Intensive Care Unit

Intensive Care Unit زهرا منتظرتربتی کارشناسی ارشد

Types Specialized 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)

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 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 & BEDS • 150 – 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 free • movement of staff and equipment, reducing risk of cross contamination. • 225 – 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.

•Partitions Privacy partitions should be of material that is easily cleaned and should be cleaned weekly and any time that it becomes soiled or contaminated. If curtains are used, they should be changed weekly and between patients.

Central Station. provide a comfortable area of sufficient size to accommodate all necessary staff functions. There must be adequate overhead and task lighting, and a wall mounted clock should be present. space foAdequate r computer terminals and printers 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).

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 or immediately adjacent to each ICU. Receptionist Area. it should be located so that all visitors must pass by this area before entering It is desirable to have a visitors' entrance separate from that used by healthcare professionals.

Medication preparation Medication prep areas should be separate from patient care areas and should be maintained as a clean area.

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 Rooms should be available close to the ICU(s) Toilet and shower facilities should be provided On-call rooms must be linked to the ICU(s) by telephone and/or voice intercommunication system cardiac arrest/emergency alarms must be audible in these rooms

EQUIPMENT mechanical ventilators to assist breathing through • an endotracheal tube • a tracheotomy cardiac monitors including • those with telemetry • external pacemakers • Defibrillators dialysis 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 to the main circuit breaker panel that serves the branch circuits in the ICU. The main panel should also be connected to an emergency power source that will quickly re-supply power in the event of power interruption. It is critical that the ICU staff have easy access to the main panel in case power must be interrupted for an electrical emergency.

Water Supply. The water supply must be from a certified source especially if hemodialysis is to be performed Hand-washing sinks deep and wide enough to prevent splashing,

Oxygen, Compressed Air two oxygen outlets per patient are required One compressed air outlet per bed is required; two are desirable Connections for oxygen and compressed air outlets must occur by keyed plugs to prevent the accidental interchanging of gases Audible and visible low and high pressure alarms must be installed both in each ICU

Lighting General overhead illumination plus light from the surroundings should be adequate for routine nursing tasks, including charting create a soft lighting environment for patient comfort. It is preferable to place lighting controls located just outside of the room. This permits changes in lighting at night from outside the room, allowing a minimum disruption of sleep during patient observation. Separate lighting for emergencies and procedures should be located in the 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.

Intensive Care Unit