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Guidelines for Intensive Care Unit Design

Guidelines for Intensive Care Unit Design

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Guidelines for Intensive CareUnit Design
Copyright © by the SOCIETY OF CRITICAL CARE MEDICINEThese guidelines can also be found in the March 1995 issue of 
Critical Care Medicine --Crit Care Med 
1995 Mar; 23(3):582-588Society of Critical Care Medicine701 Lee StreetSuite 200Des Plaines, IL 60016Phone: 847/827-6869
Society of Critical Care Medicine
Guidelines for Intensive Care Unit Design
Guidelines/Practice Parameters Committee of theAmerican College of Critical Care MedicineSociety of Critical Care Medicine
 The year 1983 marked the expiration of the Hill-Burton Act, a 1947 Federal regulation that provided funding andoversight for the design and construction of hospitals and other healthcare facilities (1). Since 1983, this oversight hasbeen carried out by each individual State. In addition, organizations such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the National Fire Prevention Association (NFPA) have independentlydeveloped minimum standards for healthcare institutions. Although the standards set by these non-State agencies aretechnically considered non-binding, many governmental and private reimbursement organizations require compliance toqualify for reimbursement.The design of intensive care units (ICUs), or the modification of existing units, requires not only a knowledge of regulatory agency standards, but also the expertise of critical care practitioners who are familiar with the special needs of this patient population. In 1988, the Society of Critical Care Medicine (SCCM) developed guidelines for the design of ICUs (2). The following is a revised version comprising a consensus opinion that encompasses a review of the medical,nursing and architectural literature from 1975 to the present as it pertains to ICU design and function, together with theopinions of experts in the field of critical care medicine and architecture represented by SCCM, AACN and others.An optimum ICU design is described. Essential and optional components are identified. Periodic revisions of theseguidelines can be expected as the practice of critical care evolves.
The Design Team
 ICU design should be approached by a multidisciplinary team consisting of, but not limited to, the ICU medical director,the ICU nurse manager, the chief architect, hospital administration, and the operating engineering staff (3). The chief architect must be experienced in hospital space programming and hospital functional planning; the engineers should beexperienced in the design of mechanical and electrical systems for hospitals, especially critical care units. The designteam should be expanded as appropriate by adding members of other hospital departments working with and/or in thecritical care unit, to assure that the design meets its intended function. In addition, environmental engineers, interiordesigners, staff nurses, physicians, and patients and families may be asked for comments on how to provide a functionaland user-friendly environment. The developmental team should assess the expected demands on the proposed ICUbased on an evaluation of its sources of patients, admission and discharge criteria, expected rate of occupancy, andservices provided by other area hospitals. The ability to provide specific levels of care must be determined by analyzingphysician resources, staff resources (nursing, respiratory therapy, etc), and the availability of support services(laboratory, radiology, pharmacy, etc.) (4).
Floor Plan and Design
 Overall ICU floor plan and design should be based upon patient admission patterns, staff and visitor traffic patterns, andthe need for support facilities such as nursing stations, storage, clerical space, administrative and educationalrequirements, and services that are unique to the individual institution. Eight to twelve beds per unit is considered bestfrom a functional perspective (3,5,6). Each healthcare facility should consider the need for positive- and negative-pressure isolation rooms within the ICU. This need will depend mainly upon patient population and State Department of Public Health requirements.
Society of Critical Care Medicine
3Each intensive care unit should be a geographically distinct area within the hospital, when possible, with controlledaccess. No through traffic to other departments should occur. Supply and professional traffic should be separated frompublic/visitor traffic. Location should be chosen so that the unit is adjacent to, or within direct elevator travel to andfrom, the Emergency Department, Operating Room, intermediate care units, and Radiology Department (7).
Patient Areas
. Patients must be situated so that direct or indirect (e.g. by video monitor) visualization byhealthcare providers is possible at all times. This permits the monitoring of patient status under both routineand emergency circumstances. The preferred design is to allow a direct line of vision between the patient andthe central nursing station. In ICUs with a modular design, patients should be visible from their respectivenursing substations. Sliding glass doors and partitions facilitate this arrangement, and increase access to theroom in emergency situations.Signals from patient call systems, alarms from monitoring equipment, and telephones add to the sensoryoverload in critical care units (8). Without reducing their importance or sense of urgency, such signals shouldbe modulated to a level that will alert staff members, yet be rendered less noxious. The International NoiseCouncil has recommended that noise levels in hospital acute care areas not exceed 45 dB(A) in the daytime, 40dB(A) in the evening, and 20 dB(A) at night. (The A-weighted decibel scale filters out lower frequency soundsand more closely represents the range of the human ear) (9). Notably, noise levels in most hospitals arebetween 50-70 dB(A) with occasional episodes above this range (10). For these reasons, floor coverings thatabsorb sound should be used, keeping infection control, maintenance, and equipment movement needs underconsideration. Walls and ceilings should be constructed of materials with high sound absorption capabilities.Ceiling soffets and baffels help reduce echoed sounds. Doorways should be offset, rather than being placed insymmetrically opposed positions, to reduce sound transmission. Counters, partitions, and glass doors are alsoeffective in reducing noise levels.
Central Station
. A central nursing station should provide a comfortable area of sufficient size toaccommodate all necessary staff functions. When an ICU is of a modular design, each nursing substationshould be capable of providing most if not all functions of a central station. There must be adequate overheadand task lighting, and a wall mounted clock should be present. Adequate space for computer terminals andprinters is essential when automated systems are in use. Patient records should be readily accessible. Adequatesurface 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 readilyaccessible by all personnel requiring their use. Although a secretarial area may be located separately from thecentral station, it should be easily accessible as well (7).
X-ray Viewing Area
. A separate room or distinct area near each ICU or ICU cluster should be designated forthe viewing and storage of patient radiographs. An illuminated viewing box or carousel of appropriate sizeshould be present to allow for the simultaneous viewing of serial radiographs. A "bright light" should also beavailable.
Work Areas and Storage
. Work areas and storage for critical supplies should be located within orimmediately adjacent to each ICU. Alcoves should provide for the storage and rapid retrieval of crash cartsand portable monitor/defibrillators. There should be a separate medication area of at least 50 square feetcontaining a refrigerator for pharmaceuticals, a double locking safe for controlled substances, and a sink withhot and cold running water. Countertops must be provided for medication preparation, and cabinets should beavailable for the storage of medications and supplies. If this area is enclosed, a glass wall or walls should beused to permit visualization of patient and ICU activities during medication preparation, and to permitmonitoring of the area itself from outside to assure that only authorized personnel are within.
Receptionist Area
. Each ICU or ICU cluster should have a receptionist area to control visitor access. Ideally,it should be located so that all visitors must pass by this area before entering. The receptionist should be linkedwith the ICU(s) by telephone and/or other intercommunication system. It is desirable to have a visitors'entrance separate from that used by healthcare professionals. The visitors' entrance should be securable if theneed arises.

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