Speaker: Dr.

Saurav Mittal
Moderator: Dr. Anju R. Bhalotra
Introduction

Intensive care unit (ICU) is a specially staffed and

equipped hospital ward dedicated to
management of patients with life threatening
illnesses, injuries or complications.
Levels of Adult ICUs

 Level I-Small district hospital and small

private nursing homes for resuscitation and
short term support
 Level II- General hospital provides high
standard of general intensive care
 Level III-Tertiary hospital provides all aspects
of intensive care for indefinite periods
Other ICUs

 Pediatric ICU-for infants and children; with

pediatric intensive care specialists
 Neonatal ICU-for neonates; managed by
neonatologists
 High dependency unit (HDU)-intermediate
between intensive care and general ward care
 Coronary care unit (CCU)
The old concept of identifying ICU as just a
separate area with high-tech gadgets no
longer holds true. One should take
cognizance of the recent developments
and the various recommendations by
bodies like the Society of Critical Care
Medicine (SCCM), Indian Society of Critical
Care Medicine (ISCCM) and the published
literature on the subject. An important
dimension is the concerns of the patients
and their families, who often complain
about overwhelming feelings of insecurity,
disorientation, anxiety, fear and anger. The
sheer volume of technology, the unfamiliar,
sterile surroundings, lack of privacy,
constantly revolving medical teams,
incessant noise and glaring light, and the
lack of natural forms, materials, and
sensory experiences all add to this
traumatic experience. As a result, the
patients feel trapped in an environment
they dislike and cannot control, and their
families feel helpless.
Planning of ICU

Design team should consist of:

 Critical care specialists
 Critical care nurses
 Administrators
 Engineers and Architects
 Inputs from other departments eg. medicine,
surgery, anaesthesia, biochem, radiology etc.
Staffing of icu
· Intensivist/s
· Resident doctors
· Nurses,
· Respiratory Therapists,
· Nutritionist
· Physiotherapist
· Technicians, Computer programmer,
· Biomedical Engineer, and
· Clinical Pharmacist
· Social worker or counsellor
· Other support staff. Like cleaning staff,
guards and Class IV.
Determining ICU function
 Level of care to be provided
 Multidisciplinary vs single discipline unit
Multidisciplinary have economic and operational
advantages
Duplication of equipment and services is avoided
Approach to treatment of all critically ill patients is
similar
Single discipline units eg. neurosurg, cardiac surg,
burns, trauma managed by single discipline doctors
are economically and operationally demanding
Site of ICU

 ICU should be geographically distinct area in

hospital
 Function as autonomous department with
controlled access and no through traffic
 In close proximity (horizontally or vertically) to
operating rooms, emergency dept,
investigational dept so that minimal transport of
critically ill patients.
 Lifts, doors and corridors to be spacious for easy
passage of beds and equipments
There should not be any thorough traffic to
other departments from the ICU. It is a
good idea to separate the supply and
professional traffic from public/ visitor
traffic. A direct elevator is an excellent idea
to transfer sick patients to and fro from the
ICU, reducing transport time and avoiding
the visitors. The patient transport corridors
should be separate than those used by the
visiting public. Patient privacy should be
preserved and transportation should be
rapid and unobstructed. The elevators
should be oversized keyed elevators,
separate from public access. The support
facilities should include nursing stations,
storage, clerical space, administrative and
educational requirements, and other
services unique to the institution.
Size of ICU

 Number of ICU beds usually 1-4 per 100

hospital beds depending upon type and role
of ICU
 Multidisciplinary require more beds than
single discipline
 Requirement also depends on availability of
separate high dependency beds
 ICU to have no less than 4 and not more than
20 beds, 8-12 beds best functionally
Design of ICU-Floor Plan

 Open ward design vs multiple single rooms

 Single rooms offer isolation and privacy but
requires more nursing staff
 Open ward ICU requires some single rooms
 Ratio of isolation room beds to open ward beds
to be 1:10 for multidisciplinary ICU
 Traffic flow patterns-for patient transport,
restocking bed side supplies, rapid staff access
Physical Design of ICU

 Reception area
 Patient Areas
 Support and storage areas
 Staff areas
 Technical areas
Reception Area

 Receptionist at the entrance of ICU who

controls access
 Waiting room for visitors (1-2 seats for every
ICU bed)
 Interview room for grieving relatives
 Overnight relatives’ room
 Patient Areas

 125-150 sq. ft. floor area for each open area bed
space and 150-180 sq. ft. for single rooms*
 Hand washing and gowning areas for each
isolation room
 Positive/negative pressure air conditioning for
isolation rooms

*Intensive care society Guidelines

 Utilities per bed space

 3 oxygen(centrally supplied oxygen must be at50- 55 psi)

 2 air
 3 suction(must maintain vacum of 290 mmhg at farthest outlet)
 16 power outlets
 A bed side light(should illuminate patient with minimum 150 fc)
Usually mounted at wall as beds are traditionally placed with the head towards the wall
 Facilities to hang IV and blood containers
 Space for monitoring equipments
 Space for charts, sampling tubes, syringes, suction catheters
 Outlets for telephone, radio optional
 Uninterrupted power supply and battery backup
 Patient call system

installation must follow NFPA standards

Central nursing station

 The middle or end of open ward for direct

visualization of patients
 Patient and video monitors
 Patient records, stationary
 Drugs cupboard
 Specimens/Drugs refrigerator
 Telephone, intercom
Other things in patient area

 Hand wash sinks-deep and wide, non splash,

infra-red operated taps
 Distinct area for storing and viewing
radiographs
 Space for parking emergency trolleys eg.
defib, airway management trolleys
Support and Storage Areas

Each ICU bed requires 25% floor space for storage

 Monitoring, electrical equipment
 Respiratory therapy equipment
 Disposables and central sterilizing supplies
 Linen
 Stationery
 Fluids, vascular catheters, infusion sets
 Utility rooms-clean and dirty
 Equipment sterilization
 Enteral meal preparation area
Staff areas

 Lounge/rest room
 Changing rooms
 Toilets and showers
 Offices
 Doctors’ on call rooms
 Seminar/conference room
Technical Areas

 Stat laboratory for ABG, serum electrolytes,

hemoglobin etc
 Workshop for repairs, maintenance and
equipment checks
 Cleaner’s room
Equipment in Major ICU

 Monitoring
 Radiology
 Respiratory therapy
 Cardiovascular therapy
 Support therapy-temp control, transport
 Dialysis therapy
 Laboratory
 List of Equipment
 Bedside monitors 1 per bed Gluometer-2
 Ventilators – 6-12 Intubating videoscope-1
 Non invasive ventilators - 3 Cervical collars-4
 Infusion pumps atleast 2 per bed Spinal boards-2
 Syringe pumps atleast 2 per bed Bedside x-ray-1
 Head end panel Echo and Ultrasound-1
 Defibrillator with pacing facility -2 Ambu mask-10
 Beds -1 for each Trays for proedures
 Over bed table-1 for each bed I A balloon pump-1
 Abg machine-1+1 Fiberoptic bronchosope-1
 Crash trolley-2
 Pulse oximeter-2 as standby
 Airbeds -6
 Leg comprssion devices-2
 Refrigerator-1+1
 Computer-2
Environmental services and
control
 Time and sensory orientation-natural
illumination, clocks, calendars
 Warm colours and soft furnishings
 Reducing noise levels(max 45db in daytime and
20 db in night)
 Overhead, task lighting, bright spotlights, night
lights
 Air conditioning with HEPA filters
 Communications and networking
 RO water recirculation system at few beds
 Exhaust at isolation rooms
Staffing of Major ICU

 Medical-director, specialists, junior doctors

 Nurses—head, intensive care nurses, in
training, nursing helpers
 Allied health-physiotherapist, pharmacist,
dietician, social worker, respiratory therapist
 Administrative staff-secretary
 Technicians, orderlies, cleaners
Operation of ICU

 Open has unlimited access to multiple doctors

with freedom to admit and manage their patients

 Closed has admission, discharge and referral

policies under intensivist’s control

 Management in consultation policy-team of

anesthetists look after emergency and day to day
aspects but co-manages the patient with the
referring specialists
 Operational policies
 Policies for admission, discharge, referral clearly
defined
 Responsibilities and job descriptions defined for all
staff members
 Hand washing, gowns, overshoes policies before
entering
 Cleanliness in ICU-floor, bed, windows, curtains,
patient, swabs for cultures
Operational policies

Standardized policies for patient care which

should be evidence based
 Antibiotic policies not to favour emergence of
resistant species
 Change of catheters
 Change of airway tubes to prevent
nosocomial infections
Quality assurance

 Structure-documentation of ICU functioning,

data on clinical work load and case mix
 Clinical process-audits of clinical performance
as review meetings, clinical-pathological
conference, critical incident reporting
 Outcome-mortality rates, scoring systems
 Summary
 · ICU is a highly specialised part of a hospital or Nursing home where very sick
 patients are treated.
 · It should be located near ER and OT and easily accessible to clinical Lab. Imaging
 and Operating rooms.
 · No Thorough fare can be allowed trough it
 · Ideal Bed strength should be 8 to 14. More than 14 beds may put stress on ICU staff
 and may also have a negative bearing on patient outcome. <6 Bed strength will be
 neither viable or provide enough training to the staff of ICU
 · Each patient should have a room size of >100 sq ft , However a space of 125 to 150
 sq ft per pt will be desirable .
 · Additional space equivalent to 100 % of patient room area should be allocated to
 accommodate nursing stn, storage etc.
 · 10% beds should be reserved for patients requiring isolation.
 · Two rooms may be made larger to accommodate more equipment for patients
 undergoing multiple procedures like Ventilation, RRT Imaging and other procedures.
 · There should be at least two barriers to the entry of ICU
 · There should be only one entry and exit to ICU to allow free access to heavy duty
 machines like mobile x-ray, -bed and trolleys on wheels and some time other
 repairing machines.
 · At the same time it is essential to have an emergency exit for rescue removal of
 patients in emergency and disaster situations.
 · Proper fire fighting /extinguishing machines should be there.
 · It is desirable to have access to natural light as much as possible to each patient .
Thank You