DESIGN & ORGANIZATION OF INTENSIVE CARE UNIT

LAYOUT(LOCATION, SIZE, TYPES, OF CCU FACILITIES)

 A CCU is a specially staffed and equipped hospital

ward /unit dedicated to the management of patients with
life threatening illnesses, injuries, or complications

 Should be easily accessible from all areas where patients

are admitted from

 In institutions which has high level floors ,it should be

situated on lower levels
BRIEF HISTORY
 Ccu’s developed from post-operative recovery room or
poliomyelitis epidemics in early 1950;s when the use of
long term artificial ventilation resulted in reduced
mortality

 KNH CCU was established in 1972

 Had 5 beds, served also as a renal dialysis unit

 1980 bed capacity increased to 10 due to high demand

 1998 HDU of 7 beds was set up

 20 century, HDU was turned into an ICU.

CONT
 Currently KNH CCU has 21 beds

 Demand has led to opening of other CCU’s

 They include- Neonatal CCU (NICU), Cardiac CCU,

Neuro , A/E and Pediatric ccu


 Soon there will be a HDU in the department of medicine

TYPES OF ICU’S
 General

 Specific

 GENERAL ICU

 Admits all conditions

 Admits all ages

 Advantages –Economical in terms of equipment's e.g. a ventilator with

all modes can be used within same setting from pediatrics to adults -
Broad learning due to variety of conditions
-Economical in terms of space eg same space for all
equipment's
DISADVANTAGES
 High infection rate due to varied conditions under one
area -Traffic flow is high - High stress levels

 SPECIFIC ICU’S
 Examples – cardiac, Neonatal, Pediatric, Respiratory,
Neurological
 Advantages - specialization is enhanced - low
infection rate -ownership
is enhanced
 Disadvantages –limited learning exposure
SIZE OF THE CCU
 Critical care bed requirement depend on the activities of
the hospital
 However, for every 40 admitted patients, there should be
an ICU BED
 A CCU OF ≤ 10 is easier to manageas compared to one
of more than 10 beds
 Most CCU’S range from 4-10 beds
DESIGN(PHYSICAL FACILITY)
 There should be a single entry and exit attended by unit receptionist

 Through traffic of goods or people to other hospital areas must never be

allowed

 It should have rooms for public reception, patient management, and support
services

 RECEPTION AREAS

 -Reception desk (customer care)

 Waiting room(with telephone and beverage facility and literature brochures)


 -Distress room( crying and interview room)

 -Overnight relatives roosm

 PATIENTS AREAS
 Open / clear partitioned wards

 Area should provide unobstructed passage around the bed

with a floor space of 20metre squared per bed, screens are
required for privacy
 For big general ICU’S, there should be an isolation room for
every seven beds
 Central nurse station
 Floors and ceiling should be constructed to support heavy
equipments
 Every bed should have a sink nearby
 Doors must allow for passage of bulky equipments as well
as wide beds
 Adequate electricity and power back up
 Adequate natural light and ventilation
 Computer networks
SUPPORT SERVICE ROOMS
 Storage and utility – dirty utility , clean utility, equipments
rooms (quantity and level of equipments will depend on
the size and type of the ICU

 Other stores –stationary – linen –monitoring and electrical

equipments –fluids –drugs –respiratory equipments

 Technical areas - laboratory –work shop

 Staff areas – rest room/lounge(with facility for meals) –

changing rooms –toilets and showers – offices – doctors on
call rooms - seminar/ conference room – cleaners room
THE FOLLOWING EQUIPMENTS ARE
ESSENTIAL
 Critical care bed

 Cardiac monitors , echo / ECG machines, defibrillators, pacemakers

 Ventilators, suction machines, ultrasonic nebulizer

 Infusion / syringe pumps, drip stands

 Resuscitation trolley

 Procedure trolleys

 rescuscitaires
CONT.
 Fire extinguisher
 Standby generator

 Laboratory equipments eg BGA machine

 Cookers/fridges

 STAFFING
 The level of staffing depends on the type of the hospital
MEDICAL PERSONELL
 CCU director –should be an intensivist – one with
experience in administration, research, teaching and
practical skills

 Medical staff –specialist anesthetist –anesthetist –junior

doctors(trainees)

 Doctor coverage should be for 24 hours

 NURSES
 Includes nurse manager –nurse specialists –nurse
educators –critical care nurse trainees
CONT.
 Critically ill patients requires close monitoring

 They require a ratio of nurse to patient of 1nurse: 1 patient

throughout 24 hour period

 For one CCU bed, 6 nurses are required ie 1-morning,1-

afternoon,1-night,1-day off,1-night, and 1 on leave

 If critical care unit is staffed with trained nurses, the better

 Due to shortages of CCU trained nurses ¾ trained nurses

is acceptable. Others can be trained on the job
ALLIED HEALTH WORKERS AND
TECHNICIANS
 Physiotherapists
 Pharmacist

 Dietician

 Social worker

 Laboratory staff

 Medical records

 Biomedical engineers /technicians

 Radiographers

 Respiratory therapists

 Occupational therapists
SECRETARIAL
 Secretary
 Ward clerk/billing clerk

 SUPPORT STAFF
 Cleaners

 orderlies
CRITICAL CARE STANDARDS AND
POLICIES
 Standards : established measures which every CCU should conform
to

 Even if they do not conform due to prevailing circumstances, it

should be understood that each CCU should aim at achieving them

 STAFFING STANDARDS

 Ratio of 1 nurse to 1 patient

 Staffing with at least ¾ trained nurses of the total nurses

 Intensivist should be available to oversee activities or at least an

anesthesiologist
 ADMISSSION STANDARD
 Those admitted to CCU should be the ones who meet
the criteria for admission
 FACILITY STANDARDS

 There should be an entry & an exit door

 Out of seven open CCU bed space one bed space should
be an isolation bed space
 Every CCU should have a protocol as a guiding tool

 There should be a HDU(HIGH DEPENDENCY UNIT)

to act as a step down for patients from CCU
CCU POLICIES
 These are guidelines that govern the running of activities in the
CCU
 They may vary from one CCU to another but do not compromise
standards
 They give a road map towards achieving the standard on each
setting
 UNIT ADMINISTRATION & OPERATION POLICIES

 Refers to the chain of command e.g. At KNH, the nursing officer

i/c oversees all the activities in the unit. He/she is central and every
other discipline liases with him/her
 OPERATIONAL

 Helps in executing responsibilities in the best way possible eg

equipment nurse
THERAPEUTIC POLICIES
 To avoid confusion & in the interest of training a
consistent approach to common therapeutic procedure
should be adopted within the unit eg in KNH CCU
medication is planned for each patient as soon as patient
is received in CCU

 INVESTIGATION ASPECTS

 Uniformity should be adopted in routine investigations

e.g. in KNH BGA’S is done in the morning for every
patient
POLICIES RELATED TO INFECTION
CONTROL
 E.g. hand washing –waste segregation –visiting hours –antibiotic policy –care
of equipment's etc.

 ADMISSION AND DISCHARGE POLICY

 A formal policy for admission should be adopted

 Admission should be agreed upon by the nursing officer i/c and the doctor in
charge of the admission

 None unit staff should never be allowed to order admissions to the unit no
matter how senior they would be

 When patient is ready for discharge the admitting ward should be informed
prior to taking the patients to the ward

 The patient should be transferred out with all his properties(personal & clinical )