Critical care

1. Critical Care Unit:
Setting, Design & Facilities
1Prof. Dr. Ram Sharan Mehta, MSND, CON, BPKIHS

2. CLASSIFICATION OF
CRITICAL CARE PATIENTS
 Level O : normal ward care
 Level 1: at risk of deteriorating , support
from critical care team
 Level 2 : more observation or
intervention, single failing organ or post
operative care
 Level 3; advanced respiratory support or
basic respiratory support ,multiorgan
failure 2Prof. Dr. R S Mehta, BPKIHS

3. Types of ICU
 General
 Medical Intensive Care Unit(MICU)
 Surgical Intensive Care Unit
 Medical Surgical Intensive Care Unit(MSICU)
 Specialized
 Neonatal Intensive Care Unit(NICU)
 Special Care Nursery(SCN)
 Paediatric Intensive Care Unit(PICU)
 Coronary Care Unit(CCU)
 Cardiac Surgery Intensive Care Unit(CSICU)
 Neuro Surgery Intensive Care Unit(NSICU)
 Burn Intensive Care Unit(BICU)
 Trauma Intensive Care Unit
3Prof. Dr. R S Mehta, BPKIHS

4. DESIGN OF ICU
Prof. Dr. R S Mehta, BPKIHS 4

5. ORGANIZATION OF ICU
 DESIGN OF ICU :
1. Should be at a geographically distinct area
within the hospital, with controlled access.
2. There should be a single entry and exit.
However, it is required to have emergency exit
points in case of emergency and disaster.
3. There should not be any through traffic of
goods or hospital staff. Supply and professional
traffic should be separated from public/visitor
traffic. 5Prof. Dr. R S Mehta, BPKIHS

6. 4. Safe, easy, fast transport of a critically sick pt
should be a priority in planning its location.
Therefore, the ICU should be located in close
proximity or ER, OT, trauma ward etc.
5. Corridors, lifts and ramps should be spacious
enough to provide easy movement of bed/trolley
of a critically sick patient.
6. Close, easy proximity is also desirable to
diagnostic facilities, blood bank, pharmacy etc.
 BED STRENGTH:
1. It is recommended that total bed strength in ICU
should be between 8-12 and not less than 6 or
not more than 24 in any case.
6Prof. Dr. R S Mehta, BPKIHS

7. 2. 3-5 beds per 100 hospital beds for a Level III ICU
or 2 to 20% of the total no of hospital beds.
3. 1 isolation bed for every ICU beds.
 BED AND ITS SPACE:
1. 150-200 sq.ft per open bed with 8 ft in between
beds.
2. 225-250 sq.ft per bed if in a single room.
3. Beds should be adjustable, no head board, with
side rails and wheels.
4. Keep bed 2 ft away from head wall.
7Prof. Dr. R S Mehta, BPKIHS

8.  ACCESSORIES:
1. 3 O2 outlets, 3 suction outlets (gastric, tracheal
and underwater seal), 2 compressed air outlets
and 16 power outlets per bed.
2. Storage by each bedside.
3. Hand rinse solution by each bedside.
4. Equipment shelf at the head end.
5. Hooks and devices to hang infusions/ blood
bags, extended from the ceiling with a sliding rail
to position.
6. Infusion pumps to be mounted on stand or poles.
7. Level II ICUs may require multi channel invasive
monitors. 8Prof. Dr. R S Mehta, BPKIHS

9. 8. ventilators, infusion pumps, portable X ray unit,
fluid and bed warmers, portable light,
defibrillators, anaesthesia machines and difficult
airway management equipments are necessary.
 STAFFING :
1. Medical Staff – the best senior medical staff to
be appointed as an Intensive Care Director or
Intensivist. Less preferred are other specialists
from anaesthesia / medicine who has clinical
commitment elsewhere. Junior staff are intensive
care trainers and trainees on deputation from
other disciplines.
2. Nursing staff – The major teaching tertiary care
ICU requires trained nurses in critical care. 9

10. The no of nurses ideally required for such unit is
1:1 ratio, however it might not be possible to have
such members in our set up. So 1 nurse for 2
patients is acceptable. The no of trained nurses
should also be worked out by the type of ICU, the
workload and work statistics and type of patient
load.
3.Allied Services – Respiratory services,
Nutritionist, Physiotherapist, Biomedical engineer,
technicians, computer programmer, clinical
pharmacist, social worker / counsellor and other
support staff, guards and grade IV workers.
10Prof. Dr. R S Mehta, BPKIHS

11. Design Summary:
 For critically ill: unstable patients
 Level: I II III
 Bed strength: ideal 8-14
 Each pt. > 100 sq. ft. ( 125-150 desirable)
 Additional space = 100%
 10% isolation bed
 At least 2 barriers to enter ICU
Prof. Dr. R S Mehta, BPKIHS 11

12.  Only one entry and exit, emergency exit
 Proper fire extinguisher
 At least 2 ft. away from head wall
 Central nursing station: all pt. visible
Environment requirements:
 Heating, ventilation, air-conditioning
system in ICU (HVAC system)
 Fully air-conditioned : 6 cycle/hr, 2 cycle
outside air
 Temperature = 16-25 oC
Prof. Dr. R S Mehta, BPKIHS 12

13.  Light: high illumination, 150 foot candle
(fc), overhead light = 20fc, floor light at
night = 10fc
 Noise control: Under 45 dBA in day, <40
in evening, <20 in night. (watch tick= 20
& normal conversation at 55)
 Furniture: solid, non-porous, stain
resistant.
 Floor: easy to clean and non-slippery
 Wall= 4-5 ft. finished with tiles
 Ceiling: paint with soft color, no wire lines
Prof. Dr. R S Mehta, BPKIHS 13

14. Thank you
14Prof. Dr. R S Mehta, BPKIHS