Intensive Care Unit
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Intensive Care Unit. زهرا منتظرتربتی. کارشناسی ارشد. Types. Specialized types of ICUs include:. Neonatal intensive-care unit( NICU ) Special Care Nursery ( SCN ) Pediatric intensive-care unit ( PICU ) Psychiatric intensive-care unit ( PICU ) Coronary care unit ( CCU )

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Intensive Care Unit

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Intensive care unit

Intensive Care Unit

زهرا منتظرتربتی

کارشناسی ارشد


Types

Types

Specialized types of ICUs include:

Neonatal intensive-care unit(NICU)

Special Care Nursery (SCN)

Pediatric intensive-care unit (PICU)

Psychiatric intensive-care unit (PICU)

Coronary care unit (CCU)

Cardiac Surgery intensive-care unit (CSICU)

Cardiovascular intensive-care unit (CVICU)

Medical intensive-care unit (MICU)

Medical Surgical intensive-care unit (MSICU)

Surgical intensive-care unit (SICU)


Location

LOCATION

  • Should be a geographically distinct area within the hospital, with controlled access.

  • No through traffic to other departments should occur. Supply and professional traffic should be separated from public/visitor traffic.


Intensive care unit

  • 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 the Radiology Department.


Bed strength

BED STRENGTH

  • IDEALLY 8 TO 12 BEDS

  • LARGER AREAS – DIFFICULT TO ADMINISTER AND SMALLER AREAS NOT BEING COST EFFECTIVE

  • 3 TO 5 BEDS PER 100 HOSPITAL BEDS FOR A LEVEL III ICU / 2 TO 20% OF THE TOTAL NUMBER OF HOSPITAL BEDS

    1 ISOLATION BED FOR EVERY 10 ICU BEDS


Bed space beds

BED SPACE & BEDS

  • 150 – 200 SQUARE FEET PER OPEN BED WITH 8 FEET IN BETWEEN BEDS.The beds should be 2.5 - 3 meters (7-9 feet) apart , to allow free

  • movement of staff and equipment, reducing risk of cross contamination.

  • 225 – 250 SQUARE FEET PER BED IF IN A SINGLE ROOM.


Infrastructure

INFRASTRUCTURE

  • PATIENTS MUST BE SITUATED SO THAT DIRECT OR INDIRECT (E.G. BY VIDEO MONITOR) VISUALIZATION BY HEALTHCARE PROVIDERS IS POSSIBLE AT ALL TIMES.

  • THE PREFERRED DESIGN IS TO ALLOW A DIRECT LINE OF VISION BETWEEN THE PATIENT AND THE CENTRAL NURSING STATION.

  • MODULAR DESIGN – SLIDING GLASS DOORS & PARTITIONS TO FACILITATE VISIBILITY.


Intensive care unit

•Partitions

Privacy partitions should be of material that is easily cleaned and

should be cleaned weekly and any time that it becomes soiled or

contaminated. If curtains are used, they should be changed weekly

and between patients.


Intensive care unit

Central Station.

provide a comfortable area of sufficient size to

accommodate all necessary staff functions.

There must be adequate overhead

and task lighting, and a wall mounted clock should be present.

space foAdequate r computer terminals and

printers is essential


Environment

ENVIRONMENT

  • SIGNALS & ALARMS – ADD TO THE SENSORY OVERLOAD; NEED TO BE MODULATED.

  • FLOOR COVERINGS AND CEILING WITH SOUND ABSORPTION PROPERTIES.

  • DOORWAYS – OFFSET TO MINIMISE SOUND TRANSMISSION.

  • LIGHT & SOFT MUSIC (EXCEPT 10 PM TO 6 AM).


Intensive care unit

  • ADDITIONAL APPROACHES TO IMPROVING SENSORY ORIENTATION FOR PATIENTS MAY INCLUDE THE PROVISION OF A CLOCK, CALENDAR,

    BULLETIN BOARD, AND/OR PILLOW SPEAKER CONNECTED TO RADIO AND TELEVISION.


Intensive care unit

  • NATURAL ILLUMINATION AND VIEW - WINDOWS ARE AN IMPORTANT ASPECT OF SENSORY ORIENTATION; HELPS TO REINFORCE DAY/NIGHT ORIENTATION.

  • WINDOW TREATMENTS SHOULD BE DURABLE AND EASY TO CLEAN, AND A SCHEDULE FOR THEIR CLEANING MUST BE ESTABLISHED.


Intensive care unit

Work Areas and Storage

should be located within or

immediately adjacent to each ICU.

Receptionist Area.

it should be located so that all visitors must pass by this area before entering

It is desirable to have a visitors'

entrance separate from that used by healthcare professionals.


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Medication preparation

Medication prep areas should be separate from patient care areas and

should be maintained as a clean area.


Intensive care unit

  • 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 TABLE TOP FOR PREPARATION OF DRUGS AND INFUSIONS.


Intensive care unit

  • X-ray Viewing Area.

  • Special Procedures Room.

  • Equipment Storage.

  • Nourishment Preparation Area.

  • Staff Lounge.

  • Conference Room.

  • Visitors' Lounge/Waiting Room.


Intensive care unit

Physician On-Call Rooms

should be available close to the

ICU(s)

Toilet and shower facilities should be provided

On-call rooms must be linked to the ICU(s) by telephone

and/or voice intercommunication system

cardiac arrest/emergency alarms must be audible in these rooms


Equipment

EQUIPMENT

mechanical ventilators to assist breathing through

  • an endotracheal tube

  • a tracheotomy

    cardiac monitors including

  • those with telemetry

  • external pacemakers

  • Defibrillators

    dialysis equipment for renal problems


Intensive care unit

equipment for the constant monitoring of bodily functions

intravenous lines

nasogastric tubes

suction pumps

drains and catheters

a wide array of drugs to treat the primary condition(s) of hospitalization


Intensive care unit

Electrical Power

Electrical service to each ICU should be provided by a separate feeder connected to

the main circuit breaker panel that serves the branch circuits in the ICU.

The main panel should also be

connected to an emergency power source that will quickly re-supply power in the event of power interruption.

It is

critical that the ICU staff have easy access to the main panel in case power must be interrupted for an electrical

emergency.


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Water Supply.

The water supply must be from a certified source

especially if hemodialysis is to be

performed

Hand-washing sinks deep and wide enough to prevent splashing,


Intensive care unit

Oxygen, Compressed Air

two

oxygen outlets per patient are required

One compressed air outlet per bed is required; two are desirable

Connections for oxygen and compressed air outlets must occur by keyed plugs to prevent the accidental

interchanging of gases

Audible and visible low and high pressure alarms must be installed both in each ICU


Intensive care unit

Lighting

General overhead illumination plus light from the surroundings should be adequate for routine

nursing tasks, including charting

create a soft lighting environment for patient comfort.

It is preferable to place lighting controls

located just outside of the room.

This permits changes in lighting at night from outside the room, allowing a

minimum disruption of sleep during patient observation.

Separate lighting for emergencies and procedures should be located in the ceiling directly above the patient


References

REFERENCES

Guidelines for Intensive Care Unit Design –

Crit Care Med 1995 Mar; 23(3):582-

588.

John, G. Essentials of Critical Care, Edition IV,

(2003), Shakti Prints, Vellore.

Worthley, L.I.G. Clinical Examination of the

Critically Ill Patient, Edition II, (2000), The

Australasian Academy of Critical Care Mediicne,

South Australia.


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