hospital design

1. 40
Intensive Care Unit
Design

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Objectives:
At the end of this lecture the student will be able to:
 Define intensive care unit
 State types of intensive care units
 Discuss planning and organization of intensive care units
Outline:
 Definition of intensive care unit
 Types of intensive care units
 Planning and organization of intensive care units

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Intensive Care Unit Design
During the last two decades critical care medicine has undergone rapid changes
and has emerged as a discipline by itself. Critically ill patients consume
disproportionate resources in the form of manpower, specialized equipment,
facilities, and expensive medications. In the past, all this was generally provided
to critically ill patients in respective wards in which the patient was admitted. It
was realized that this arrangement was not conducive to efficiency, economy,
and reduction in mortality and complications.
Definition of Intensive Care Unit (ICU):
- It is a nursing unit specially designed, equipped and staffed to manage
critically ill patients who are requiring constant observation, irrespective of age,
sex and diagnosis, and requiring extraordinary nursing care.
- It is a nursing unit where intensive monitoring, active life support, specific
therapy and specialized nursing care is provided, where technical expertise and
sophisticated equipment are concentrated for critically ill patients.
Types of Intensive Care Units:
Depending upon types of patients admitted, intensive care units can be
classified as following:
 MICU: Medical Intensive Care Unit
 SICU: Surgical Intensive Care Unit
 ICCU: Intensive Coronary Care Unit
 BICU: Burns Intensive Care Unit
 NICU: Neonatal Intensive Care Unit
 PICU: Paediatric Intensive Care Unit
 OICU: Obstetrics Intensive Care Unit
Planning and organization of ICUs:
1. Intensive Care Unit Size:
It is estimated that a 10 bed multidisciplinary ICU should meet the requirement
of up to 300 bed district hospital. Every hospital above 100 beds should have a
fully equipped and staffed ICU.

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2.Location and spatial Requirements:
The ICU should preferably be located on the ground floor with convenient
access from the Operation Theater and emergency department and easy
accessibility for wards. However, there is no bar on its location on upper floors,
if other factors are suitable. The location should be away from the main hospital
traffic corridors. It must have a close relationship with laboratory, radiology,
and physiotherapy department.
3.Private ICU room versus Open Ward:
A higher level of privacy should be made available, where appropriate, with
walls, doors blinds or curtains in an environment which features enough glass to
ensure that clinical observation requirements can easily be met as necessary.
4.Design and Layout:
The design of the ICU should take into consideration the integration and smooth
functioning of three areas, these are:
a) The patient area
b)The staff area
c) The support area
The design should meet four basic requirements. They are:
1) Direct observation of the patient by nursing and medical staff
2) Surveillance of physiological monitoring
3) Provision and efficient use of routine and emergency diagnostic procedures
and therapeutic interventions
4) Recording and maintenance of patient information.
An ICU has to be spacious and uncluttered so that the movement of staff and
equipment is easy, free, and un-cramped.
5.Patient bed area:
- The essential planning feature is a fully observable bed area with adequate
space for positioning of equipment.
- It requires space to accommodate ventilator, cardiac monitor, pulse oximeter,
suction machine, and mobile x-ray machine.
- Each patient bed area should have a minimum or space of 150 to 200 sq. feet
in an open bay design, and there should be a minimum distance of 8 feet
between beds.

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- The portioning between beds can be of thick particle board, up to 4 feet
height from ground level and transparent glass above it up to the ceiling. Thus a
patient in bed has no view of the adjacent room, but medical staff have a
constant view of the patient in adjoining room.
- Each bed must have an oxygen outlet, a central suction outlet and a number
of power outlets. As far as possible, oxygen outlets, suction outlets and
monitoring equipment should be wall mounted. This saves space and allows
more easy movements.
6.Central nursing station:
- The central nursing station should be located so as to allow an unobstructed
view of each patient. This is problematic if the patient beds are in straight line,
and easier if the beds are placed along an arch opposite the nursing station.
- It should provide seating arrangement for at least one nurse and one
physician. There should be counters for writing notes and for reception and
interaction with other staff.
- The station should have adequate room for storage of essential items, records,
charts, and supplies. A telephone at the station is a must. Also, an alarm button
should be provided here which can be activated whenever there is any dire
emergency in the ICU.
- A mobile emergency trolley carrying all emergency drugs required for
cardiopulmonary resuscitation should be at hand at the nursing station.
- Medication preparation area should be closed to the nursing station and
patient area. Equipment in this area include a counter top, a refrigerator, locked
cabinet for narcotics and expensive drugs, and a wash basin.
- The other accommodation in the ICU will include nurses room with toilet,
doctors’ room with toilet, and store room.
7.Toilets for the ICU:
- Toilets may be individual or shared between rooms. In most cases, the toilets
are used most often to empty the bedpans, rather than a site for the patient to
eliminate.
- The best disposal method for bedpan, whether used in bed or a chair, would
be a deep clinical sink with sufficient size and a bedpan washer to properly
clean a bedpan.

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8.Clean and dirty utility rooms:
- The clean utility room contains procedure trays, bandages, linen, intravenous
solutions, catheters, and other similar items.
- The dirty utility room should be separate from the other work area. Waste
material, disposable, soiled material, and soiled linen are all housed in this
room. The room should have one or two large sinks.
9. Storage room:
- An ICU has a large number of items of various equipment. It is necessary to
have a large storage area to house equipment, stretchers, ECG machines and
numerous other items of storage.
- The storage room should have an area of about 15-20 percent of the patient
area.
10. Visitor lounge:
A visitor’s lounge, where such people can wait their turn to go in for a brief
period to see the patient thus becomes almost a necessity near the ICU. In the
entrance, space can be provided for donning caps and masks, and gown if
considered necessary.
11. Air conditioning:
Ideally the ICU should be centrally air-conditioned, and designed to provide 7-8
air change per hour and a positive pressure to prevent reentry of outside
contaminated air. Adequate number of window type air conditioners with
efficient filters is the next best option.
12. Lighting and electricity:
- The main light at the bed head should be fitted with a dimmer switch.
Additionally a high intensity emergency light or spot focusing light should also
be provided.
- Due to multiple electrical gadgets required to be used for the patient, each
room or patient cubicle should have at least four or five power sockets on either
side of the bed, two of which must be of 15 Amp rating, to plug on mobile X-
ray machine or other high power equipment.

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- The entire ICU must be connected to a stand by generator. It should be
powerful enough to take on the full load of the ICU, including a large number of
equipment. The generator should be capable of automatically switching on
within seconds on failure of the main electric supply.