Intensive Care Unit

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Intensive Care Unit
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Types
Specialized types of ICUs include
Neonatal intensive-care unit(NICU) Special Care
Nursery (SCN) Pediatric intensive-care unit
(PICU) Psychiatric intensive-care unit
(PICU) Coronary care unit (CCU) Cardiac Surgery
intensive-care unit (CSICU)
Cardiovascular intensive-care unit
(CVICU) Medical intensive-care unit
(MICU) Medical Surgical intensive-care unit
(MSICU) Surgical intensive-care unit (SICU)
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Overnight intensive recovery (OIR) Neurotrauma intensive-care unit (NICU) Neurointensive-care unit (NICU) Burn wound intensive-care unit (BWICU) Trauma Intensive care Unit (TICU) Surgical Trauma intensive-care unit (STICU) Trauma-Neuro Critical Care (TNCC) Respiratory intensive-care unit (RICU) Geriatric intensive-care unit (GICU) Mobile Intensive Care Unit (MICU) Post Anaesthesia Care Unit (PACU)
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LOCATION

• Should be a geographically distinct area within
  the hospital, with controlled access.
• No through traffic to other departments should
  occur. Supply and professional traffic should be
  separated from public/visitor traffic.

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• Location should be chosen so that the unit is
  adjacent to, or within direct elevator travel to
  and from, the Emergency Department, Operating
  Room, Intermediate care units, and the Radiology
  Department.

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BED STRENGTH

• IDEALLY 8 TO 12 BEDS
• LARGER AREAS DIFFICULT TO ADMINISTER AND
  SMALLER AREAS NOT BEING COST EFFECTIVE
• 3 TO 5 BEDS PER 100 HOSPITAL BEDS FOR A LEVEL III
  ICU / 2 TO 20 OF THE TOTAL NUMBER OF HOSPITAL
  BEDS
• 1 ISOLATION BED FOR EVERY 10 ICU BEDS

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BED SPACE BEDS

• 150 200 SQUARE FEET PER OPEN BED WITH 8 FEET IN
  BETWEEN BEDS. The beds should be 2.5 - 3 meters
  (7-9 feet) apart , to allow free
• movement of staff and equipment, reducing risk of
  cross contamination.
• 225 250 SQUARE FEET PER BED IF IN A SINGLE
  ROOM.

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INFRASTRUCTURE

• PATIENTS MUST BE SITUATED SO THAT DIRECT OR
  INDIRECT (E.G. BY VIDEO MONITOR) VISUALIZATION BY
  HEALTHCARE PROVIDERS IS POSSIBLE AT ALL TIMES.
• THE PREFERRED DESIGN IS TO ALLOW A DIRECT LINE OF
  VISION BETWEEN THE PATIENT AND THE CENTRAL
  NURSING STATION.
• MODULAR DESIGN SLIDING GLASS DOORS PARTITIONS
  TO FACILITATE VISIBILITY.

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Partitions Privacy partitions should be of
material that is easily cleaned and should be
cleaned weekly and any time that it becomes
soiled or contaminated. If curtains are used,
they should be changed weekly and between
patients.
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Central Station.
provide a comfortable area of sufficient size
to accommodate all necessary staff functions.
There must be adequate overhead and task
lighting, and a wall mounted clock should be
present.
space foAdequate r computer terminals
and printers is essential
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ENVIRONMENT

• SIGNALS ALARMS ADD TO THE SENSORY OVERLOAD
  NEED TO BE MODULATED.
• FLOOR COVERINGS AND CEILING WITH SOUND ABSORPTION
  PROPERTIES.
• DOORWAYS OFFSET TO MINIMISE SOUND TRANSMISSION.
• LIGHT SOFT MUSIC (EXCEPT 10 PM TO 6 AM).

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• ADDITIONAL APPROACHES TO IMPROVING SENSORY
  ORIENTATION FOR PATIENTS MAY INCLUDE THE
  PROVISION OF A CLOCK, CALENDAR,
• BULLETIN BOARD, AND/OR PILLOW SPEAKER
  CONNECTED TO RADIO AND TELEVISION.

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• NATURAL ILLUMINATION AND VIEW - WINDOWS ARE AN
  IMPORTANT ASPECT OF SENSORY ORIENTATION HELPS TO
  REINFORCE DAY/NIGHT ORIENTATION.
• WINDOW TREATMENTS SHOULD BE DURABLE AND EASY TO
  CLEAN, AND A SCHEDULE FOR THEIR CLEANING MUST BE
  ESTABLISHED.

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Work Areas and Storage
should be located within or immediately adjacent
to each ICU.
Receptionist Area.
it should be located so that all visitors must
pass by this area before entering
It is desirable to have a visitors' entrance
separate from that used by healthcare
professionals.
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Medication preparation
Medication prep areas should be separate from
patient care areas and should be maintained as a
clean area.
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• THERE SHOULD BE A SEPARATE MEDICATION AREA OF AT
  LEAST 50 SQUARE FEET CONTAINING A REFRIGERATOR
  FOR PHARMACEUTICALS, A DOUBLE LOCKING SAFE FOR
  CONTROLLED SUBSTANCES, AND A TABLE TOP FOR
  PREPARATION OF DRUGS AND INFUSIONS.

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• X-ray Viewing Area.

• Special Procedures Room.

• Equipment Storage.

• Nourishment Preparation Area.

• Staff Lounge.

• Conference Room.

• Visitors' Lounge/Waiting Room.

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Physician On-Call Rooms
should be available close to the ICU(s)
Toilet and shower facilities should be provided
On-call rooms must be linked to the ICU(s) by
telephone and/or voice intercommunication system
cardiac arrest/emergency alarms must be audible
in these rooms
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EQUIPMENT

• mechanical ventilators to assist breathing
  through
• an endotracheal tube
• a tracheotomy
• cardiac monitors including
• those with telemetry
• external pacemakers
• Defibrillators
• dialysis equipment for renal problems

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equipment for the constant monitoring of
bodily functions
intravenous lines nasogastric tubes
suction pumps drains and catheters
a wide array of drugs to treat the primary
condition(s) of hospitalization
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Electrical Power
Electrical service to each ICU should be provided
by a separate feeder connected to the main
circuit breaker panel that serves the branch
circuits in the ICU.
The main panel should also be connected to an
emergency power source that will quickly
re-supply power in the event of power
interruption.
critical that the ICU staff have easy access to
the main panel in case power must be interrupted
for an electrical emergency.
It is
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Water Supply.
The water supply must be from a certified source
especially if hemodialysis is to be performed
Hand-washing sinks deep and wide enough to
prevent splashing,
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Oxygen, Compressed Air
two oxygen outlets per patient are required
One compressed air outlet per bed is required
two are desirable
Connections for oxygen and compressed air outlets
must occur by keyed plugs to prevent the
accidental interchanging of gases
Audible and visible low and high pressure alarms
must be installed both in each ICU
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Lighting
General overhead illumination plus light from the
surroundings should be adequate for
routine nursing tasks, including charting
create a soft lighting environment for patient
comfort.
It is preferable to place lighting
controls located just outside of the room.
This permits changes in lighting at night from
outside the room, allowing a minimum disruption
of sleep during patient observation.
Separate lighting for emergencies and procedures
should be located in the ceiling directly above
the patient
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REFERENCES

• Guidelines for Intensive Care Unit Design
• Crit Care Med 1995 Mar 23(3)582-
• 588.
• John, G. Essentials of Critical Care, Edition IV,
  
• (2003), Shakti Prints, Vellore.
• Worthley, L.I.G. Clinical Examination of the
• Critically Ill Patient, Edition II, (2000), The
• Australasian Academy of Critical Care Mediicne,
• South Australia.

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