Transcript concept of critical care

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 –
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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 lifethreatening problems.
CRITICAL CARE NURSING
Critical care nursing is that specialty
within nursing that deals specifically
with human responses to lifethreatening 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
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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
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.
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.
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.
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
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General surgeon or trauma surgeon
Neurosurgeon
Cardiovascular surgeon
Obstetric-gynecologic surgeon
Urologist
Thoracic surgeon
Vascular surgeon
Anesthesiologist
Cardiologist with interventional capabilities
Pulmonologist
PHYSICIAN SUBSPECIALISTS
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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
technicians
Maintain equipment, including patient
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 lifethreatening 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
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LIFE SUPPORT & RESUSCITATIVE
EQUIPMENTS
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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
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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.
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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
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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
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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 wardtype units.
Lightning
• Total luminance should not exceed 30 foot-candles .
• It is preferable to place lighting controls on variablecontrol 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