularly consistent theme across the evidence, with studies suggesting benefits for both patients and staff working long shifts in intensive care environments.
“Natural light sounds simple, but it changes the entire experience of an ICU,” Gary said. “When patients and staff are spending long periods in these spaces, having daylight and windows supports recovery, alertness and overall well-being.”
The guidelines also reflect lessons learned during the COVID-19 pandemic, when hospitals had to rapidly adapt ICU spaces to manage surges in critically ill patients while maintaining infection control standards.
“That period really showed how important flexibility and infection prevention are in ICU design,” Gary said. “Units need to be able to adapt without compromising safety or efficiency.”
Another major focus of the work is the role of nurses in ICU design. Because nurses spend the most time in patient rooms, they often identify workflow and safety challenges that are not obvious during planning or construction.
“Nurses see the day-to-day realities of these environments in a way no other discipline does,” Gary said. “Their perspective is essential to building units that actually work in practice.”
Gary said the multidisciplinary nature of the panel strengthened the final recommendations by bringing together clinical care intensivists as well as nursing, engineering and architectural perspectives.
“When you bring these disciplines together, you get a much clearer picture of how the environment affects care,” she said.
By Emily Godsey '24, Texas A&M University College of Nursing
Critical Care Nursing Clinics of North America
Systematic review
Not applicable
Impacts and Outcomes of Intensive Care Unit Design
11-Mar-2026
Authors J.C. Gary, D.K. Hamilton, and C.D. Cadenhead have nothing to disclose. Author S.J. Oczkowski discloses travel funding Fisher & Paykel Healthcare. Methodology consultation fees - VitalAire, Brain Trauma Foundation.