PLANNING AN INTENSIVE CARE UNIT

Posted on 25-June-2020 at 12:39 AM
The COVID19 outbreak exposed the lack of ICU facilities in Indian Hospitals. When the Peak which was supposed to come in End of June or early July is now predicted to come sometime in mid-November the country is moving towards an uncertain future. Now the need for proper ICU is more than any other times.

ICU is highly specified and sophisticated area of a hospital which is specifically designed, staffed, located, furnished and equipped, dedicated to the management of a critically sick patient, injuries or complications. It is a department with dedicated medical, nursing and allied staff. It operates with defined policies; protocols and procedures should have its own quality control, education, training and research programmes. It is emerging as a separate speciality and can no longer be regarded purely as part of anaesthesia, medicine, surgery or any other speciality. It has to have its own separate team in terms of doctors, nursing personnel and other staff who are tuned to the requirement of the speciality.

The first step involves the formation of the team which will be responsible for the operation and planning of ICU. It is important to decide about priorities based on inputs from team members and should answer the following questions –

  • Budget available
  • Level of ICU needed
  • Location
  • Number of Beds needed
  • Designs Human Resource
  • Development Engineering and designing constraints
  • What type of Case-mix the ICU team is likely to deal with and
  • therefore help in prioritise equipment type
  • In Case of existing facility being upgraded or relocated, then the
  • review of past mistakes
  • Patient safety and prevention of infection programme
  • Transition in case of relocation during reconstruction of the existing
  • ICU

Following thoughts may help in making decisions and implementation easier:

  • Features that must be adopted
  • Features that should be adopted
  • Features that can be adopted
  • Features that should not be adopted
  • Features that must not be adopted.

When everything has been put in writing and approved by the whole team, the process must begin in the earnest and a time framework should be fixed and all efforts must be made to accomplish the implementation within the stipulated time unless there are unforeseen circumstances.

Floor Plan and Design

  •  Overall ICU floor plan and design should be based upon patient admission patterns, staff and visitor traffic patterns, and the need for support facilities such as nursing stations, storage, clerical space, administrative and educational requirements, and services that are unique to the individual institution. Eight to twelve beds per unit is considered best from a functional perspective.
  • Each healthcare facility should consider the need for positive- and negative pressure isolation rooms within the ICU. 
  • Each intensive care unit should be a geographically distinct area within the hospital, when possible, with controlled access.
  • No through traffic to other departments should occur. Supply and professional traffic should be separated from public/visitor traffic.
  • The 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 Radiology Department.

Central Station.

  • A central nursing station should provide a comfortable area of sufficient size to accommodate all necessary staff functions.
  • When an ICU is of a modular design, each nursing substation should be capable of providing most if not all functions of a central station.
  • There must be adequate overhead and task lighting, and a wall-mounted clock should be present.
  • Adequate space for computer terminals and printers is essential when automated systems are in use.
  • Patient records should be readily accessible.
  • Adequate surface 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 readily accessible by all personnel requiring their use.

Patient Areas

  • Patients must be situated so that direct or indirect (e.g. by video monitor) visualization by healthcare providers are possible at all times.
  • This permits the monitoring of patient status under both routine and emergency circumstances. 
  • The preferred design is to allow a direct line of vision between the patient and the central nursing station.
  • In ICUs with a modular design, patients should be visible from their respective nursing substations. Sliding glass doors and partitions facilitate this arrangement, and increase access to the room in emergency situations. 

Work Areas and Storage.

  • Work areas and storage for critical supplies should be located within or immediately adjacent to each ICU.
  • Alcoves should provide for the storage and rapid retrieval of crash carts and portable monitor/defibrillators.
  • 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 sink with hot and cold running water. Countertops must be provided for medication preparation, and cabinets should be available for the storage of medications and supplies.
  • If this area is enclosed, a glass wall or walls should be used to permit visualization of patient and ICU activities during medication preparation, and to permit monitoring of the area itself from outside to assure that only authorized personnel are within.

Utilities

Each intensive care unit must have electrical power, water, oxygen, compressed air, vacuum, lighting, and environmental control systems that support the needs of the patients and critical care team under normal and emergency situations, and these must meet or exceed regulatory and accreditation agency codes and standards. A utility column (freestanding, ceiling-mounted, or floor-mounted) is the preferred source of electrical power, oxygen, compressed air, and vacuum, and should contain the controls for temperature and lighting. When appropriately placed, utility columns permit easy access to the patient's head to facilitate emergency airway management if needed. If utility columns are not feasible, utility services may be supplied on the headwall.

Lighting

  • General overhead illumination plus light from the surroundings should be adequate for routine nursing tasks, including charting, yet create a soft lighting environment for patient comfort. Total luminance should not exceed 30 foot-candles (fc).
  • It is preferable to place lighting controls on variable-control dimmers located just outside of the room. This permits changes in lighting at night from outside the room thus minimizing disruption of sleep during patient observation.
  • Night lighting should not exceed 6.5 fc for continuous use or 19 fc for short periods.
  • Separate lighting for emergencies and procedures should be located in the ceiling directly above the patient and should fully illuminate the patient with at least 150 fc shadow-free.
  • A patient reading light is desirable, and should be mounted so that it will not interfere with the operation of the bed or monitoring equipment.
  • The luminance of the reading lamp should not exceed 30 fc. 

Environmental Control Systems

  • Suitable and safe air quality must be maintained at all times. A minimum of six total air changes per room per hour are required, with two air changes per hour composed of outside air.
  • For rooms having toilets, the required toilet exhaust of 75 cubic feet per minute should be composed of outside air.
  • Central air-conditioning systems and recirculated air must pass through appropriate filters. Airconditioning and heating should be provided with an emphasis on patient comfort.
  • For critical care units having enclosed patient modules, the temperature should be adjustable within each module.

The recent time call for reviewing the ICU setup available with Hospitals.
For More details on Planning your ICU
Or write to us: drsalil@hosconnnconsulting.com
DR. SALIL CHOUDHARY
Managing Director
HOSCONNN CONSULTING SERVICES

Copyright 2018 Hosconnn Consulting. All Rights Reserved. Designed By: Parnets