PLANNING AND SET UP

OF ICU

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
Cleaners 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

Nurseshead, 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 intensivists 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