Intensive Care Unit
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Intensive Care Unit
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 STRENGTHIDEALLY 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
BED SPACE & BEDS150 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 freemovement of staff and equipment, reducing risk of cross contamination.
225 250 SQUARE FEET PER BED IF IN A SINGLE ROOM.
INFRASTRUCTUREPATIENTS 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.
Privacy partitions should be of material that is easily cleaned andshould be cleaned weekly and any time that it becomes soiled orcontaminated. If curtains are used, they should be changed weeklyand between patients.
Central Station.provide a comfortable area of sufficient size toaccommodate all necessary staff functions.There must be adequate overheadand task lighting, and a wall mounted clock should be present.space foAdequate r computer terminals andprinters is essential
ENVIRONMENTSIGNALS & 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).
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 Storageshould be located within orimmediately adjacent to each ICU.Receptionist Area.it should be located so that all visitors must pass by this area before enteringIt is desirable to have a visitors'entrance separate from that used by healthcare professionals.
Medication prep areas should be separate from patient care areas andshould be maintained as a clean area.Medication preparation
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.Special Procedures Room.Equipment Storage.Nourishment Preparation Area.Staff Lounge.Conference Room.Visitors' Lounge/Waiting Room.
Physician On-Call Roomsshould be available close to theICU(s)Toilet and shower facilities should be providedOn-call rooms must be linked to the ICU(s) by telephoneand/or voice intercommunication systemcardiac arrest/emergency alarms must be audible in these rooms
EQUIPMENTmechanical ventilators to assist breathing through an endotracheal tubea tracheotomycardiac monitors includingthose with telemetryexternal pacemakersDefibrillatorsdialysis equipment for renal problems
equipment for the constant monitoring of bodily functions intravenous lines
drains and catheters a wide array of drugs to treat the primary condition(s) of hospitalization
Electrical PowerElectrical 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 electricalemergency.It is
Water Supply.The water supply must be from a certified sourceespecially if hemodialysis is to beperformedHand-washing sinks deep and wide enough to prevent splashing,
Oxygen, Compressed Airtwooxygen outlets per patient are requiredOne compressed air outlet per bed is required; two are desirableConnections for oxygen and compressed air outlets must occur by keyed plugs to prevent the accidentalinterchanging of gasesAudible and visible low and high pressure alarms must be installed both in each ICU
LightingGeneral overhead illumination plus light from the surroundings should be adequate for routinenursing tasks, including chartingcreate a soft lighting environment for patient comfort.It is preferable to place lighting controlslocated just outside of the room.This permits changes in lighting at night from outside the room, allowing aminimum disruption of sleep during patient observation.Separate lighting for emergencies and procedures should be located in the ceiling directly above the patient
REFERENCESGuidelines 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.