CRITICAL CARE NURSING

KTITIS
 KRUSIAL
 CRISIS

 EMERGENVY

 SERIUS

 MEMERLUKAN TINDAKN SEGERA

 MEMERLUKAN OBSERVASI SECARA BERKALA

DAN KETAT
 KETERGANTUNGAN TOTAL
KEPERAWATAN KTITIS
 PERAWATAN TERHADAP PASIEN DENGAN
PENYAKIT YANG SERIUS AKIBAT DARI TRAUMA
ATAU PENYAKITNYA SAMPAI BISA KELUAR
DARI RUANG PERAWATAN INTENSIVE

 PERAWATAN TERHADAP RESPON PASIEN

DENGAN KONDISI YANG MENGANCAM NYAWA
AKIBAT TRAUMA ATAU OPERASI BESAR
THE AIM OF THE CRITICAL
CARE:-
is to see that one provides a care
such that patient improves and
survives the acute illness or tides
over the acute exacerbation of the
chronic illness.
 THE EVOLUTION OF CRITICAL
CARE
•Forty years of development in
critical care and critical care
nursing has given rise to a
recognized speciality in nursing
practice .
•Critical care units have evolved
over the last four decades in
response to medical advances .
HISTORICAL PRESPECTIVES
 Florence nightingale recognized the
need to consider the severity of
illness in bed allocation of patients
and placed the seriously ill patients
near the nurses’ station.
 1923, John Hopkins University
Hospital developed a special care unit
for neurosurgical patients .
 Modern medicines boomed to its
higher ladder after world war 2
Bennett, D. et al. BMJ 1999;318:1468-1470
Bennett, D. et al. BMJ 1999;318:1468-1470
Bennett, D. et al. BMJ 1999;318:1468-1470
HISTORICAL PRESPECTIVES
 As surgical techniques advanced it
became necessary that post operative
patient required careful monitoring and
this came about the recovery room.
 In 1950, the epidemic of poliomyelitis
necessitated thousands of patients
requiring respiratory assist devices and
intensive nursing care.
 At the same time came about newer
horizons in cardiothoracic surgery, with
refinements in intraoperative membrane
oxygen techniques.
HISTORICAL PRESPECTIVES
In 1953, Manchester
Memorial Hospital opened a
four bedded unit at
Philadelphia was started.
 By 1957, there were 20
units in USA and
In 1958,the number
increased to 150.
CONTEXTUAL FORCES
 The expansion of American hospital
system and hospital insurance.
 Architectural, hospital changes towards
private and semi private
accommodations.
 Reallocations for direct patient care
responsibility and creations of new forms
of care.
 During 1970’s,the term critical care unit
came into existence which covered all
types of special care
STRUKTUR ORGANISASI ICU
 OPEN ( DOKTER DARI UNIT LAIN )
 CLOSED (DOKTER PENANGGUNGJAWAB ICU)

 SEMI / TRANSITUASIONAL UNIT ( TIM AICU)

KLASIFIKASI ICU
 LEVEL 1
 MEMERLUKAN MONITORING BERKALA, MEMERLUKAN
VENTILASI JANGKA PENDEK, RASIO PERAWAT: PASIE (1:3),
STAF DOKTER TIDAK SELALU HADIR SEPANJANG WAKTU
DI ICU
 LEVEL 2
 MEMERLUKAN MONITORING BERKALA DAN KETAT,
MEMERLUKAN VENTILASI JANGKA PANJANG DENGAN
PENGAWASAN DOKTER SPESILIS, PERBANDINGAN
PERAWAT : PASIEN ( 1: 2), DOKTER MAGANG SPESIALIS
SELALU BERADA DI RUANGAN DAN DOKTER SPESIALIS
KONSULTAN DAPAT DIKONSULTASI SEPANJANG WAKTU
 LEVEL 3
 MEMILIKI SEMUA ASPEK PERAWATAN INTENSIVE TERMASUK
INVASIF HEMODINAMIK MONITORING DAN DIALISIS ,
PERBANDINGAN PERAWAT : PASIEN (1:1)
TIPE ICU
 UMUM
 MEDICAL INTENSIVE CARE UNIT(MICU)
 SURGICAL INTENSIVE CARE UNIT (SICU)
 MEDICAL SURGICAL INTENSIVE CARE UNIT(MSICU)
 SPESIALIS
 NEONATAL INTENSIVE CARE UNIT(NICU)
 SPECIAL CARE NURSERY (SCN)
 PEDIATRIC INTENSIVE CARE UNIT (PICU)
 CORONARY CARE UNIT(CCU)
 CARDIAC SURGERY INTENSIVE CARE UNIT( CSICU)
 NEUROSURGERY INTENSIVE CARE UNIT(NSICU)
 BURN INTENSIVE CARE UNIT(BICU)
 TRAUMA INTENSIVE CARE UNIT(TICU)
 SHOCK TRAUMA INTENSIVE CARE UNIT(STICU)
 OVERNIGHT INTENSIVE RECOVERY (OIR)
 CARDIOVASCULAR INTENSIVER CARE UNIT(CVCU)
PERAWAT KRITIS
 ORANG YANG MERAWAT PASIEN DENGAN
KONDISI SANGAT KRITIS
 MEMBERIKAN PERAWATAN LANGSUG DAN
SEGERA KEPADA SETIAP PASIEN
 MEMILIKI ANGGUNGJAWAB UNTUK
MEMUTUSKAN KONDISI PASIEN HIDUP ATAU
MATI
 MEMILIKI RESIKO TINGGI TERPAPAR AKIBAT
AGEN AGEN INFEKSIUS
 DITUNTUT MEMILIKI KEMAMPUAN
KOMUNIKASI
 DITUNTUK MEMILIKI KEMAMPUAN KLINIS
YANG MEMADAI
DEFINSI PERAWATAN INTENSIVE
 PERAWATAN INTENSIVE BOASANYA
DIGUNAKAN UNTUK MENDESKRIPSIKAN
TERHADP PERAWATAN PASIEN YANG MEMILIKI
KONDISI SAKIT SANGAT KRITIS DAN MEMILIKI
KONDISI YANG TIDAK STABIL ATAU
BERPOTENSI DENGAN KONDISI YANG TIDAK
STABIL
RUANG PERAWATAN INTENSIVE(ICU)
 DAPAT DIARTIKAN SEBAGAI RUANGAN YANG
MEMILIKI PERAWATAN SECARA KOMPREHENSIF
TERHADAP PASIEN KRITIS YANG MEMILIKI
HARAPAN DAPAT DISEMBUHKAN
 TEMPAT PERAWATAN PASIEN KRITIS /GAWAT
ATAU PASIEN YANG MEMILIKI RESIKO TINGGI
TERJADINYA KEWAGATAN DENGAN SIFAT
PENYAKIT YANG MASIH REVERSIBLE, DENGAN
MENERAPKAN:
 TERAPI AGRESIF
 TEKNOLOGI TINGGI
 MONITORINGINTENSIVE/NON INVASIVE
 PENGGUNAAN OBAT OBATAN PATEN
CRITICAL CARE NURSING
 DAPAT DIARTIKAN SEBAGAI SESEORANG YANG
MEMILIKI KEMAMPUAN PERAWATAN SECARA
KOMPREHENSIVE, PERAWATAN SECARA
SPESIALISTIK DAN INDUVIDUAL YANG
DIBERIKAN KEPADA PASIEN DENGAN KONDISI
YANG DAPAT MENGANCAM NYAWA BESERTA
KELUARGANYA
PASIEN YANG BERADA DI ICU
 PASIEN YANG DIRAWAT DI ICU MEMILIKI
KONDISI KLINIS YANG BERVARIASI AKAN
TETAPI PADA DASARNYA MEMILIKI DISFUNGSI
SATU MACAM ORGAN ATAU LEBIH, TERUTAMA
GANGGUAN FUNGSI NAFAS DAN SIRKULASI.
 ASAL PASIEN DAPAT DARI :
 KAMAR OPERASI
 IGD
 RUANGAN PERAWATAN BIASA
 RUJUKAN RS LAIN
PEMBGIAN PASIEN ICU
 PRIORITAS TINGGI
 PASIEN KRITIS, TIDAK STABIL, PENYAKITNYA MASIH
REVERSIBLE, MEMERLUKAN PERAWATAN INTENSIVE,
MISALNYA RESPIRATOR, OBAT-OBATAN INOTROPIK,
HEMODIALISIS SEGERA, LAIN-LAIN
 TIDAK BERLAKU UNTUK PASIEN DENGAN KASUS-KASUS
TERMINAL ATAU PENYAKIT KRONIS YANG KONDISINYA
TIDAK STABIL ATAU JELEK
 PRIORITAS RENDAH
 PASIEN DENGAN KEMUNGKINAN MEMERLUKAN
PERAWATAN INTENSIVE, DAN PASIEN DENGAN KONDISI
IREVESIBLE TETAPI MEMILIKI KEGAWATAN BUKAN
KARENA PENYAKIT DASARNYA, DENGAN CATATAN
BAHWA PASIEN ATAU KELUARGANYA SANGGUP
MENERIMA BEBAN AKIBAT TERAPI TERSEBUT
INDIKASI PASIEN YANG MEMERLUKAN
PERAWATAN ICU
 MEMERLUKAN INOTROPIK UNTUK
MEMERTAHANKAN TEKANAN DARAH DAN PERFUSI
JARINGAN
 TEKANAN DIASTOLIK > 120 MMHG DENGAN EDEMA
PARU, HIPERTENSI ENSEPALOPATI
 GAGAL NAFAS , Pao2 < 50 mmHg DENGAN Fi02 > 0,4
RR > 35/MENIT (DEWASA)
 KOMA APAPUN SEBABNYA (GCS < 12)
 AMI
 ARITMIA JANTUNG YANG MENGANCAM JIWA
 TRAUMA GANDA
 PASKA BEDAH OPERASI BESAR ( TREPANASI,
OPERASI JANTUNG, THORAKOTOMI, DLL)
PERALATAN ICU
 MONITORING
 BED SIDE MONITOR (EKG, NADI, SpO2, TEKANAN DARAH,
RESPIRATORI RATE)
 EKG RECORDER 12 LEAD

 PULSE OXIMETER

 TEMPERATUR KONTINYU

 TEKANAN DARAH INVASIVE DAN NON INVASIVE

 RESPIRATORY TERAPI
 VENTILATOR
 HUMIDIFIER/ NEBULIZER
 ALAT TERAPI OKSIGEN (NASAL, MASKER)
 AMBU BAG, JACKTION REES
 SET INTUBASI
PERALATAN ICU
 CARDIOVASKULAR
 DC SHOCK
 INFUSE PUMP
 SYRINGE PUMP
 PACE MAKER TRANVENA

 LABORATORIUM
 BLOOD GAS ANALYSER
 GULA DARAH
 ELEKTROLIT

 RADIOLOGI
 PORTABLE X RAY
 VIEWER
PERALATAN ICU
 HARDWARE
 STANDARD INFUSE
 TROLLY DRESSING
 PENAHAN PASIEN
 SELIMUT PENGHAMGAT DAN PENDINGIN
 KASUR ANTI DEKBITUS
 STELISATOR PORTABLE
 LAMPU TINDAKAN
 SET BEDAH MINOR (VENA SEKSI, PEMASANGAN THORAK
DRAIN)
 PENGHANGAT CAIRAN
 SUMBER LISTRIK
 OKSIGEN SENTRAL, KOMPRESOR DAN SUCTION DINDING ,,
MESIN SUCTION, GENERATOR
 LEMARI/RAK
 INTERCOM
 TEMPAT CUCI TANGAN
 CANGGIH
 CARDIAC OUTPUT COMPUTER
 BRONCHOSCOPE
 IABP
 MESIN HEMODIALISA
 TEE (TRANSESOPHAGEAL ECHOCARDIOGRAFI)
BENTUK FISIK ICU
 AREA PENERIMAAN
 RUANG TUNGGU KELUARGA
 RUANG INTERVIEW/PENJELASAN KELUARGA
 RUANG PASIEN
 TERBUKA DENGAN BANYAK TEMPAT TIDUR
 CUBICLE/ISOLASI
 NURSE STATION
 RUANG KHUSUS(TINDAKAN, LUKA BAKARM HD)
 AREASTORAGE DAN UTILITY
 ALAT MONITOR
 ALAT TERAPI RESPIRASI
 BARANG-BARANG DISPOSIBLE
 BARANG STERIL
 LINEN
 CAIRAN, KATETER, JARUM INFUS, INFUSE SET
 BARANG-BARANG KOTOR, PENCUCIAN
 PERALATAN STERILISASI
 AREA STAFF
 RUANG ISTIRAHAT
 RUANG GANTI
 TOILET
 KANTOR
 RUANG PERTEMUAN
 RUANG DOKTER JAGA

 LAIN-LAIN
 ALAT CLEANINGSERVISE
 PERPUSTAKAAN MINI
 DAPUR SAJI
MEDICAL STAFF

 Carrier intensivists are the best senior medical

Staff to be appointed to the ICU.
 He/she will be the director.

 Less preferred are other specialists viz. From

Anaesthesia, medicine and chest who have
clinical Commitment elsewhere.
 Junior staff are intensive care trainees and
trainees on deputation from other disciplines.
 NURSING STAFF

 The major teaching tertiary care ICU will require trained

nurses in critical care.
 It may be ideal to have an in house training programme
for critical Care nursing.
 The number of nurses ideally required for such units is
1:1 ratio.
 In complex situations they may require two nurses per
patient.
 The number of trained nurses should be also worked out
by the type of ICU, the workload and work statistics and
type of patient load.
UNIT DIRECTOR:-

Specific requirements for the unit director include the

following:
 Training, interest, and time availability to give clinical,
administrative, and educational direction to the ICU.
 Board certification in critical care medicine.

 Time and commitment to maintain active and regular

involvement in the care of patients in the unit.
 Availability (either the director or a similarly qualified
surrogate) to the unit 24 hrs a day, 7 days a week for
both clinical and administrative matters.
 Active involvement in local and/or national critical care
societies.
 Participation in continuing education programs in the
field of critical care medicine.
 Hospital privileges to perform relevant invasive
procedures.
 Active involvement as an advisor and participant in
organizing care of the critically ill patient in the
community as a whole.
 Active participation in the education of unit staff.

 Active participation in the review of the appropriate use

of ICU resources in the hospital.
 NURSE MANAGER
 An RN (registered nurse) with a BSN (bachelor of
science in nursing) or preferably an MSN (master of
science in nursing) degree
 Certification in critical care or equivalent graduate
education
 At least 2 yrs experience working in a critical care
unit
 Experience with health information systems, quality
improvement/risk management activities, and
healthcare economics
 Ability to ensure that critical care nursing practice
meets appropriate standards .
 Preparation to participate in the on-site education
of critical care unit nursing staff
 NURSE MANAGER
 Ability to foster a cooperative atmosphere with regard to
the training of nurses, physicians, pharmacists,
respiratory therapists, and other personnel involved in
the care of critical care unit patients
 Regular participation in ongoing continuing nursing
education
 Knowledge about current advances in the field of critical
care nursing
 Participation in strategic planning and redesign efforts
CRITICAL CARE UNIT NURSING
REQUIREMENTS:-
 All patient care is carried out directly by
or under supervision of a trained critical
care nurse.
 All nurses working in critical care should
complete a clinical/didactic critical care
course before assuming full responsibility
for patient care.
 Unit orientation is required before
assuming responsibility for patient care.
 Nurse-to-patient ratios should be based
on patient acuity according to written
hospital policies.
CRITICAL CARE UNIT NURSING
REQUIREMENTS :-
 All critical care nurses must participate in continuing
education.
 An appropriate number of nurses should be trained in
highly specialized techniques such as renal replacement
therapy, intra-aortic balloon pump monitoring, and
intracranial pressure monitoring.
 All nurses should be familiar with the indications for and
complications of renal replacement therapy.
RESPIRATORY CARE PERSONNEL
REQUIREMENTS

 Respiratory care services should be available 24 hrs a

day, 7 days a week.
 An appropriate number of respiratory therapists with
specialized training must be available to the unit at all
times. Ideal levels of staffing should be based on acuity,
using objective measures whenever possible.
 Therapists must undergo orientation to the unit before
providing care to ICU patients.
RESPIRATORY CARE PERSONNEL
REQUIREMENTS
 The therapist must have expertise in the use of
mechanical ventilators, including the various ventilatory
modes.
 Proficiency in the transport of critically ill patients is
required.
 Respiratory therapists should participate in continuing
education and quality improvement related to their unit
activities.
 Ideally, 24-hr in-house coverage should be provided by
intensivists who are dedicated to the care of ICU patients
and do not have conflicting responsibilities.
 Ideal intensivist-to-patient ratios vary from ICU to ICU
depending on the hospital’s unique patient population.
Hospitals should have guidelines for these ratios based
on acuity, complexity, and safety considerations.
 The following physician subspecialists should be
available and be able to provide bedside patient care
within 30 mins:
 PHYSICIAN SUBSPECIALISTS
 General surgeon or trauma surgeon
 Neurosurgeon

 Cardiovascular surgeon

 Obstetric-gynecologic surgeon

 Urologist

 Thoracic surgeon

 Vascular surgeon

 Anesthesiologist

 Cardiologist with interventional capabilities

 Pulmonologist
 PHYSICIAN SUBSPECIALISTS

 Gastroenterologist
 Hematologist

 Infectious disease specialist

 Nephrologist

 Neuroradiologist (with interventional capability)

 Pathologist

 Radiologist (with interventional capability)

 Neurologist

 Orthopedic surgeon
S.NO THERAPIST FUNCTION
.
1. Physiotherapists prevents and treat chest problems,
assist mobilization, and prevent
contractures in immobilized patients

2. Pharmacists A advise on potential drug

interactions and side effects, and
drug dosing in patients with liver or
renal dysfunction

3. Dietitians Advise on nutritional requirements

and feeds

4. Microbiologists Advise on treatment and infection

control
5. Medical physics Maintain equipment, including patient
technicians monitors, ventilators, haemofiltration
machines, and blood gas analysers
 OTHER PERSONNEL:

A variety of other personnel may contribute significantly to

the efficient operation of the ICU. These include:-
 Unit clerks

 physical therapists

 occupational therapists

 Advanced practice nurses

 Physician assistants

 Dietary specialists, and

 Biomedical engineers.
 LABORATORY SERVICES

A clinical laboratory should be

available on a 24-hr basis to provide
basic hematologic, chemistry,
blood gas, and toxicology analysis.
 Laboratory tests must be obtained
in a timely manner, immediately in
some instances. "STAT" or
"bedside" laboratories adjacent to
the ICU or rapid transport systems.
RADIOLOGY AND IMAGING
SERVICES:
 The diagnostic and therapeutic radiologic
procedures should be immediately
available to ICU patients, 24 hrs per day.
 Portable chest radiographs affect decision
making in critically ill patients.
 ORGANIZATION OF ICU

 It requires intelligent planning.

 One must keep the need of the hospital and
its location.
 One ICU may not cater to all needs.

 An institute may plan beds into multiple

units under separate management by single
discipline specialist viz. medical ICU, surgical
ICU, CCU, burns ICU, trauma ICU, etc.
 ORGANIZATION OF ICU

 The number of ICU beds in a hospital

ranges from 1 to 10 per 100 total hospital
beds.
 Multidisciplinary requires more beds than
single speciality. ICUs with fewer than 4
beds are not cost effective and over 20
beds are unmanageable.
 ICU should be sited in close proximity to
relevant areas viz. operating rooms,
image logy, acute wards, emergency
department.
 There should be sufficient number of lifts
available to carry these critically ill
patients to different areas.
ORGANIZATIONAL MODELS FOR ICUS:

 the open model allows many different

members of the medical staff to manage
patients in the ICU.
 the closed model is limited to ICU-certified
physicians managing the care of all patients;
and
 the hybrid model, which combines aspects of
open and closed models by staffing the ICU
with an attending physician and/or team to
work in tandem with primary physicians.
 DEFINITION OF INTENSIVE CARE UNIT
EQUIPMENTS:-

 Intensive care unit (ICU) equipment includes

patient monitoring, respiratory and cardiac
support, pain management, emergency
resuscitation devices, and other life support
equipment designed to care for patients who
are seriously injured, have a critical or life-
threatening illness, or have undergone a
major surgical procedure, thereby requiring
24-hour care and monitoring.
 PURPOSE

 An ICU may be designed and equipped

to provide care to patients with a range
of conditions, or it may be designed and
equipped to provide specialized care to
patients with specific conditions
 DESCRIPTION

Intensive care unit equipment

includes:-
patient monitoring
 life support and emergency
resuscitation devices
 diagnostic devices
PATIENT MONITORING EQUIPMENTS
Acute care physiologic monitoring
system
Pulse oximeter
Intracranial pressure monitor
Apnea monitor
Bennett, D. et al. BMJ 1999;318:1468-1470
 LIFE SUPPORT & RESUSCITATIVE
EQUIPMENTS
VENTILATOR
INFUSIONPUMP
CRASH CART
INTRAAORTIC BALOON PUMP
Bennett, D. et al. BMJ 1999;318:1468-1470
 DIAGNOSTIC EQUIPMENTS
 MOBILE X-RAYS
 PORTABLE CLINICAL LAB. DEVICES
 BLOOD ANALYZER
 THERAPEUTIC ELEMENTS IN ICU
ENVIORNMENT
Window and art that provides
natural views; views of nature
can reduce stress, hasten
recovery, lower blood pressure
and lower pain medication needs.
Family participation ,including
facilities for overnight stay and
comfortable waiting rooms.
 THERAPEUTIC ELEMENTS IN ICU
ENVIORNMENT
Providng a measure of privacy and
personal control through adjustable
curtains and blinds ,accessible bed
controls ,and TV ,VCR and CD players.
Noise reduction through computerized
pagers and silent alarms.
Medical team continuity that allows one
team to follow the patient through his or
her entire stay.
 ICU TEAM
ICU deign should be approached by
multidisciplinary team consisting of :-
 ICU MEDICAL DIRECTORS
 ICU NURSE MANAGER
 THE CHIEF ARCHITECT
 THE OPERATING ENGINEERING
STAFF
OTHER ADDITIONAL
MEMBERS
 ENVIORNMENTAL ENGINEER
 INTERIOR DESIGNERS
 STAFF NURSES
 PHYSICIANS
 PATIENTS
 FAMILIES
 THE CHIEF ARCHITECT -He must be
experienced in hospital space programming
and hospital functional planning.

 ENGINEER – He should be experienced in

the design of mechanical and electrical
systems For hopitals,especially critical care
unit.
 FLOOR PLAN AND DESIGN
IT SHOULD BE BASED ON:-
 Patient admission pattern

 Staff & visitor traffic patterns

 Need for support facilities such a nursing

station ,Storage, clerical space,
 Administrative & educational requirements.

 Services that are unique to the individual

institution.
 FLOOR PLAN AND DESIGN
 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.
 This need will depend mainly upon
patient population and State Department
of Public Health requirements.
 FLOOR PLAN AND DESIGN
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.
 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
 PATIENT AREAS.:-

 Patients must be situated so that direct or indirect (e.g. by

video monitor) visualization by healthcare providers is
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.
 RECOMMENDED NOISE
RANGES
 Signals from patient call systems, alarms from
monitoring equipment, and telephones add to the
sensory overload in critical care units.
 The International Noise Council has recommended
that noise levels in hospital acute care areas
 not exceed 45 dB(A) in the daytime,
 40 dB(A) in the evening,
 20 dB(A) at night.

☻Notably, noise levels in most hospitals are between

50-70 dB(A) with occasional episodes above this
range
 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 .
 CENTRAL STATION
 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.
 Although a secretarial area may be located
separately from the central station, it should
be easily accessible as well
 X-RAY VIEWING
AREA.
 A separate room or distinct area near each
ICU or ICU cluster should be designated for
the viewing and storage of patient
radiographs.
 An illuminated viewing box or carousel of
appropriate size should be present to allow
for the simultaneous viewing of serial
radiographs.
 A "bright light" should also be available.
 WORK AREAS AND
STORAGE
 Work areas and storage for critical supplies should
be located within or immediately adjacent to each
ICU.
 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.
RECEPTION AREA
 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 linked with 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 the need
arises.
 SPECIAL PROCEDURES
ROOM.
 Ifa special procedures room is desired, it should
be located within, or immediately adjacent to, the
ICU.
 One special procedures room may serve several
ICUs in close proximity.
 Consideration should be given to ease of access
for patients transported from areas outside the
ICU.
 Room size should be sufficient to accommodate
necessary equipment and personnel.
SPECIAL PROCEDURES
ROOM.
 Monitoring capabilities, equipment, support
services, and safety considerations must be
consistent with those provided in the ICU
proper.
 Work surfaces and storage areas must be
adequate enough to maintain all necessary
supplies and permit the performance of all
desired procedures without the need for
healthcare personnel to leave the room
 CLEAN AND DIRTY UTILITY
ROOMS.
 Clean and dirty utility rooms must be
separate rooms that lack
interconnection.
 They must be adequately temperature
controlled, and the air supply from the
dirty utility room must be exhausted.
 Floors should be covered with materials
without seams to facilitate cleaning.
 The clean utility room should be used for
the storage of all clean and sterile
supplies, and may also be used for the
storage of clean linen.
CLEAN AND DIRTY UTILITY ROOMS.
 Shelving and cabinets for storage must be located
high enough off the floor to allow easy access to
the floor underneath for cleaning.
 The dirty utility room must contain a clinical sink
and a hopper both with hot and cold mixing
faucets.
 Separate covered containers must be provided for
soiled linen and waste materials.
 There should be designated mechanisms for the
disposal of items contaminated by body substances
and fluids.
 Special containers should be provided for the
disposal of needles and other sharp objects.
 EQUIPMENT STORAGE
 An area must be provided for the
storage and securing of large patient
care equipment items not in active use.
 Space should be adequate enough to
provide easy access, easy location of
desired equipment, and easy retrieval.
 Grounded electrical outlets should be
provided within the storage area in
sufficient numbers to permit recharging
of battery operated items.
NOURISHMENT PREPARATION
AREA
A patient nourishment preparation area
should be identified and equipped with
food preparation surfaces, an ice-
making machine, a sink with hot and
cold running water, a countertop stove
and/or microwave oven, and a
refrigerator.
 The refrigerator should not be used for
the storage of laboratory specimens.
A hand washing facility should be
located in or near the area.
 STAFF LOUNGE.
 A staff lounge must be available on or near
each ICU or ICU cluster to provide a private,
comfortable, and relaxing environment.
 Secured locker facilities, showers and toilets
should be present.
 The area should include comfortable seating
and adequate nourishment storage and
preparation facilities, including a refrigerator,
a countertop stove and/or microwave oven.
 The lounge must be linked to the ICU by
telephone or intercommunication system, and
emergency cardiac arrest alarms should be
audible within.
 CONFERENCE ROOM.
 A conference room should be conveniently located for ICU
physician and staff use.
 This room must be linked to each relevant ICU by telephone or
other intercommunication system, and emergency cardiac arrest
alarms should be audible in the room.
 The conference room may have multiple purposes including
continuing education, house staff education, or multidisciplinary
patient care conferences.
 A conference room is ideal for the storage of medical and
nursing reference materials and resources, VCRs, and
computerized interactive and self-paced learning equipment.
 If the conference room is not large enough for educational
activities, a classroom should also be provided nearby.
 VISITORS' LOUNGE/WAITING
ROOM.
 A visitors' lounge or waiting area should be provided
near each ICU or ICU cluster.
 Visitor access should be controlled from the
receptionist area. One and one-half to two seats per
critical care bed are recommended.
 Public telephones (preferably with privacy
enclosures) and dining facilities must be available to
visitors.
 Television and/or music should be provided.
 Public toilet facilities and a drinking fountain should
be located within the lounge area or immediately
adjacent.
VISITORS' LOUNGE/WAITING
ROOM.
 Warm colours, carpeting, indirect soft
lighting, and windows are desirable .
 A variety of seating, including upright,
lounge, and reclining chairs, is also desirable.
 Educational materials and lists of hospital
and community-based support and resource
services should be displayed.
 A separate family consultation room is
strongly recommended.
PATIENT TRANSPORTATION
ROUTES
 Patients transported to and from an ICU
should be transported through corridors
separate from those used by the visiting
public.
 Patient privacy should be preserved and
patient transportation should be rapid and
unobstructed.
 When elevator transport is required, an
oversized keyed elevator, separate from public
access, should be provided.
SUPPLY AND SERVICE
CORRIDORS
 A perimeter corridor with easy
entrance and exit should be provided
for supplying and servicing each ICU.
 Removal of soiled items and waste
should also be accomplished through
this corridor.
 This helps to minimize any disruption of
patient care activities and minimizes
unnecessary noise.
 SUPPLY AND SERVICE
CORRIDORS
 The corridor should be at least 8 feet in width.
 Doorways, openings, and passages into each
ICU must be a minimum of 36 inches in width
to allow easy and unobstructed movement of
equipment and supplies.
 Floor coverings should be chosen to withstand
heavy use and allow heavy wheeled
equipment to be moved without difficulty .
 PATIENT MODULES
 Ward-type icus should allow at least
225 square feet of clear floor area
per bed.
 Icus with individual patient modules
should allow at least 250 square feet
per room (assuming one patient per
room),
 Provide a minimum width of 15 feet,
excluding ancillary spaces (anteroom,
toilet, storage).
PATIENT MODULES
 Isolation rooms should each
contain at least 250 square feet
of floor space plus an anteroom.
 Each anteroom should contain at
least 20 square feet to
accommodate hand-washing,
gowning, and storage.
 If a toilet is provided, it must be
private.
 PATIENT MODULES
A cardiac arrest/emergency alarm button
must be present at every bedside within the
ICU. The alarm should automatically sound in
the hospital telecommunications center,
central nursing station, ICU conference
room, staff lounge, and any on-call rooms.
The origin of these alarms must be
discernable.
 Space and surfaces for computer terminals
and patient charting should be incorporated
into the design of each patient module as
indicated.
PATIENT MODULES
 Storage must be provided for each patient's
personal belongings, patient care supplies,
linen and toiletries. Locking drawers and
cabinets must be used if syringes and
pharmaceuticals are stored at the bedside.
 Personal valuables should not be kept in the
ICU. Rather, these should be held by Hospital
Security until patient discharge.
 Every effort should be made to provide an
environment that minimizes stress to patients
and staff. Therefore, design should consider
natural illumination and view.
 PATIENT MODULES
 Windows are an important aspect of
sensory orientation, and as many rooms
as possible should have windows to
reinforce day/night orientation .
 Drapes or shades of fireproof fabric
can make attractive window coverings
and serve to absorb sound.
 Window treatments should be durable
and easy to clean, and a schedule for
their cleaning must be established
 IMPROVING SENSORY
ORIENTATION
Additional approaches to improving sensory
orientation for patients may include :-
 the provision of a clock, calendar, bulletin board,

 pillow speaker connected to radio and television.

 Televisions must be out of reach of patients and

operated by remote control.
 If possible, telephone service should be provided
in each room.
 Comfort considerations should include methods for
establishing privacy for the patient. Shades, blinds,
curtains, and doors should control the patient's
contact with his/her surroundings.
 A supply of portable or folding chairs should be
available to allow for family visits at the bedside. An
additional comfort consideration is the choice of color
scheme for the room, which should promote rest and
have a calming effect.

To provide for visual interest, one
or more walls within patient view
may be selected for an accent
color, texture, graphic design or
picture .
Advice from environmental
engineers and designers should be
sought to deinstitutionalize patient
care areas as much as possible.
 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 .
 ELECTRIC SUPPLY
 Grounded 110 volt electrical outlets with 30 amp
circuit breakers should be located within a few feet of
each patient's bed .
 Sixteen outlets per bed are desirable.
 Outlets at the head of the bed should be placed
approximately 36 inches above the floor to facilitate
connection,
 To discourage disconnection by pulling the power
cord rather than the plug.
 Outlets at the sides and foot of the bed should be
placed close to the floor to avoid tripping over
electrical cords.
 WATER SUPPLY.
 The water supply must be from a certified source,
especially if hemodialysis is to be performed.
 Zone stop valves must be installed on pipes
entering each ICU to allow service to be turned
off should line breaks occur.
 Hand-washing sinks deep and wide enough to
prevent splashing, preferably equipped with
elbow-, knee-, foot-, or sonar-operated faucets,
must be available near the entrances to patient
modules, or between every two patients in ward-
type units.
 LIGHTNING

 Total luminance should not exceed 30 foot-candles .

 It is preferable to place lighting controls on variable-
control dimmers located just outside of the room.
 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
ENVIRONMENTAL CONTROL SYSTEMS.

 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.
 Air-conditioning 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.
 COMPUTERIZED CHARTING

 These systems provide for "paperless" data

management, order entry, and nurse and physician
charting. If and when a decision is made to utilize this
technology, it is important to integrate such a system
fully with all ICU activities.
 Bedside terminals facilitate patient management by
permitting nurses and physicians to remain at the
bedside during the charting process.
 OTHER FACILITIES
Voice Intercommunication Systems
Satellite Laboratory
Physician On-Call Rooms
Administrative Offices