intensive care unit_concept of criticare
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Jul 07, 2024
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About This Presentation
intensive care unit_concept of criticare
Slide Content
CONCEPTOF CRITICAL CARE
INTRODUCTION
Theintensivecareunitisnot
merelyaroomorseriesofroom
filledwithpatientsattachedto
interventionaltechnology;itis
thehomeofanorganization:
theintensivecareteam.
Theintensivecareunitisnot
merelyaroomorseriesofroom
filledwithpatientsattachedto
interventionaltechnology;itis
thehomeofanorganization:
theintensivecareteam.
THE INTENSIVE CARE TEAM.
Thisteam–
•Doctor
•Nurses
•Therapists
•Nutritionists
•Chaplainsandothersupport
staff,buildsanenvironment
forhealingordying.
Thisteam–
•Doctor
•Nurses
•Therapists
•Nutritionists
•Chaplainsandothersupport
staff,buildsanenvironment
forhealingordying.
CRITICAL CARE NURSING
Critical care nursing is that specialty
within nursing that deals specifically
with human responses to life-
threatening problems.
Critical care nursing is that specialty
within nursing that deals specifically
with human responses to life-
threatening problems.
CRITICAL CARE NURSING
Critical care nursing is that specialty
within nursing that deals specifically
with human responses to life-
threatening problems.
Critical care nursing is that specialty
within nursing that deals specifically
with human responses to life-
threatening problems.
SEVEN Cs OF CRITICAL CARE
•Compassion
•Communication (withpatientandfamily).
•Consideration(topatients,relativesand
colleagues)andavoidanceofConflict.
•Comfort:preventionofsuffering
•Carefulness(avoidanceofinjury)
•Consistency
•Closure(ethicsandwithdrawalofcare).
•Compassion
•Communication (withpatientandfamily).
•Consideration(topatients,relativesand
colleagues)andavoidanceofConflict.
•Comfort:preventionofsuffering
•Carefulness(avoidanceofinjury)
•Consistency
•Closure(ethicsandwithdrawalofcare).
CRITICAL CARE NURSE
Acriticalcarenurseisa
licensedprofessionalnurse
who isresponsible for
ensuringthatacutelyand
criticallyillpatientsand
their families receive
optimalcare.
Acriticalcarenurseisa
licensedprofessionalnurse
who isresponsible for
ensuringthatacutelyand
criticallyillpatientsand
their families receive
optimalcare.
CRITICAL CARE UNIT
•Criticalcareunitisaspeciallydesigned
andequippedfacilitystaffedbyskilled
personneltoprovideeffectiveandsafe
carefordependentpatientswithalife
threateningproblem.
•Criticalcareunitisaspeciallydesigned
andequippedfacilitystaffedbyskilled
personneltoprovideeffectiveandsafe
carefordependentpatientswithalife
threateningproblem.
THE AIM OF THE CRITICAL
CARE:-
is to see that one provides a care
such that patient improves and
survives the acute illness or tides
over the acute exacerbation of the
chronic illness.
CARE:-
is to see that one provides a care
such that patient improves and
survives the acute illness or tides
over the acute exacerbation of the
chronic illness.
THE EVOLUTION OF CRITICAL
CARE
•Forty years of development in
critical care and critical care
nursing has given rise to a
recognized speciality in nursing
practice .
•Critical care units have evolved
over the last four decades in
response to medical advances .
CARE
•Forty years of development in
critical care and critical care
nursing has given rise to a
recognized speciality in nursing
practice .
•Critical care units have evolved
over the last four decades in
response to medical advances .
HISTORICAL PRESPECTIVES
•Florence nightingale recognized the need
to consider the severity of illness in bed
allocation of patients and placed the
seriously ill patients near the nurses’
station.
•1923, John Hopkins University Hospital
developed a special care unit for
neurosurgical patients .
•Modern medicines boomed to its higher
ladder after world war 2
•Florence nightingale recognized the need
to consider the severity of illness in bed
allocation of patients and placed the
seriously ill patients near the nurses’
station.
•1923, John Hopkins University Hospital
developed a special care unit for
neurosurgical patients .
•Modern medicines boomed to its higher
ladder after world war 2
Bennett, D. et al. BMJ 1999;318:1468-1470
Bennett, D. et al. BMJ 1999;318:1468-1470
Bennett, D. et al. BMJ 1999;318:1468-1470
HISTORICAL PRESPECTIVES
•As surgical techniques advanced it became
necessary that post operative patient
required careful monitoring and this came
about the recovery room.
•In 1950, the epidemic of poliomyelitis
necessitated thousands of patients requiring
respiratory assist devices and intensive
nursing care.
•At the same time came about newer horizons
in cardiothoracic surgery, with refinements in
intraoperative membrane oxygen techniques.
•As surgical techniques advanced it became
necessary that post operative patient
required careful monitoring and this came
about the recovery room.
•In 1950, the epidemic of poliomyelitis
necessitated thousands of patients requiring
respiratory assist devices and intensive
nursing care.
•At the same time came about newer horizons
in cardiothoracic surgery, with refinements in
intraoperative membrane oxygen techniques.
HISTORICAL PRESPECTIVES
•In 1953, Manchester Memorial
Hospital opened a four bedded
unit at Philadelphia was
started.
•By 1957, there were 20 units
in USA and
•In 1958,the number increased
to 150.
•In 1953, Manchester Memorial
Hospital opened a four bedded
unit at Philadelphia was
started.
•By 1957, there were 20 units
in USA and
•In 1958,the number increased
to 150.
CONTEXTUAL FORCES
•The expansion of American hospital system
and hospital insurance.
•Architectural, hospital changes towards
private and semi private accommodations.
•Reallocations for direct patient care
responsibility and creations of new forms of
care.
•During 1970’s,the term critical care unit
came into existence which covered all types
of special care
•The expansion of American hospital system
and hospital insurance.
•Architectural, hospital changes towards
private and semi private accommodations.
•Reallocations for direct patient care
responsibility and creations of new forms of
care.
•During 1970’s,the term critical care unit
came into existence which covered all types
of special care
TYPES OF ICUs
There are two types of ICUs,
•An open :-. In this type, physicians admit,
treat and discharge and
•A closed: in this type, the admission,
discharge and referral policies are under the
control of intensivists.
There are two types of ICUs,
•An open :-. In this type, physicians admit,
treat and discharge and
•A closed: in this type, the admission,
discharge and referral policies are under the
control of intensivists.
ICUS CAN BE CLASSIFIED AS:
•Level I: This can be referred as high dependency is
where close monitoring, resuscitation, and short term
ventilation <24hrs has to be performed.
•Level II: Can be located in general hospital, undertake
more prolonged ventilation. Must have resident doctors,
nurses, access to pathology, radiology, etc.
•Level III: Located in a major tertiary hospital, which is a
referral hospital. It should provide all aspects of intensive
care required.
•Level I: This can be referred as high dependency is
where close monitoring, resuscitation, and short term
ventilation <24hrs has to be performed.
•Level II: Can be located in general hospital, undertake
more prolonged ventilation. Must have resident doctors,
nurses, access to pathology, radiology, etc.
•Level III: Located in a major tertiary hospital, which is a
referral hospital. It should provide all aspects of intensive
care required.
STAFFING
•Large hospital requires bigger team.
•Large hospital requires bigger team.
Medical staff
•Carrier intensivists are the best senior medical
Staff to be appointed to the ICU.
•He/she will be the director.
•Less preferred are other specialists viz. From
Anaesthesia, medicine and chest who have
clinical Commitment elsewhere.
•Junior staff are intensive care trainees and
trainees on deputation from other disciplines.
•Carrier intensivists are the best senior medical
Staff to be appointed to the ICU.
•He/she will be the director.
•Less preferred are other specialists viz. From
Anaesthesia, medicine and chest who have
clinical Commitment elsewhere.
•Junior staff are intensive care trainees and
trainees on deputation from other disciplines.
NURSING STAFF
•ThemajorteachingtertiarycareICUwillrequiretrained
nursesincriticalcare.
•Itmaybeidealtohaveaninhousetrainingprogramme
forcriticalCarenursing.
•Thenumberofnursesideallyrequiredforsuchunitsis
1:1ratio.
•Incomplexsituationstheymayrequiretwonursesper
patient.
•Thenumberoftrainednursesshouldbealsoworked
outbythetypeofICU,theworkloadandworkstatistics
andtypeofpatientload.
•ThemajorteachingtertiarycareICUwillrequiretrained
nursesincriticalcare.
•Itmaybeidealtohaveaninhousetrainingprogramme
forcriticalCarenursing.
•Thenumberofnursesideallyrequiredforsuchunitsis
1:1ratio.
•Incomplexsituationstheymayrequiretwonursesper
patient.
•Thenumberoftrainednursesshouldbealsoworked
outbythetypeofICU,theworkloadandworkstatistics
andtypeofpatientload.
UNIT DIRECTOR:-
Specific requirements for the unit director include the
following:
•Training, interest, and time availability to give clinical,
administrative, and educational direction to the ICU.
•Board certification in critical care medicine.
•Time and commitment to maintain active and regular
involvement in the care of patients in the unit.
Specific requirements for the unit director include the
following:
•Training, interest, and time availability to give clinical,
administrative, and educational direction to the ICU.
•Board certification in critical care medicine.
•Time and commitment to maintain active and regular
involvement in the care of patients in the unit.
•Availability (either the director or a similarly qualified
surrogate) to the unit 24 hrs a day, 7 days a week for
both clinical and administrative matters.
•Active involvement in local and/or national critical care
societies.
surrogate) to the unit 24 hrs a day, 7 days a week for
both clinical and administrative matters.
•Active involvement in local and/or national critical care
societies.
•Participation in continuing education programs in the
field of critical care medicine.
•Hospital privileges to perform relevant invasive
procedures.
•Active involvement as an advisor and participant in
organizing care of the critically ill patient in the
community as a whole.
•Active participation in the education of unit staff.
•Active participation in the review of the appropriate use
of ICU resources in the hospital.
field of critical care medicine.
•Hospital privileges to perform relevant invasive
procedures.
•Active involvement as an advisor and participant in
organizing care of the critically ill patient in the
community as a whole.
•Active participation in the education of unit staff.
•Active participation in the review of the appropriate use
of ICU resources in the hospital.
NURSE MANAGER
•An RN (registered nurse) with a BSN (bachelor of
science in nursing) or preferably an MSN (master
of science in nursing) degree
•Certification in critical care or equivalent
graduate education
•At least 2 yrs experience working in a critical
care unit
•Experience with health information systems,
quality improvement/risk management activities,
and healthcare economics
•Ability to ensure that critical care nursing
practice meets appropriate standards .
•Preparation to participate in the on-site education
of critical care unit nursing staff
•An RN (registered nurse) with a BSN (bachelor of
science in nursing) or preferably an MSN (master
of science in nursing) degree
•Certification in critical care or equivalent
graduate education
•At least 2 yrs experience working in a critical
care unit
•Experience with health information systems,
quality improvement/risk management activities,
and healthcare economics
•Ability to ensure that critical care nursing
practice meets appropriate standards .
•Preparation to participate in the on-site education
of critical care unit nursing staff
NURSE MANAGER
•Ability to foster a cooperative atmosphere with regard to
the training of nurses, physicians, pharmacists,
respiratory therapists, and other personnel involved in
the care of critical care unit patients
•Regular participation in ongoing continuing nursing
education
•Knowledge about current advances in the field of critical
care nursing
•Participation in strategic planning and redesign efforts
•Ability to foster a cooperative atmosphere with regard to
the training of nurses, physicians, pharmacists,
respiratory therapists, and other personnel involved in
the care of critical care unit patients
•Regular participation in ongoing continuing nursing
education
•Knowledge about current advances in the field of critical
care nursing
•Participation in strategic planning and redesign efforts
Critical Care Unit nursing
requirements:-
•All patient care is carried out directly by or
under supervision of a trained critical care
nurse.
•All nurses working in critical care should
complete a clinical/didactic critical care
course before assuming full responsibility for
patient care.
•Unit orientation is required before assuming
responsibility for patient care.
•Nurse-to-patient ratios should be based on
patient acuity according to written hospital
policies.
requirements:-
•All patient care is carried out directly by or
under supervision of a trained critical care
nurse.
•All nurses working in critical care should
complete a clinical/didactic critical care
course before assuming full responsibility for
patient care.
•Unit orientation is required before assuming
responsibility for patient care.
•Nurse-to-patient ratios should be based on
patient acuity according to written hospital
policies.
Critical Care Unit nursing
requirements :-
•All critical care nurses must participate in continuing
education.
•An appropriate number of nurses should be trained in
highly specialized techniques such as renal replacement
therapy, intra-aortic balloon pump monitoring, and
intracranial pressure monitoring.
•All nurses should be familiar with the indications for and
complications of renal replacement therapy.
requirements :-
•All critical care nurses must participate in continuing
education.
•An appropriate number of nurses should be trained in
highly specialized techniques such as renal replacement
therapy, intra-aortic balloon pump monitoring, and
intracranial pressure monitoring.
•All nurses should be familiar with the indications for and
complications of renal replacement therapy.
RESPIRATORY CARE PERSONNEL
REQUIREMENTS
•Respiratory care services should be available 24 hrs a
day, 7 days a week.
•An appropriate number of respiratory therapists with
specialized training must be available to the unit at all
times. Ideal levels of staffing should be based on acuity,
using objective measures whenever possible.
•Therapists must undergo orientation to the unit before
providing care to ICU patients.
REQUIREMENTS
•Respiratory care services should be available 24 hrs a
day, 7 days a week.
•An appropriate number of respiratory therapists with
specialized training must be available to the unit at all
times. Ideal levels of staffing should be based on acuity,
using objective measures whenever possible.
•Therapists must undergo orientation to the unit before
providing care to ICU patients.
RESPIRATORY CARE PERSONNEL
REQUIREMENTS
•The therapist must have expertise in the use of
mechanical ventilators, including the various ventilatory
modes.
•Proficiency in the transport of critically ill patients is
required.
•Respiratory therapists should participate in continuing
education and quality improvement related to their unit
activities.
REQUIREMENTS
•The therapist must have expertise in the use of
mechanical ventilators, including the various ventilatory
modes.
•Proficiency in the transport of critically ill patients is
required.
•Respiratory therapists should participate in continuing
education and quality improvement related to their unit
activities.
•Ideally, 24-hr in-house coverage should be provided by
intensivists who are dedicated to the care of ICU patients
and do not have conflicting responsibilities.
•Ideal intensivist-to-patient ratios vary from ICU to ICU
depending on the hospital’s unique patient population.
Hospitals should have guidelines for these ratios based
on acuity, complexity, and safety considerations.
•The following physician subspecialists should be
available and be able to provide bedside patient care
within 30 mins:
intensivists who are dedicated to the care of ICU patients
and do not have conflicting responsibilities.
•Ideal intensivist-to-patient ratios vary from ICU to ICU
depending on the hospital’s unique patient population.
Hospitals should have guidelines for these ratios based
on acuity, complexity, and safety considerations.
•The following physician subspecialists should be
available and be able to provide bedside patient care
within 30 mins:
PHYSICIAN SUBSPECIALISTS
•General surgeon or trauma surgeon
•Neurosurgeon
•Cardiovascular surgeon
•Obstetric-gynecologic surgeon
•Urologist
•Thoracic surgeon
•Vascular surgeon
•Anesthesiologist
•Cardiologist with interventional capabilities
•Pulmonologist
•General surgeon or trauma surgeon
•Neurosurgeon
•Cardiovascular surgeon
•Obstetric-gynecologic surgeon
•Urologist
•Thoracic surgeon
•Vascular surgeon
•Anesthesiologist
•Cardiologist with interventional capabilities
•Pulmonologist
PHYSICIAN SUBSPECIALISTS
•Gastroenterologist
•Hematologist
•Infectious disease specialist
•Nephrologist
•Neuroradiologist (with interventional capability)
•Pathologist
•Radiologist (with interventional capability)
•Neurologist
•Orthopedic surgeon
•Gastroenterologist
•Hematologist
•Infectious disease specialist
•Nephrologist
•Neuroradiologist (with interventional capability)
•Pathologist
•Radiologist (with interventional capability)
•Neurologist
•Orthopedic surgeon
S.NO
.
THERAPIST FUNCTION
1. Physiotherapistsprevents and treat chest problems,
assist mobilization, and prevent
contractures in immobilized patients
2. Pharmacists A advise on potential drug
interactions and side effects, and drug
dosing in patients with liver or renal
dysfunction
3. Dietitians Advise on nutritional requirements
and feeds
4. Microbiologists Advise on treatment and infection
control
5. Medical physics
technicians
Maintain equipment, including patient
monitors, ventilators, haemofiltration
machines, and blood gas analysers
.
THERAPIST FUNCTION
1. Physiotherapistsprevents and treat chest problems,
assist mobilization, and prevent
contractures in immobilized patients
2. Pharmacists A advise on potential drug
interactions and side effects, and drug
dosing in patients with liver or renal
dysfunction
3. Dietitians Advise on nutritional requirements
and feeds
4. Microbiologists Advise on treatment and infection
control
5. Medical physics
technicians
Maintain equipment, including patient
monitors, ventilators, haemofiltration
machines, and blood gas analysers
OTHER PERSONNEL :
Avarietyofotherpersonnelmaycontributesignificantlyto
theefficientoperationoftheICU.Theseinclude:-
•Unitclerks
•physicaltherapists
•occupationaltherapists
•Advancedpracticenurses
•Physicianassistants
•Dietaryspecialists,and
•Biomedicalengineers.
Avarietyofotherpersonnelmaycontributesignificantlyto
theefficientoperationoftheICU.Theseinclude:-
•Unitclerks
•physicaltherapists
•occupationaltherapists
•Advancedpracticenurses
•Physicianassistants
•Dietaryspecialists,and
•Biomedicalengineers.
LABORATORY SERVICES
•A clinical laboratory should be
available on a 24-hr basis to provide
basic hematologic, chemistry, blood
gas, and toxicology analysis.
•Laboratory tests must be obtained in a
timely manner, immediately in some
instances. "STAT" or "bedside"
laboratories adjacent to the ICU or
rapid transport systems.
•A clinical laboratory should be
available on a 24-hr basis to provide
basic hematologic, chemistry, blood
gas, and toxicology analysis.
•Laboratory tests must be obtained in a
timely manner, immediately in some
instances. "STAT" or "bedside"
laboratories adjacent to the ICU or
rapid transport systems.
Radiology and imaging services:
•The diagnostic and therapeutic radiologic
procedures should be immediately
available to ICU patients, 24 hrs per day.
•Portable chest radiographs affect decision
making in critically ill patients.
•The diagnostic and therapeutic radiologic
procedures should be immediately
available to ICU patients, 24 hrs per day.
•Portable chest radiographs affect decision
making in critically ill patients.
ORGANIZATION OF ICU
•It requires intelligent planning.
•One must keep the need of the hospital and
its location.
•One ICU may not cater to all needs.
•An institute may plan beds into multiple
units under separate management by single
discipline specialist viz. medical ICU,
surgical ICU, CCU, burns ICU, trauma ICU,
etc.
•It requires intelligent planning.
•One must keep the need of the hospital and
its location.
•One ICU may not cater to all needs.
•An institute may plan beds into multiple
units under separate management by single
discipline specialist viz. medical ICU,
surgical ICU, CCU, burns ICU, trauma ICU,
etc.
ORGANIZATION OF ICU
•The number of ICU beds in a hospital ranges
from 1 to 10 per 100 total hospital beds.
•Multidisciplinary requires more beds than
single speciality. ICUs with fewer than 4 beds
are not cost effective and over 20 beds are
unmanageable.
•ICU should be sited in close proximity to
relevant areas viz. operating rooms, image
logy, acute wards, emergency department.
•There should be sufficient number of lifts
available to carry these critically ill patients
to different areas.
•The number of ICU beds in a hospital ranges
from 1 to 10 per 100 total hospital beds.
•Multidisciplinary requires more beds than
single speciality. ICUs with fewer than 4 beds
are not cost effective and over 20 beds are
unmanageable.
•ICU should be sited in close proximity to
relevant areas viz. operating rooms, image
logy, acute wards, emergency department.
•There should be sufficient number of lifts
available to carry these critically ill patients
to different areas.
ORGANIZATIONAL MODELS FOR ICUs:
•the open modelallows many different
members of the medical staff to manage
patients in the ICU.
•the closed modelis limited to ICU-certified
physicians managing the care of all patients;
and
•the hybrid model,which combines aspects
of open and closed models by staffing the
ICU with an attending physician and/or team
to work in tandem with primary physicians.
•the open modelallows many different
members of the medical staff to manage
patients in the ICU.
•the closed modelis limited to ICU-certified
physicians managing the care of all patients;
and
•the hybrid model,which combines aspects
of open and closed models by staffing the
ICU with an attending physician and/or team
to work in tandem with primary physicians.
DEFINITION OF INTENSIVE CARE UNIT
EQUIPMENTS:-
•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.
EQUIPMENTS:-
•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.
PURPOSE
•AnICUmaybedesignedandequipped
toprovidecaretopatientswitharange
ofconditions,oritmaybedesigned
andequippedtoprovidespecialized
caretopatientswithspecific
conditions
•AnICUmaybedesignedandequipped
toprovidecaretopatientswitharange
ofconditions,oritmaybedesigned
andequippedtoprovidespecialized
caretopatientswithspecific
conditions
DESCRIPTION
•Intensive care unit equipment
includes:-
•patient monitoring
•life support and emergency
resuscitation devices
•diagnostic devices
•Intensive care unit equipment
includes:-
•patient monitoring
•life support and emergency
resuscitation devices
•diagnostic devices
PATIENT MONITORING EQUIPMENTS
•Acute care physiologic monitoring
system
•Pulse oximeter
•Intracranial pressure monitor
•Apnea monitor
•Acute care physiologic monitoring
system
•Pulse oximeter
•Intracranial pressure monitor
•Apnea monitor
Bennett, D. et al. BMJ 1999;318:1468-1470
LIFE SUPPORT & RESUSCITATIVE
EQUIPMENTS
•VENTILATOR
•INFUSION PUMP
•CRASH CART
•INTRAAORTIC BALOON PUMP
EQUIPMENTS
•VENTILATOR
•INFUSION PUMP
•CRASH CART
•INTRAAORTIC BALOON PUMP
Bennett, D. et al. BMJ 1999;318:1468-1470
DIAGNOSTIC EQUIPMENTS
•MOBILE X-RAYS
•PORTABLE CLINICAL LAB. DEVICES
•BLOOD ANALYZER
•MOBILE X-RAYS
•PORTABLE CLINICAL LAB. DEVICES
•BLOOD ANALYZER
THERAPEUTIC ELEMENTS IN ICU
ENVIORNMENT
•Windowandartthatprovidesnatural
views;viewsofnaturecanreducestress,
hastenrecovery,lowerbloodpressureand
lowerpainmedicationneeds.
•Familyparticipation,includingfacilities
forovernightstayandcomfortablewaiting
rooms.
ENVIORNMENT
•Windowandartthatprovidesnatural
views;viewsofnaturecanreducestress,
hastenrecovery,lowerbloodpressureand
lowerpainmedicationneeds.
•Familyparticipation,includingfacilities
forovernightstayandcomfortablewaiting
rooms.
THERAPEUTIC ELEMENTS IN ICU
ENVIORNMENT
•Providngameasureofprivacyandpersonal
controlthroughadjustablecurtainsandblinds
,accessiblebedcontrols,andTV,VCRandCD
players.
•Noisereductionthroughcomputerizedpagersand
silentalarms.
•Medicalteamcontinuitythatallowsoneteamto
followthepatientthroughhisorherentirestay.
ENVIORNMENT
•Providngameasureofprivacyandpersonal
controlthroughadjustablecurtainsandblinds
,accessiblebedcontrols,andTV,VCRandCD
players.
•Noisereductionthroughcomputerizedpagersand
silentalarms.
•Medicalteamcontinuitythatallowsoneteamto
followthepatientthroughhisorherentirestay.
ICU TEAM
ICU deign should be approached by
multidisciplinary team consisting of :-
•ICU MEDICAL DIRECTORS
•ICU NURSE MANAGER
•THE CHIEF ARCHITECT
•THE OPERATING ENGINEERING
STAFF
ICU deign should be approached by
multidisciplinary team consisting of :-
•ICU MEDICAL DIRECTORS
•ICU NURSE MANAGER
•THE CHIEF ARCHITECT
•THE OPERATING ENGINEERING
STAFF
OTHER ADDITIONAL MEMBERS
•ENVIORNMENTAL ENGINEER
•INTERIOR DESIGNERS
•STAFF NURSES
•PHYSICIANS
•PATIENTS
•FAMILIES
•ENVIORNMENTAL ENGINEER
•INTERIOR DESIGNERS
•STAFF NURSES
•PHYSICIANS
•PATIENTS
•FAMILIES
•THECHIEFARCHITECT-Hemustbe
experienced inhospitalspace
programmingandhospitalfunctional
planning.
•ENGINEER–Heshouldbeexperiencedin
thedesignofmechanicaland
electrical systems For
hopitals,especiallycriticalcareunit.
experienced inhospitalspace
programmingandhospitalfunctional
planning.
•ENGINEER–Heshouldbeexperiencedin
thedesignofmechanicaland
electrical systems For
hopitals,especiallycriticalcareunit.
FLOOR PLAN AND DESIGN
IT SHOULD BE BASED ON:-
•Patientadmissionpattern
•Staff&visitortrafficpatterns
•Needforsupportfacilitiessuchanursing
station,Storage,clericalspace,
•Administrative&educationalrequirements.
•Servicesthatareuniquetotheindividual
institution.
IT SHOULD BE BASED ON:-
•Patientadmissionpattern
•Staff&visitortrafficpatterns
•Needforsupportfacilitiessuchanursing
station,Storage,clericalspace,
•Administrative&educationalrequirements.
•Servicesthatareuniquetotheindividual
institution.
FLOOR PLAN AND DESIGN
•Eighttotwelvebedsperunitis
consideredbestfromafunctional
perspective.
•Eachhealthcarefacilityshouldconsider
theneedforpositive-andnegative
pressureisolationroomswithintheICU.
•Thisneedwilldependmainlyuponpatient
populationandStateDepartmentofPublic
Healthrequirements.
•Eighttotwelvebedsperunitis
consideredbestfromafunctional
perspective.
•Eachhealthcarefacilityshouldconsider
theneedforpositive-andnegative
pressureisolationroomswithintheICU.
•Thisneedwilldependmainlyuponpatient
populationandStateDepartmentofPublic
Healthrequirements.
FLOOR PLAN AND DESIGN
•Eachintensivecareunitshouldbeageographically
distinctareawithinthehospital,whenpossible,
withcontrolledaccess.
•Nothroughtraffictootherdepartmentsshould
occur.Supplyandprofessionaltrafficshouldbe
separatedfrompublic/visitortraffic.
•Locationshouldbechosensothattheunitis
adjacentto,orwithindirectelevatortraveltoand
from,theEmergencyDepartment,Operating
Room,intermediatecareunits,andRadiology
Department
•Eachintensivecareunitshouldbeageographically
distinctareawithinthehospital,whenpossible,
withcontrolledaccess.
•Nothroughtraffictootherdepartmentsshould
occur.Supplyandprofessionaltrafficshouldbe
separatedfrompublic/visitortraffic.
•Locationshouldbechosensothattheunitis
adjacentto,orwithindirectelevatortraveltoand
from,theEmergencyDepartment,Operating
Room,intermediatecareunits,andRadiology
Department
PATIENT AREAS.:-
Patients must be situated so that direct or indirect
(e.g. by video monitor) visualization by healthcare
providers is possible at all times. This permits the
monitoring of patient status under both routine .and
emergency circumstances. 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.
Patients must be situated so that direct or indirect
(e.g. by video monitor) visualization by healthcare
providers is possible at all times. This permits the
monitoring of patient status under both routine .and
emergency circumstances. 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.
RECOMMENDED NOISE RANGES
Signalsfrompatientcallsystems,alarmsfrom
monitoringequipment,andtelephonesaddtothe
sensoryoverloadincriticalcareunits.
TheInternationalNoiseCouncilhasrecommended
thatnoiselevelsinhospitalacutecareareas
• notexceed45dB(A)inthedaytime,
• 40dB(A)intheevening,
• 20dB(A)atnight.
☻Notably,noiselevelsinmosthospitalsarebetween
50-70dB(A)withoccasionalepisodesabovethis
range
Signalsfrompatientcallsystems,alarmsfrom
monitoringequipment,andtelephonesaddtothe
sensoryoverloadincriticalcareunits.
TheInternationalNoiseCouncilhasrecommended
thatnoiselevelsinhospitalacutecareareas
• notexceed45dB(A)inthedaytime,
• 40dB(A)intheevening,
• 20dB(A)atnight.
☻Notably,noiselevelsinmosthospitalsarebetween
50-70dB(A)withoccasionalepisodesabovethis
range
CENTRAL STATION
•Acentralnursingstationshouldprovidea
comfortableareaofsufficientsizetoaccommodate
allnecessarystafffunctions.
•WhenanICUisofamodulardesign,eachnursing
substationshouldbecapableofprovidingmostif
notallfunctionsofacentralstation.
•Theremustbeadequateoverheadandtasklighting,
andawallmountedclockshouldbepresent.
•Adequatespaceforcomputerterminalsandprinters
isessentialwhenautomatedsystemsareinuse.
•Patientrecordsshouldbereadilyaccessible.
•Acentralnursingstationshouldprovidea
comfortableareaofsufficientsizetoaccommodate
allnecessarystafffunctions.
•WhenanICUisofamodulardesign,eachnursing
substationshouldbecapableofprovidingmostif
notallfunctionsofacentralstation.
•Theremustbeadequateoverheadandtasklighting,
andawallmountedclockshouldbepresent.
•Adequatespaceforcomputerterminalsandprinters
isessentialwhenautomatedsystemsareinuse.
•Patientrecordsshouldbereadilyaccessible.
CENTRAL STATION
•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.
•Although a secretarial area may be located
separately from the central station, it should
be easily accessible as well
•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.
•Although a secretarial area may be located
separately from the central station, it should
be easily accessible as well
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.
A "bright light" should also be available.
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.
A "bright light" should also be available.
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.
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.
RECEPTION AREA
RECEPTIONIST AREA
•EachICUorICUclustershouldhavea
receptionistareatocontrolvisitoraccess.
•Ideally,itshouldbelocatedsothatallvisitors
mustpassbythisareabeforeentering.
•ThereceptionistshouldbelinkedwiththeICU(s)
bytelephoneand/orotherintercommunication
system.
•Itisdesirabletohaveavisitors'entrance
separatefromthatusedbyhealthcare
professionals.
•Thevisitors'entranceshouldbesecurableifthe
needarises.
•EachICUorICUclustershouldhavea
receptionistareatocontrolvisitoraccess.
•Ideally,itshouldbelocatedsothatallvisitors
mustpassbythisareabeforeentering.
•ThereceptionistshouldbelinkedwiththeICU(s)
bytelephoneand/orotherintercommunication
system.
•Itisdesirabletohaveavisitors'entrance
separatefromthatusedbyhealthcare
professionals.
•Thevisitors'entranceshouldbesecurableifthe
needarises.
Special Procedures Room.
•Ifaspecialproceduresroomisdesired,itshould
belocatedwithin,orimmediatelyadjacentto,
theICU.
•Onespecialproceduresroommayserveseveral
ICUsincloseproximity.
•Considerationshouldbegiventoeaseofaccess
forpatientstransportedfromareasoutsidethe
ICU.
•Roomsizeshouldbesufficienttoaccommodate
necessaryequipmentandpersonnel.
•Ifaspecialproceduresroomisdesired,itshould
belocatedwithin,orimmediatelyadjacentto,
theICU.
•Onespecialproceduresroommayserveseveral
ICUsincloseproximity.
•Considerationshouldbegiventoeaseofaccess
forpatientstransportedfromareasoutsidethe
ICU.
•Roomsizeshouldbesufficienttoaccommodate
necessaryequipmentandpersonnel.
Special Procedures Room.
•Monitoringcapabilities,equipment,support
services,andsafetyconsiderationsmustbe
consistentwiththoseprovidedintheICU
proper.
•Worksurfacesandstorageareasmustbe
adequateenoughtomaintainallnecessary
suppliesandpermittheperformanceofall
desiredprocedureswithouttheneedfor
healthcarepersonneltoleavetheroom
•Monitoringcapabilities,equipment,support
services,andsafetyconsiderationsmustbe
consistentwiththoseprovidedintheICU
proper.
•Worksurfacesandstorageareasmustbe
adequateenoughtomaintainallnecessary
suppliesandpermittheperformanceofall
desiredprocedureswithouttheneedfor
healthcarepersonneltoleavetheroom
Clean and Dirty Utility Rooms.
•Cleananddirtyutilityroomsmustbe
separateroomsthatlackinterconnection.
•Theymustbeadequatelytemperature
controlled,andtheairsupplyfromthe
dirtyutilityroommustbeexhausted.
•Floorsshouldbecoveredwithmaterials
withoutseamstofacilitatecleaning.
•Thecleanutilityroomshouldbeusedfor
thestorageofallcleanandsterile
supplies,andmayalsobeusedforthe
storageofcleanlinen.
•Cleananddirtyutilityroomsmustbe
separateroomsthatlackinterconnection.
•Theymustbeadequatelytemperature
controlled,andtheairsupplyfromthe
dirtyutilityroommustbeexhausted.
•Floorsshouldbecoveredwithmaterials
withoutseamstofacilitatecleaning.
•Thecleanutilityroomshouldbeusedfor
thestorageofallcleanandsterile
supplies,andmayalsobeusedforthe
storageofcleanlinen.
Clean and Dirty Utility Rooms.
•Shelvingandcabinetsforstoragemustbelocated
highenoughoffthefloortoalloweasyaccessto
thefloorunderneathforcleaning.
•Thedirtyutilityroommustcontainaclinicalsink
andahopperbothwithhotandcoldmixing
faucets.
•Separatecoveredcontainersmustbeprovidedfor
soiledlinenandwastematerials.
•Thereshouldbedesignatedmechanismsforthe
disposalofitemscontaminatedbybodysubstances
andfluids.
•Specialcontainersshouldbeprovidedforthe
disposalofneedlesandothersharpobjects.
•Shelvingandcabinetsforstoragemustbelocated
highenoughoffthefloortoalloweasyaccessto
thefloorunderneathforcleaning.
•Thedirtyutilityroommustcontainaclinicalsink
andahopperbothwithhotandcoldmixing
faucets.
•Separatecoveredcontainersmustbeprovidedfor
soiledlinenandwastematerials.
•Thereshouldbedesignatedmechanismsforthe
disposalofitemscontaminatedbybodysubstances
andfluids.
•Specialcontainersshouldbeprovidedforthe
disposalofneedlesandothersharpobjects.
Equipment Storage
•Anareamustbeprovidedforthestorage
andsecuringoflargepatientcare
equipmentitemsnotinactiveuse.
•Spaceshouldbeadequateenoughto
provideeasyaccess,easylocationof
desiredequipment,andeasyretrieval.
•Groundedelectricaloutletsshouldbe
providedwithinthestorageareain
sufficientnumberstopermitrechargingof
batteryoperateditems.
•Anareamustbeprovidedforthestorage
andsecuringoflargepatientcare
equipmentitemsnotinactiveuse.
•Spaceshouldbeadequateenoughto
provideeasyaccess,easylocationof
desiredequipment,andeasyretrieval.
•Groundedelectricaloutletsshouldbe
providedwithinthestorageareain
sufficientnumberstopermitrechargingof
batteryoperateditems.
Nourishment Preparation Area
•Apatientnourishmentpreparationarea
shouldbeidentifiedandequippedwithfood
preparationsurfaces,anice-making
machine,asinkwithhotandcoldrunning
water,acountertopstoveand/ormicrowave
oven,andarefrigerator.
•Therefrigeratorshouldnotbeusedfor
thestorageoflaboratoryspecimens.
•Ahandwashingfacilityshouldbelocatedin
ornearthearea.
•Apatientnourishmentpreparationarea
shouldbeidentifiedandequippedwithfood
preparationsurfaces,anice-making
machine,asinkwithhotandcoldrunning
water,acountertopstoveand/ormicrowave
oven,andarefrigerator.
•Therefrigeratorshouldnotbeusedfor
thestorageoflaboratoryspecimens.
•Ahandwashingfacilityshouldbelocatedin
ornearthearea.
Staff Lounge.
•Astaffloungemustbeavailableonorneareach
ICUorICUclustertoprovideaprivate,
comfortable,andrelaxingenvironment.
•Securedlockerfacilities,showersandtoilets
shouldbepresent.
•Theareashouldincludecomfortableseatingand
adequatenourishmentstorageandpreparation
facilities,includingarefrigerator,acountertop
stoveand/ormicrowaveoven.
•TheloungemustbelinkedtotheICUbytelephone
orintercommunicationsystem,andemergency
cardiacarrestalarmsshouldbeaudiblewithin.
•Astaffloungemustbeavailableonorneareach
ICUorICUclustertoprovideaprivate,
comfortable,andrelaxingenvironment.
•Securedlockerfacilities,showersandtoilets
shouldbepresent.
•Theareashouldincludecomfortableseatingand
adequatenourishmentstorageandpreparation
facilities,includingarefrigerator,acountertop
stoveand/ormicrowaveoven.
•TheloungemustbelinkedtotheICUbytelephone
orintercommunicationsystem,andemergency
cardiacarrestalarmsshouldbeaudiblewithin.
Conference Room.
•AconferenceroomshouldbeconvenientlylocatedforICU
physicianandstaffuse.
•ThisroommustbelinkedtoeachrelevantICUbytelephoneor
otherintercommunicationsystem,andemergencycardiac
arrestalarmsshouldbeaudibleintheroom.
•Theconferenceroommayhavemultiplepurposesincluding
continuingeducation,house staffeducation,or
multidisciplinarypatientcareconferences.
•Aconferenceroomisidealforthestorageofmedicaland
nursingreferencematerialsandresources,VCRs,and
computerizedinteractiveandself-pacedlearningequipment.
•Iftheconferenceroomisnotlargeenoughforeducational
activities,aclassroomshouldalsobeprovidednearby.
•AconferenceroomshouldbeconvenientlylocatedforICU
physicianandstaffuse.
•ThisroommustbelinkedtoeachrelevantICUbytelephoneor
otherintercommunicationsystem,andemergencycardiac
arrestalarmsshouldbeaudibleintheroom.
•Theconferenceroommayhavemultiplepurposesincluding
continuingeducation,house staffeducation,or
multidisciplinarypatientcareconferences.
•Aconferenceroomisidealforthestorageofmedicaland
nursingreferencematerialsandresources,VCRs,and
computerizedinteractiveandself-pacedlearningequipment.
•Iftheconferenceroomisnotlargeenoughforeducational
activities,aclassroomshouldalsobeprovidednearby.
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.
•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.
Visitors' Lounge/Waiting Room.
•Warmcolours,carpeting,indirectsoft
lighting,andwindowsaredesirable.
•Avarietyofseating,includingupright,
lounge,andrecliningchairs,isalso
desirable.
•Educationalmaterialsandlistsofhospital
andcommunity-basedsupportandresource
servicesshouldbedisplayed.
•Aseparatefamilyconsultationroomis
stronglyrecommended.
•Warmcolours,carpeting,indirectsoft
lighting,andwindowsaredesirable.
•Avarietyofseating,includingupright,
lounge,andrecliningchairs,isalso
desirable.
•Educationalmaterialsandlistsofhospital
andcommunity-basedsupportandresource
servicesshouldbedisplayed.
•Aseparatefamilyconsultationroomis
stronglyrecommended.
Patient Transportation Routes
•PatientstransportedtoandfromanICU
shouldbetransportedthroughcorridors
separatefromthoseusedbythevisiting
public.
•Patientprivacyshouldbepreservedand
patienttransportationshouldberapidand
unobstructed.
•Whenelevatortransportisrequired,an
oversizedkeyedelevator,separatefrom
publicaccess,shouldbeprovided.
•PatientstransportedtoandfromanICU
shouldbetransportedthroughcorridors
separatefromthoseusedbythevisiting
public.
•Patientprivacyshouldbepreservedand
patienttransportationshouldberapidand
unobstructed.
•Whenelevatortransportisrequired,an
oversizedkeyedelevator,separatefrom
publicaccess,shouldbeprovided.
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.
•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.
Supply and Service Corridors
•Thecorridorshouldbeatleast8feetin
width.
•Doorways,openings,andpassagesintoeach
ICUmustbeaminimumof36inchesinwidth
toalloweasyandunobstructedmovementof
equipmentandsupplies.
•Floorcoveringsshouldbechosento
withstandheavyuseandallowheavy
wheeledequipmenttobemovedwithout
difficulty.
•Thecorridorshouldbeatleast8feetin
width.
•Doorways,openings,andpassagesintoeach
ICUmustbeaminimumof36inchesinwidth
toalloweasyandunobstructedmovementof
equipmentandsupplies.
•Floorcoveringsshouldbechosento
withstandheavyuseandallowheavy
wheeledequipmenttobemovedwithout
difficulty.
Patient Modules
•Ward-typeicusshouldallowatleast
225squarefeetofclearfloorareaper
bed.
•Icuswithindividualpatientmodules
shouldallowatleast250squarefeet
perroom(assumingonepatientper
room),
•Provideaminimumwidthof15feet,
excludingancillaryspaces(anteroom,
toilet,storage).
•Ward-typeicusshouldallowatleast
225squarefeetofclearfloorareaper
bed.
•Icuswithindividualpatientmodules
shouldallowatleast250squarefeet
perroom(assumingonepatientper
room),
•Provideaminimumwidthof15feet,
excludingancillaryspaces(anteroom,
toilet,storage).
Patient Modules
•Isolationroomsshouldeachcontainat
least250squarefeetoffloorspace
plusananteroom.
•Eachanteroomshouldcontainat
least20squarefeettoaccommodate
hand-washing,gowning,andstorage.
•Ifatoiletisprovided,itmustbe
private.
•Isolationroomsshouldeachcontainat
least250squarefeetoffloorspace
plusananteroom.
•Eachanteroomshouldcontainat
least20squarefeettoaccommodate
hand-washing,gowning,andstorage.
•Ifatoiletisprovided,itmustbe
private.
Patient Modules
•Acardiacarrest/emergencyalarmbutton
mustbepresentateverybedsidewithinthe
ICU.Thealarmshouldautomaticallysoundin
thehospitaltelecommunicationscenter,
centralnursingstation,ICUconference
room,stafflounge,andanyon-callrooms.
Theoriginofthesealarmsmustbe
discernable.
•Spaceandsurfacesforcomputerterminals
andpatientchartingshouldbeincorporated
intothedesignofeachpatientmoduleas
indicated.
•Acardiacarrest/emergencyalarmbutton
mustbepresentateverybedsidewithinthe
ICU.Thealarmshouldautomaticallysoundin
thehospitaltelecommunicationscenter,
centralnursingstation,ICUconference
room,stafflounge,andanyon-callrooms.
Theoriginofthesealarmsmustbe
discernable.
•Spaceandsurfacesforcomputerterminals
andpatientchartingshouldbeincorporated
intothedesignofeachpatientmoduleas
indicated.
Patient Modules
•Storagemustbeprovidedforeachpatient's
personalbelongings,patientcaresupplies,linenand
toiletries.Lockingdrawersandcabinetsmustbe
usedifsyringesandpharmaceuticalsarestoredat
thebedside.
•PersonalvaluablesshouldnotbekeptintheICU.
Rather,theseshouldbeheldbyHospitalSecurity
untilpatientdischarge.
•Everyeffortshouldbemadetoprovidean
environmentthatminimizesstresstopatientsand
staff.Therefore,designshouldconsidernatural
illuminationandview.
•Storagemustbeprovidedforeachpatient's
personalbelongings,patientcaresupplies,linenand
toiletries.Lockingdrawersandcabinetsmustbe
usedifsyringesandpharmaceuticalsarestoredat
thebedside.
•PersonalvaluablesshouldnotbekeptintheICU.
Rather,theseshouldbeheldbyHospitalSecurity
untilpatientdischarge.
•Everyeffortshouldbemadetoprovidean
environmentthatminimizesstresstopatientsand
staff.Therefore,designshouldconsidernatural
illuminationandview.
Patient Modules
•Windowsareanimportantaspectof
sensoryorientation,andasmanyroomsas
possibleshouldhavewindowstoreinforce
day/nightorientation.
•Drapesorshadesoffireprooffabriccan
makeattractivewindowcoveringsandserve
toabsorbsound.
•Windowtreatmentsshouldbedurableand
easytoclean,andaschedulefortheir
cleaningmustbeestablished
•Windowsareanimportantaspectof
sensoryorientation,andasmanyroomsas
possibleshouldhavewindowstoreinforce
day/nightorientation.
•Drapesorshadesoffireprooffabriccan
makeattractivewindowcoveringsandserve
toabsorbsound.
•Windowtreatmentsshouldbedurableand
easytoclean,andaschedulefortheir
cleaningmustbeestablished
IMPROVING SENSORY ORIENTATION
Additionalapproachestoimprovingsensory
orientationforpatientsmayinclude:-
•theprovisionofaclock,calendar,bulletin
board,
•pillowspeakerconnectedtoradioand
television.
•Televisionsmustbeoutofreachofpatients
andoperatedbyremotecontrol.
•Ifpossible,telephoneserviceshouldbe
providedineachroom.
Additionalapproachestoimprovingsensory
orientationforpatientsmayinclude:-
•theprovisionofaclock,calendar,bulletin
board,
•pillowspeakerconnectedtoradioand
television.
•Televisionsmustbeoutofreachofpatients
andoperatedbyremotecontrol.
•Ifpossible,telephoneserviceshouldbe
providedineachroom.
•Comfort considerationsshouldinclude
methodsforestablishingprivacyforthe
patient.Shades,blinds,curtains,anddoors
shouldcontrolthepatient'scontactwithhis/her
surroundings.
•Asupplyofportableorfoldingchairsshouldbe
availabletoallowforfamilyvisitsatthe
bedside.Anadditionalcomfortconsiderationis
thechoiceofcolorschemefortheroom,which
shouldpromoterestandhaveacalmingeffect.
•
methodsforestablishingprivacyforthe
patient.Shades,blinds,curtains,anddoors
shouldcontrolthepatient'scontactwithhis/her
surroundings.
•Asupplyofportableorfoldingchairsshouldbe
availabletoallowforfamilyvisitsatthe
bedside.Anadditionalcomfortconsiderationis
thechoiceofcolorschemefortheroom,which
shouldpromoterestandhaveacalmingeffect.
•
•Toprovideforvisualinterest,one
ormorewallswithinpatientview
maybeselectedforanaccent
color,texture,graphicdesignor
picture.
•Advice from environmental
engineersanddesignersshouldbe
soughttodeinstitutionalizepatient
careareasasmuchaspossible.
ormorewallswithinpatientview
maybeselectedforanaccent
color,texture,graphicdesignor
picture.
•Advice from environmental
engineersanddesignersshouldbe
soughttodeinstitutionalizepatient
careareasasmuchaspossible.
Utilities
•Each intensive care unit must have :-
•Electrical power,
•Water, oxygen,
•Compressed air,
•Vacuum, lighting,
•And environmental control systems
thatsupporttheneedsofthepatients
andcriticalcareteamundernormalandemergency
situations,andthesemustmeetorexceed
regulatoryandaccreditationagencycodesand
standards.
•Each intensive care unit must have :-
•Electrical power,
•Water, oxygen,
•Compressed air,
•Vacuum, lighting,
•And environmental control systems
thatsupporttheneedsofthepatients
andcriticalcareteamundernormalandemergency
situations,andthesemustmeetorexceed
regulatoryandaccreditationagencycodesand
standards.
ELECTRIC SUPPLY
•Grounded110voltelectricaloutletswith30amp
circuitbreakersshouldbelocatedwithinafewfeet
ofeachpatient'sbed.
•Sixteenoutletsperbedaredesirable.
•Outletsattheheadofthebedshouldbeplaced
approximately36inchesabovethefloortofacilitate
connection,
•Todiscouragedisconnectionbypullingthepower
cordratherthantheplug.
•Outletsatthesidesandfootofthebedshouldbe
placedclosetothefloortoavoidtrippingover
electricalcords.
•Grounded110voltelectricaloutletswith30amp
circuitbreakersshouldbelocatedwithinafewfeet
ofeachpatient'sbed.
•Sixteenoutletsperbedaredesirable.
•Outletsattheheadofthebedshouldbeplaced
approximately36inchesabovethefloortofacilitate
connection,
•Todiscouragedisconnectionbypullingthepower
cordratherthantheplug.
•Outletsatthesidesandfootofthebedshouldbe
placedclosetothefloortoavoidtrippingover
electricalcords.
Water Supply.
•Thewatersupplymustbefromacertified
source,especiallyifhemodialysisistobe
performed.
•Zonestopvalvesmustbeinstalledonpipes
enteringeachICUtoallowservicetobeturned
offshouldlinebreaksoccur.
•Hand-washingsinksdeepandwideenoughto
preventsplashing,preferablyequippedwith
elbow-,knee-,foot-,orsonar-operatedfaucets,
mustbeavailableneartheentrancestopatient
modules,orbetweeneverytwopatientsinward-
typeunits.
•Thewatersupplymustbefromacertified
source,especiallyifhemodialysisistobe
performed.
•Zonestopvalvesmustbeinstalledonpipes
enteringeachICUtoallowservicetobeturned
offshouldlinebreaksoccur.
•Hand-washingsinksdeepandwideenoughto
preventsplashing,preferablyequippedwith
elbow-,knee-,foot-,orsonar-operatedfaucets,
mustbeavailableneartheentrancestopatient
modules,orbetweeneverytwopatientsinward-
typeunits.
Lightning
•Totalluminanceshouldnotexceed30foot-candles.
•Itispreferabletoplacelightingcontrolsonvariable-
controldimmerslocatedjustoutsideoftheroom.
•Nightlightingshouldnotexceed6.5fcfor
continuoususeor19fcforshortperiods.
•Separatelightingforemergenciesandprocedures
shouldbelocatedintheceilingdirectlyabovethe
patientandshouldfullyilluminatethepatientwithat
least150fcshadow-free
•Apatientreadinglightisdesirable,andshouldbe
mounted
•Totalluminanceshouldnotexceed30foot-candles.
•Itispreferabletoplacelightingcontrolsonvariable-
controldimmerslocatedjustoutsideoftheroom.
•Nightlightingshouldnotexceed6.5fcfor
continuoususeor19fcforshortperiods.
•Separatelightingforemergenciesandprocedures
shouldbelocatedintheceilingdirectlyabovethe
patientandshouldfullyilluminatethepatientwithat
least150fcshadow-free
•Apatientreadinglightisdesirable,andshouldbe
mounted
Environmental Control Systems.
•Aminimumofsixtotalairchangesperroomper
hourarerequired,withtwoairchangesperhour
composedofoutsideair.
•Forroomshavingtoilets,therequiredtoiletexhaust
of75cubicfeetperminuteshouldbecomposedof
outsideair.
•Centralair-conditioningsystemsandrecirculatedair
mustpassthroughappropriatefilters.
•Aminimumofsixtotalairchangesperroomper
hourarerequired,withtwoairchangesperhour
composedofoutsideair.
•Forroomshavingtoilets,therequiredtoiletexhaust
of75cubicfeetperminuteshouldbecomposedof
outsideair.
•Centralair-conditioningsystemsandrecirculatedair
mustpassthroughappropriatefilters.
•Air-conditioningandheatingshouldbe
providedwithanemphasisonpatient
comfort.
•Forcriticalcareunitshavingenclosed
patientmodules,thetemperature
shouldbeadjustablewithineach
module.
providedwithanemphasisonpatient
comfort.
•Forcriticalcareunitshavingenclosed
patientmodules,thetemperature
shouldbeadjustablewithineach
module.
Computerized Charting
•Thesesystemsprovidefor"paperless"datamanagement,orderentry,andnurse
andphysiciancharting.Ifandwhenadecisionismadetoutilizethistechnology,it
isimportanttointegratesuchasystemfullywithallICUactivities.
•Bedsideterminalsfacilitatepatientmanagementbypermittingnursesand
physicianstoremainatthebedsideduringthechartingprocess.
•Thesesystemsprovidefor"paperless"datamanagement,orderentry,andnurse
andphysiciancharting.Ifandwhenadecisionismadetoutilizethistechnology,it
isimportanttointegratesuchasystemfullywithallICUactivities.
•Bedsideterminalsfacilitatepatientmanagementbypermittingnursesand
physicianstoremainatthebedsideduringthechartingprocess.
OTHER FACILITIES
•Voice Intercommunication Systems
•Satellite Laboratory
•Physician On-Call Rooms
•Administrative Offices
•Voice Intercommunication Systems
•Satellite Laboratory
•Physician On-Call Rooms
•Administrative Offices
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