Organisation and physical set up of CCU:

• Intensive care has its roots in the resuscitation of dying patients. Exemplary
critical care provides rapid therapeutic responses to failure of vital organ
systems, utilising standardised and effective protocols such as advanced
cardiac life support and advanced trauma life support.

Design Of ICU:
• 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.

The Design Team:

• ICU design should be approached by a multidisciplinary team consisting of,
but not limited to, the ICU medical director, the ICU nurse manager, the chief
architect, hospital administration, and the operating engineering staff.
• The chief architect must be experienced in hospital space programming and
hospital functional planning; the engineers should be experienced in the
design of mechanical and electrical systems for hospitals, especially critical
care units.
• The design team should be expanded as appropriate by adding members of
other hospital departments working with and/or in the critical care unit, to
assure that the design meets its intended function. In addition, environmental
engineers, interior designers, staff nurses, physicians, and patients and
families may be asked for comments on how to provide a functional and user-
friendly environment.
• The developmental team should assess the expected demands on the
proposed ICU based on an evaluation of its sources of patients, admission and
discharge criteria, expected rate of occupancy, and services provided by
other area hospitals.
• The ability to provide specific levels of care must be determined by analysing
physician resources, staff resources (nursing, respiratory therapy, etc), and the
availability of support services (laboratory, radiology, pharmacy, etc.).

Location /Entry / Exit Points of ICU in Hospital:

• There should be a single entry and exit point to ICU. However, it is required to
have emergency exit points in case of emergencies and disasters. There
should not be any through traffic of goods or hospital staff.
• Safe, easy, fast transport of a critically sick patient should be priority in
planning its location. Therefore, the ICU should be located in close proximity
of ER, Operating rooms, trauma ward, etc.
• Corridors, lifts & ramps should be spacious enough to provide easy movement
of bed / trolley of a critically sick patient. Close/ easy proximity is also
desirable to diagnostic facilities, blood bank, pharmacy etc.

ICU Bed Designing and Space Issues:

• Space per bed has been recommended from125 to 150 sq ft area per bed in
the patient care area or the room of the patient. Some recommendation has
placed it even higher up to 250 sq ft per bed.
• In addition there should be 100 to 150% extra space to accommodate nursing
station, storage, patient movement area, equipment area, doctors and nurses
rooms and toilet. However in Indian circumstances after reviewing and feed
back from various ICUs in our country, it may be satisfactory to suggest an
area of 100 to 125 sq ft be provided in patient care area for comfortable
working with a critically sick patient.
• It may be prudent to make one or two bigger rooms or area which may be
utilised for patients who may undergo big bedside procedures like ECMO,
RKT etc and have large number Gadgets attached to them. 10 % one to two
rooms may be designated isolation rooms where immunocompromised
patients may be kept. These rooms may have 20% extra space than other
rooms.

Floor and wall coverings:

• The ideal floor should be easy, non slippery, while enhancing the overall look
and feel of the environment. Carts and beds equipped with large wheels
should roll easily over it.
• In Indian context Vitrified non-slippery tiles seem to be the best option which
can be fitted into reasonable budgets, easy to clean and move on and may be
stain proof. It can be non-porous, strong and easy to clean.

Walls should meet following criteria:

• Durability, ability to clean and maintain, flame resistant, mildew resistant,
sound absorption and visual appeal. It has been very useful to have a height
up to 4 to5 ft finished with similar tiles as of floor for similar reasons.
• Wooden panelling has also found favour with some architects but costs may
go high.
• Doorstoppers and handrails should be placed well to reduce abuse and noise
to minimum; it helps patient movement and ambulation.

Patient Areas:
• Patients must be situated so that direct or indirect (e.g. by video monitor)
visualisation 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.
• It is recommended that there should be a partition between rooms when
patient privacy is desired. Standard curtains soften the look and can be
placed between two patients which is very common in most Indian ICUs.
However they are displaced and become unclean easily and patient privacy is
disturbed. Therefore, two rooms may be separated by unbreakable fixed or
removable partitions. There are also electronic windows, which are
transparent when switched is off and are opaque when the switch is on. This
option allows a view of the external surroundings, but presently is expensive.

Central Nursing Station:

• This is the nerve centre of ICU. A central nursing station should provide a
comfortable area of sufficient size to accommodate all necessary staff
functions.
• All/nearly-all monitors and patients must be observable from there, either
directly or through the central monitoring system. Patients in rooms may be
difficult to observe and therefore may be placed on remote television
monitoring, These monitors may satisfy regulatory requirements but do not
really provide adequate patient safety if the clarity of the picture is poor.
• Adequate space for computer terminals and printers is essential when
automated systems are in use. Patient records should be readily accessible.
• 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.
It is also important that a storage space is provided for equipment, linen,
instruments, drugs, medicines, disposables, stationary and other articles to be
stored at the nursing station.

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 should be used to permit visualisation of patient and
ICU activities during medication preparation, and to permit monitoring of the
area itself from outside to assure that only authorised personnel are within.

Special Procedures Room:

• If a 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. 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.
• 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.

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.

Visitors' Lounge / Waiting Room:

• A visitors' lounge or waiting area should be provided near each ICU or IC
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 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. 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.

Isolation Rooms:
• 10% of beds (1 or 2) rooms may be used exclusively as isolation cases like for
burns, serious contagious infected patients or immunosuppressed patients.

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 computerised interactive and self-paced
learning equipment. If the conference room is not large enough for
educational activities, a classroom should also be provided nearby.

Administrative Of ces:
• It is often desirable to have office space available adjacent to the ICU(s) for
medical and nursing management and administrative personnel. These offices
should be large enough to permit meetings and consultations with ICU team
members and/ or patients' families.
• Additional office space may be allocated for staff development personnel,
clinical specialists, and social services, as applicable. The ability to place these
individuals in close proximity to an ICU may facilitate an integrated and
broad-based team approach to patient management.
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