Intensive Care UnitIntensive Care Unit

منتظرتربتی منتظرتربتی زهرا زهراارشد ارشد کارشناسی کارشناسی

TypesSpecialized 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)

•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)

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.

• 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.

BED STRENGTH

• IDEALLY 8 TO 12 BEDSIDEALLY 8 TO 12 BEDS

• LARGER AREAS – DIFFICULT TO ADMINISTER AND SMALLER AREAS LARGER AREAS – DIFFICULT TO ADMINISTER AND SMALLER AREAS NOT BEING COST EFFECTIVENOT BEING COST EFFECTIVE

• 3 TO 5 BEDS PER 100 HOSPITAL BEDS FOR A LEVEL III ICU / 2 TO 20% 3 TO 5 BEDS PER 100 HOSPITAL BEDS FOR A LEVEL III ICU / 2 TO 20% OF THE TOTAL NUMBER OF HOSPITAL BEDS OF THE TOTAL NUMBER OF HOSPITAL BEDS

1 ISOLATION BED FOR EVERY 10 ICU BEDS 1 ISOLATION BED FOR EVERY 10 ICU BEDS

BED SPACE & BEDS

• 150 – 200 SQUARE FEET PER OPEN BED WITH 8 FEET IN 150 – 200 SQUARE FEET PER OPEN BED WITH 8 FEET IN BETWEEN BEDS.BETWEEN BEDS. The beds should be 2.5 - 3 meters (7-9 The beds should be 2.5 - 3 meters (7-9 feet) apart , to allow freefeet) apart , to allow free

• movement of staff and equipment, reducing risk of cross movement of staff and equipment, reducing risk of cross contamination.contamination.

• 225 – 250 SQUARE FEET PER BED IF IN A SINGLE ROOM225 – 250 SQUARE FEET PER BED IF IN A SINGLE ROOM..

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.

•• PartitionsPartitions

Privacy partitions should be of material that is easily Privacy partitions should be of material that is easily cleaned andcleaned and

should be cleaned weekly and any time that it should be cleaned weekly and any time that it becomes soiled orbecomes soiled or

contaminated. If curtains are used, they should be contaminated. If curtains are used, they should be changed weeklychanged weekly

and between patientsand between patients.

Central Station.Central Station.

provide a comfortable area of sufficient size toprovide a comfortable area of sufficient size toaccommodate all necessary staff functions.accommodate all necessary staff functions.

There must be adequate overheadThere must be adequate overheadand task lighting, and a wall mounted clock should be and task lighting, and a wall mounted clock should be

present.present.

space foAdequate r computer terminals andspace foAdequate r computer terminals andprinters is essentialprinters is essential

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).LIGHT & SOFT MUSIC (EXCEPT 10 PM TO 6 AM).

• 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.

• 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.

Work Areas and Storage

should be located within orshould be located within orimmediately immediately adjacentadjacent to each ICU. to each ICU.

Receptionist Area.Receptionist Area.

it should be located so that all visitors must pass by it should be located so that all visitors must pass by this area before enteringthis area before entering

It is desirable to have a visitors'It is desirable to have a visitors'entrance separate from that used by healthcare entrance separate from that used by healthcare

professionalsprofessionals.

Medication prep areas should be Medication prep areas should be separate from patient care areas separate from patient care areas

andandshould be maintained as a clean should be maintained as a clean

area.area.

Medication Medication preparationpreparation

• 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.

X-ray Viewing Area.X-ray Viewing Area.

Special Procedures Room.Special Procedures Room.

Equipment Storage.Equipment Storage.

Nourishment Preparation Area.

Staff Lounge.Staff Lounge.

Conference Room.Conference Room.

Visitors' Lounge/Waiting Room.Visitors' Lounge/Waiting Room.

Physician On-Call RoomsPhysician On-Call Rooms

should be available close to theshould be available close to theICU(s)ICU(s)

Toilet and shower facilities should be providedToilet and shower facilities should be provided

On-call rooms must be linked to the ICU(s) by On-call rooms must be linked to the ICU(s) by telephonetelephone

and/or voice intercommunication systemand/or voice intercommunication system

cardiac arrest/emergency alarms must cardiac arrest/emergency alarms must be audible in these roomsbe audible in these rooms

EQUIPMENT

mechanical ventilators to assist breathing through • an endotracheal tube• a tracheotomycardiac monitors including• those with telemetry• external pacemakers• Defibrillatorsdialysis equipment for renal problems

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

Electrical Power

Electrical service to each ICU should be provided by a separate feeder connected tothe main circuit breaker panel that serves the branch circuits in the ICU.

The main panel should also beconnected 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

Water Supply.

The water supply must be from a certified The water supply must be from a certified sourcesource

especially if hemodialysis is to beespecially if hemodialysis is to beperformedperformed

Hand-washing sinks deep and wide enough to Hand-washing sinks deep and wide enough to prevent splashing,prevent splashing,

Oxygen, Compressed AirOxygen, Compressed Air

twotwooxygen outlets per patient are requiredoxygen outlets per patient are required

One compressed air outlet per bed is required; two are desirableOne compressed air outlet per bed is required; two are desirable

Connections for oxygen and compressed air Connections for oxygen and compressed air outlets must occur by keyed plugs to prevent the outlets must occur by keyed plugs to prevent the

accidentalaccidentalinterchanging of gasesinterchanging of gases

Audible and visible low and high Audible and visible low and high pressure alarms must be installed both pressure alarms must be installed both

in each ICUin each ICU

LightingLighting

General overhead illumination plus light from the surroundings should be General overhead illumination plus light from the surroundings should be adequate for routineadequate for routine

nursing tasks, including chartingnursing tasks, including charting

create a soft lighting environment for patient create a soft lighting environment for patient comfort.comfort.

It is preferable to place lighting controlsIt is preferable to place lighting controlslocated just outside of the room.located just outside of the room.

This permits changes in lighting at night from outside the room, This permits changes in lighting at night from outside the room, allowing aallowing a

minimum disruption of sleep during patient observation.minimum disruption of sleep during patient observation.

Separate lighting for emergencies and procedures should be located in Separate lighting for emergencies and procedures should be located in the ceiling directly above the patientthe ceiling directly above the patient

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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