CONCEPT OF CRITICAL CARE

INTRODUCTION

The intensive care unit is not

merely a room or series of room
filled with patients attached to
interventional technology; it is the
home of an organization: the
intensive care team.
THE INTENSIVE CARE TEAM.

This team –
• Doctor
• Nurses
• Therapists
• Nutritionists
• Chaplains and other
support staff, builds an
environment for healing or
dying.
CRITICAL CARE NURSING
Critical care nursing is that specialty
within nursing that deals specifically
with human responses to life-
threatening problems.
CRITICAL CARE NURSING
Critical care nursing is that specialty
within nursing that deals specifically
with human responses to life-
threatening problems.
 SEVEN Cs OF CRITICAL CARE

• Compassion
• Communication (with patient and family).
• Consideration (to patients, relatives and
colleagues) and avoidance of Conflict.
• Comfort: prevention of suffering
• Carefulness (avoidance of injury)
• Consistency
• Closure (ethics and withdrawal of care).
CRITICAL CARE NURSE

A critical care nurse is a

licensed professional nurse
who is responsible for ensuring
that acutely and critically ill
patients and their families
receive optimal care .
CRITICAL CARE UNIT
• Critical care unit is a specially designed
and equipped facility staffed by skilled
personnel to provide effective and safe
care for dependent patients with a life
threatening problem.
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.
HISTORICAL PRESPECTIVES
• The first ICU started in Nepal in 1973
at Bir Hospital, as a five bed medical
ICU.
• This ICU was developed after the
then King, Mahendra Bir Bikarm
Shahdev, developed a heart problem
in 1970. This was the only ICU in the
country for almost 20 years.
HISTORICAL PRESPECTIVES
• In 1990 a six bed mixed medical surgical ICU became
functional after the development of Tribhuvan University
Teaching Hospital at the Institute of Medicine (IOM),
Maharajgunj.

• Immediately following this, a five bed coronary ICU and 10

additional beds in high dependency units referred to as
Intermediate Cardiac Care Unit (ICCU) and Surgical ICU
were added.
• Furthermore, with increasing demands on ICU beds,
critical care is slowly progressing and has reached its
present shape.
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
 TYPES OF ICUs
There are two types of ICUs,
• An open :-. In this type, physicians admit, treat
and discharge and
• A closed: in this type, the admission, discharge
and referral policies are under the control of
intensivists.
Open Units
Definition :
any attending physician with hospital
admitting privileges can be the physician of
record and direct ICU care. (All other
physicians are consultants)
Disadvantage :
• lack of a cohesive plan
• Inconsistent night coverage
• Duplication of services
Closed Units
• Definition:
An intensivist is the physician of record for
ICU patients. (other physicians are
consultants), All orders & procedures carried
out by ICU staff
• advantage:
• improved efficiency
• standardized protocol for care
• disadvantage:
• potential to lock out private physician
• increase physician conflict
ICUS CAN BE CLASSIFIED AS:

• Level I: This can be referred as high dependency is

where close monitoring, resuscitation, and short term
ventilation <24hrs has to be performed.
• Level II: Can be located in general hospital, undertake
more prolonged ventilation. Must have resident doctors,
nurses, access to pathology, radiology, etc.
• Level III: Located in a major tertiary hospital, which is a
referral hospital. It should provide all aspects of intensive
care required.
Différent zones in ICU

1. Patient care zone

2. Clinical support zone
3. Unit support zone
4. Family support zone
 Patient care zone
1. Per bed space : 4 feet at head and leg end 6 feet on either side
2. Outlets per bed space : 4 oxygen 3 air 3 suction 16-20 power
outlets •
3. Flat, Column, Boom configuration •
4. Multi panel monitor • Bedside illumination
5. Natural light : large clear windows
6. Diminish glare • Diminish sound levels •
7. Air-conditioning : emphasis on patient comfort
8. Beds : multi-functional
9. Single vs Multibed rooms
10. Data entry desk
• Room décor
• • Color schemes
• • Ceiling
• • Nature view
• • Clock
• • Calendar
• • Avoid geometric patterns/bold patterns
• Isolation : Isolation rooms for immuno-compromised and highly
infective patients
• • Negative pressure isolation • Positive pressure isolation
• Pet visitation • Shown to be therapeutic • Particularly useful for long
term patients • Clear hospital policies are mandated
Clinical support zone
• Central location
• • Interdisciplinary team centre “ITC”
• Storage space
• Computer/High speed internet
• A picture archiving and communication system (PACS)
• Communication : telephone, intercom
• Wash station
• Patient visibility
• Central monitor
• Remote monitoring (electronic ICU)
• Computerized order entry
• Mobile data entry device
Ancillary services • Pharmacy • Laboratory • Imaging •
Transport • House keeping • Kitchen • Bio-medical
Specialized areas • Emergency equipment • Emergency
drug cart • Dirty utilities storage • Clean utilities storage •
Washroom • Procedure room
Unit support zone
• Administrative functions
• Multipurpose conference room
• Staff support room on-call room staff lounge lockers
Family support zone
• Family lounge • Signage and way-finding
• Environmental considerations
• Consultation rooms
• Meditation spaces
• Family sleep rooms
• Family nourishment
 STAFFING

• Large hospital requires bigger team.

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.
 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
• INFUSION PUMP
• 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.
• 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.
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 .
 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