Intensive Care Unit Services
The intensive care unit is a room or series of room filled with patients attached to interventional technology team. Critical care unit is a specially designed and equipped facility staffed by skilled personnel to provide effective and safe care for dependent patients with a life threatening problem.
This interventional technology team consists of :
Doctor
Critical care nurses
Therapists
Nutritionists
Chaplains and other support staff, builds an environment for healing or dying.
There are three types of ICUs:
An open ICU: In this type, physicians admit, treat and discharge the patients
An closed ICU: In this type, the admission, discharge and referral policies are under the control of intensivists.
The hybrid model: In this type a combination of both the aspects of open and closed models by staffing the ICU with an attending physician and/or team to work in tandem with primary physicians.
ICUs can be classified as:
Level I: This can be referred as high dependency where close monitoring, resuscitation, and short term ventilation i.e. in <24hrs has to be performed.
Level II: This can be located in general hospital, undertake more prolonged ventilation, must have resident doctors, nurses, access to pathology, radiology, etc.
Level III: This is located in a major tertiary care hospital, which is a referral hospital. It should provide all aspects of intensive care.
Intensive care unit equipment includes:
patient monitoring
life support and emergency resuscitation devices
diagnostic devices
Acute care physiologic monitoring system
Pulse oximeter
Intracranial pressure monitor
Apnea monitor
Intensive care unit (ICU) equipment includes patient monitoring, respiratory and cardiac support, pain management, emergency resuscitation devices, and other life support equipment designed to care for patients who are seriously injured, have a critical or life-threatening illness, or have undergone a major surgical procedure, thereby requiring 24-hour care and monitoring.
Design aspects of an Intensive Care Unit
Floor plan and design should be based on:
Patient admission pattern
Staff & visitor traffic patterns
Need for support facilities such a nursing station, storage, clerical space, administrative & educational requirements.
Eight to twelve beds per unit is considered best from a functional perspective.
Each healthcare facility should consider the need for positive and negative pressure isolation rooms within the ICU.
This need will depend mainly upon patient population and State Department of Public Health requirements.
Each intensive care unit should be a geographically distinct area within the hospital, with controlled access.
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 radiology department
The preferred design is to allow a direct line of vision between the patient and the central nursing station.
In ICUs with a modular design, patients should be visible from their respective nursing substations.
Sliding glass doors and partitions facilitate this arrangement, and increase access to the room in emergency situations.
Signals from patient call systems, alarms from monitoring equipment, and telephones add to the sensory overload in critical care units.
The International Noise Council has recommended that noise levels in hospital acute care areas
¤ should not exceed 45 dB(A) in the daytime,
¤ 40 dB(A) in the evening,
¤ 20 dB(A) at night.
Notably, noise levels in most hospitals are between 50-70 dB(A) with occasional episodes above this range
Central Station
A central nursing station should provide a comfortable area of sufficient size to accommodate all necessary staff functions.
When an ICU is of a modular design, each nursing substation should be capable of providing most, if not all functions of a central station.
There must be adequate overhead and task lighting, and a wall mounted clock should be present.
Adequate space for computer terminals and printers is essential when automated systems are in use.
Patient records should be readily accessible.
Adequate surface space and seating for medical record charting by both physicians and nurses should be provided.
Shelving, file cabinets and other storage for medical record forms must be located so that they are readily accessible by all personnel requiring their use.
X-RAY viewing area
A separate room or distinct area near each ICU or ICU cluster should be designated for the viewing and storage of patient radiographs.
An illuminated viewing box or carousel of appropriate size should be present to allow for the simultaneous viewing of serial radiographs.
Work areas and storage
Work areas and storage for critical supplies should be located within or immediately adjacent to each ICU.
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 sink with hot and cold running water.
Countertops must be provided for medication preparation, and cabinets should be available for the storage of medications and supplies.
Receptionist area
Each ICU or ICU cluster should have a receptionist area to control visitor access.
Ideally, it should be located so that all visitors must pass by this area before entering.
The receptionist should be linked with the ICU(s) by telephone and/or other intercommunication system.
It is desirable to have a visitors' entrance separate from that used by healthcare professionals. This entrance should be securable if the need arises.
Special Procedures Room
If a special procedures room is desired, it should be located within, or immediately adjacent to, the ICU.
One special procedures room may serve several ICUs in close proximity.
Consideration should be given to ease of access for patients transported from areas outside the ICU.
Room size should be sufficient to accommodate necessary equipment and personnel.
Monitoring capabilities, equipment, support services, and safety considerations must be consistent with those provided in the ICU proper.
Work surfaces and storage areas must be adequate enough to maintain all necessary supplies and permit the performance of all desired procedures without the need for healthcare personnel to leave the room
Clean and Dirty Utility Rooms
Clean and dirty utility rooms must be separate rooms that lack interconnection.
They must be adequately temperature controlled, and the air supply from the dirty utility room must be exhausted.
Floors should be covered with materials without seams to facilitate cleaning.
The clean utility room should be used for the storage of all clean and sterile supplies, and may also be used for the storage of clean linen.
Shelving and cabinets for storage must be located high enough off the floor to allow easy access to the floor underneath for cleaning.
The dirty utility room must contain a clinical sink and a hopper both with hot and cold mixing faucets.
Separate covered containers must be provided for soiled linen and waste materials.
There should be designated mechanisms for the disposal of items contaminated by body substances and fluids.
Special containers should be provided for the disposal of needles and other sharp objects.
Equipment storage
An area must be provided for the storage and securing of large patient care equipment items not in active use.
Space should be adequate enough to provide easy access, easy location of desired equipment, and easy retrieval.
Grounded electrical outlets should be provided within the storage area in sufficient numbers to permit recharging of battery operated items.
Nourishment preparation area
A patient nourishment preparation area should be identified and equipped with food preparation surfaces, an ice-making machine, a sink with hot and cold running water, a countertop stove and/or microwave oven, and a refrigerator.
The refrigerator should not be used for the storage of laboratory specimens.
A hand washing facility should be located in or near the area.
Staff Lounge
A staff lounge must be available near each ICU or ICU cluster to provide a private, comfortable, and relaxing environment.
Secured locker facilities, showers and toilets should be present.
The area should include comfortable seating and adequate nourishment storage and preparation facilities, including a refrigerator, microwave oven, etc.
The lounge must be linked to the ICU by telephone or intercommunication system, and emergency cardiac arrest alarms should be audible within.
Visitors' lounge / waiting room
A visitors' lounge or waiting area should be provided near each ICU or ICU cluster.
Visitor access should be controlled from the receptionist area. One and one-half to two seats per critical care bed are recommended.
Public telephones (preferably with privacy enclosures) and dining facilities must be available to visitors.
Television and/or music should be provided.
Public toilet facilities and a drinking fountain should be located within the lounge area or immediately adjacent.
Warm colors, carpeting, indirect soft lighting, and windows are desirable.
A variety of seating, including upright, lounge, and reclining chairs, is also desirable.
Educational materials and lists of hospital and community-based support and resource services should be displayed.
A separate family consultation room is strongly recommended.
Patient transportation routes
Patients transported to and from an ICU should be transported through corridors separate from those used by the visiting public.
Patient privacy should be preserved and patient transportation should be rapid and unobstructed.
When elevator transport is required, an oversized keyed elevator, separate from public access, should be provided.
Supply and Service Corridors
A perimeter corridor with easy entrance and exit should be provided for supplying and servicing each ICU.
Removal of soiled items and waste should also be accomplished through this corridor.
This helps to minimize any disruption of patient care activities and minimizes unnecessary noise.
The corridor should be at least eight feet in width.
Doorways, openings, and passages into each ICU must be a minimum of 36 inches in width to allow easy and unobstructed movement of equipment and supplies.
Floor coverings should be chosen to withstand heavy use and allow heavy wheeled equipment to be moved without difficulty.
Patient modules
Ward-type ICUs should allow at least 225 square feet of clear floor area per bed.
ICUs with individual patient modules should allow at least 250 square feet per room (assuming one patient per room),
Provide a minimum width of 15 feet, excluding ancillary spaces (anteroom, toilet, storage).
Isolation rooms should each contain at least 250 square feet of floor space plus an anteroom.
Each anteroom should contain at least 20 square feet to accommodate hand-washing, gowning, and storage.
If a toilet is provided, it must be private.
A cardiac arrest/emergency alarm button must be present at every bedside within the ICU. The alarm should automatically sound in the hospital telecommunications center, central nursing station, ICU conference room, staff lounge, and any on-call rooms. The origin of these alarms must be discernable.
Space and surfaces for computer terminals and patient charting should be incorporated into the design of each patient module as indicated.
Storage must be provided for each patient's personal belongings, patient care supplies, linen and toiletries. Locking drawers and cabinets must be used if syringes and pharmaceuticals are stored at the bedside.
Personal valuables should not be kept in the ICU. Rather, these should be held by Hospital Security until patient discharge.
Every effort should be made to provide an environment that minimizes stress to patients and staff. Therefore, design should consider natural illumination and view.
Windows are an important aspect of sensory orientation, and as many rooms as possible should have windows to reinforce day/night orientation.
Drapes or shades of fireproof fabric can make attractive window coverings and serve to absorb sound.
Window treatments should be durable and easy to clean, and a schedule for their cleaning must be established
Improving sensory orientation
Additional approaches to improving sensory orientation for patients may include:
The provision of a clock, calendar, bulletin board, pillow speaker connected to radio and television.
Televisions must be out of reach of patients and operated by remote control.
If possible, telephone service should be provided in each room.
Comfort considerations should include methods for establishing privacy for the patient. Shades, blinds, curtains, and doors should control the patient's contact with his/her surroundings.
A supply of portable or folding chairs should be available to allow for family visits at the bedside. An additional comfort consideration is the choice of color scheme for the room, which should promote rest and have a calming effect.
Utilities
Each intensive care unit must have:
Electrical power,
Water, oxygen,
Compressed air,
Vacuum, lighting,
And environmental control systems that support the needs of the patients and critical care team under normal and emergency situations, and these must meet or exceed regulatory and accreditation agency codes and standards.
Electric supply
Grounded 110 volt electrical outlets with 30 amp circuit breakers should be located within a few feet of each patient's bed.
Sixteen outlets per bed are desirable.
Outlets at the head of the bed should be placed approximately 36 inches above the floor to facilitate connection,
To discourage disconnection by pulling the power cord rather than the plug.
Outlets at the sides and foot of the bed should be placed close to the floor to avoid tripping over electrical cords.
Water supply
The water supply must be from a certified source, especially if hemodialysis is to be performed.
Zone stop valves must be installed on pipes entering each ICU to allow service to be turned off should line breaks occur.
Hand-washing sinks deep and wide enough to prevent splashing, preferably equipped with elbow, knee, foot, or sonar-operated faucets, must be available near the entrances to patient modules, or between every two patients in ward-type units.
Lightning
Total luminance should not exceed 30 foot-candles.
It is preferable to place lighting controls on variable-control dimmers located just outside of the room.
Night lighting should not exceed 6.5 fc for continuous use or 19 fc for short periods.
Separate lighting for emergencies and procedures should be located in the ceiling directly above the patient and should fully illuminate the patient with at least 150 fc shadow-free
A patient reading light is desirable, and should be mounted
Environmental control systems
A minimum of six total air changes per room per hour are required, with two air changes per hour composed of outside air.
For rooms having toilets, the required toilet exhaust of 75 cubic feet per minute should be composed of outside air.
Central air-conditioning systems and re-circulated air must pass through appropriate filters.
Air-conditioning and heating should be provided with an emphasis on patient comfort.
For critical care units having enclosed patient modules, the temperature should be adjustable within each module.
Computerized Charting
These systems provide for "paperless" data management, order entry, and nurse and physician charting. If and when a decision is made to utilize this technology, it is important to integrate such a system fully with all ICU activities.
Bedside terminals facilitate patient management by permitting nurses and physicians to remain at the bedside during the charting process.
Other Facilities
Voice Intercommunication Systems
Satellite Laboratory
Physician On-Call Rooms
Administrative Offices
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