ICU and HDU guideliness from MOH&FW.pdf

Department of Health & Family W
Department of Health & Family
Welfare
Operational Guidelines for
Critical Care Unit & High
Dependency Unit
Version 3.0
Strategic Planning & Sector
Reform Cell (SPSRC)
Government of West Bengal

Content
Sl.
No.
Subject
Page
No.
Forwarding i - ii
Preface iii - iv
I. Overview 1
II. Goal 2
III. Objectives 2
IV. Strategies 3
V. Service package standards for CCU 4
VI. Operational steps for planning & rolling out CCUS 5
VII. Design Team 5
VIII. Location 6
IX. Human Resources Standards 7
X. Standard Operating Procedures (Content) 11
XI. State & District Level Supervision & Monitoring 12
XII. Hospital Level Supervision & Monitoring 13
XIII. Equipment Management 15
XIV. Reporting 16
XV. Financing & Accounting 17
XVI. Training of Staffs for CCU 18
XVII. Plan of training for MOs & Nursing Personnel on Critical Care 19
A. Primary Training Plan for Medical Officers 19
B. Short term training for Specialist Medical Officers 22
C. Plan of training of Nursing Staff on CCU 24
XVIII. Technical Aspects & other logistics for CCU/HDU 26
A. Civil Construction 26
B. Electrical Construction 27
C. Environmental 28
D. Centralised laminar flow 28
E. Where trilaminar flow not available 28
F. Lighting 29
G. Noise control 29
H. Waste Disposal & pollution 29
XIX. Standard list of equipment 30
1. Major equipment recommended for each Critical Care Units present in
Medical College Hospitals & M R Bangur Hospital
30

2. Major equipment recommended for each 12 Bedded Critical Care Unit
(CCU)
31
3. Major equipment recommended for each 6 – 12 Bedded High
Dependency Unit (HDU)
32
4. Ancillary equipment (CMS Items) recommended for each unit 34
5. Ancillary equipment (Non-CMS Items) recommended for each unit 35
6. Furniture (CMS Items) recommended for each unit 35
7. Furniture (Non-CMS Items) recommended for each unit 36
XX. Standard List of Medicine & Consumables 37
1. Basic Requirement of Medicines 37
2. Basic Requirement of Consumables 41
XXI. Essential Tests to be done in CCU or HDU 24x7 44
XXII. Cost Analysis – 12 Bedded CCU 45
XXIII. Cost Analysis – 6 Bedded CCU 46
XXIV. Protocol for Infection control in Critical Care settings 47
A. Patient at risk of nosocomial infections 47
B. Factors related to inappropriate practices in CCU / HDU 47
C. Common CCU acquired infections 48
D. Sources of Cross-Infection in the CCU 48
E. Strategies To Reduce Infections In CCU / HDU 48
1. Room sterilization 49
2. Isolation 49
3. Universal protocol : Hand hygiene & Barrier protection 50
i. Hand hygiene 50
ii. Barrier protection 51
iii. Details of Personal protective equipments or barrier protection 51
a. Gloves 51
b. Gown 52
c. Mask / Eye protection 52
4. Device related protocol 53
Peripheral venous catheter 53
Central venous catheter 53
IV Drip set 53
Ryle's tube 53
Tracheostomy tube 53
Foley's catheter 53
Arterial Catheter and Pulmonary Arterial Catheter 53
5. Equipment sterilization 54

i. Ventilator Circuit 54
ii. Endotracheal suction Catheters 54
iii. Endotracheal Tubes 54
iv. Ambu-bags 54
v. Oxygen Delivery masks 55
vi. Suction & drainage bottles 55
6. Disposal of waste 55
7. Procedural Care 56
i. IV care practices 56
ii. Respiratory care - Patient-Based Interventions 56
F. Specific strategies focused on prevention of specific nosocomial
infections
57
1. Strategies to reduce ventilator-associated pneumonia (VAP) 58
2. Strategies to reduce Catheter-Related Blood Stream Infection or
CRBSI
58
3. Strategies to reduce UTI 59
G. Patients needing ICU care should be assessed for 60
H. Regarding Health care workers in CCU 60
I. Environmental Factors and CCU Design Related Issues 60
1. Space 61
2. Ventilation of the unit 61
3. Traffic flow 62
4. Visitors 62
5. Non-ICU Staff 62
Annexure –1 Admission, Discharge policy & Triage for CCU & HDU 63
Admission Policy 63
Admission Protocol 63
Discharge Criteria 66
Triage 67
Annexure -2 APACHE II (Acute Physiology And Chronic Health Evaluation) 68
Annexure –3 Devices/ Accessories monitoring chart 72
Annexure -4 Ventilator & Haemodynamic parameters monitoring chart 73
Annexure -5 Checklist regarding layout & Design 74
Annexure -6 Monthly report of CCU/HDU 77
Annexure -7 Standard specification of some equipment (NON Cat) 82
1. Biphasic External Defibrillator 82
2. Ripple Mattress 83
3. Ventilator – Standard 84
4. Non –Invasive Bi-PAP Ventilator 86
5. Automated Cell Counter 88
6. Fogger Machine 89
7. Rapid Infusion Pump 90

i
FORWARDING
This is a Health & Family Welfare Department’s endeavour to alleviate the delay in treatment
initiation, ensure prompt primary treatment to the patients and also to provide affordable and
accessible, high quality emergency patient care services at all level of hospitals in West Bengal.
Critical Care Unit & High Dependency Units at secondary and tertiary level hospitals is one of the
important interventions to achieve the vision of the Department in the reduction of the morbidity /
mortality of the patient and wage loss of the family members as well as reduce the out of pocket
expenses by ensuring early emergency management to minimise subsequent complications.
Early intervention and zero delay in the initiation of treatment are very much essential to stabilise a
critically ill patient and diminishes the anguish and apprehension of the relatives of the patients
attending Emergency. Critical Care Units and High Dependency Units at Tertiary and Secondary Tier
Hospitals have been planned on the recommendation of Multi-Disciplinary Expert Group (MDEG)
constituted by Government of West Bengal with the target to provide one facility at each 50
Kilometer distance in all districts of the State. These CCUs and HDUs will provide advanced support
to the patients attending emergency department.
Under the guidance of Department, State Level Advisory Committee and Technical
Assistance & Support Team (SLAC & TAST) have prepared the Standard Operational Guidelines
and Technical details for Critical Care unit & High Dependency Units which will act as reference for
facilitating, planning, establishment of new facilities and operation and monitoring of the functional
units at various level of health care facilities in West Bengal. This will be immensely useful to health
care providers and in smooth running of the different units.
This guideline will be applicable to all the hospitals where Critical Care Units, High Dependency
Units are already established or going to be established in a phased manner and it is expected that all
concerned officials including Medical & Paramedical personnel may follow this guideline.
Hope our enthusiastic Doctors, Nursing staffs and other support staffs will deliver their best to make
this concept of critical care at secondary level hospitals a major step forward in ensuring affordable
and accessible health care to all.
I acknowledge the contribution of Late Dr Subrata Maitra, Chairman Multi Disciplinary Expert
Group for his recommendation to establish Critical care Unit & High Dependency Unit in the tertiary

ii
and secondary level hospitals and active guidance to publish this guidelines. We also appreciate the
coordinating support of State Level Advisory Committee (SLAC), Technical Assistance and Support
Team (TAST) and SPSRC for this initiative.
Director of Health Service & e.o. Secretary
Department of Health & Family Welfare
Director of Medical education & e.o. Secretary
Department of Health & Family Welfare

iii
Preface
Government of West Bengal has prioritized to minimize out of pocket expenditure of
common people related to medical care. Priority is also given to minimize the delay of
each critically ill patient to reach appropriate institution in an emergency situation. To
fulfil this priority one of the premier achievements of Department of Health & FW is to
set up Critical Care Units, where critically ill patients of the remote areas of West Bengal
would get sophisticated high end management for critical life threatening diseases
completely free of cost at their doorstep. These units are targeted to be established at a
distance of 50 km of distance from each other to minimize the delay to reach
appropriate institution in any emergency and life threatening situation, so that the
patient can be treated within the “golden hour”.
Accordingly, it was decided to set up 42 Critical Care Units and 30 High Dependency
Units at Medical College & Hospital, District and Sub District level Hospitals within the
year 2015-16. Among these units, 37 CCUs have been made functional till date in 14
Medical Colleges, 20 District Hospitals and 3 Sub Divisional Hospitals having a total
bed strength of 552 beds and 19 HDUs also have been made functional in 18 different
Sub-divisional hospitals and 1 Rural Hospital having a total bed strength of 114.
Critical Care Unit (CCU) provides general or multispecialty care to critically ill patients
in general. (Older terminology for the same is Intensive Therapy unit or ITU). To
facilitate planning, establishment, operation and monitoring of critical care units at
various levels of Public Health facilities an operational guide has already been
developed and published in August 2014. The aim was to assist program managers and
service providers at state and district level in planning and delivering critical care. This
guide has been put together based on recommendations of a State Level Advisory
Committee (SLAC-CCU) and a Technical Assistance and Support Team (TAST-CCU)
set up by the GoWB along with experts from public and private sectors.
Now, after thorough DATA analysis generated by all the functional units and
situational analysis regarding patient management, Human resource and inventories
some changes are required to be included in the Operational Guideline for CCUs &
HDUs.
Version 3.0 of this Guideline is introduced with a number of changes and new
inclusions in running the Critical Care Units & High Dependency Units in different
level of hospitals like Medical Colleges, District Hospitals, Sub-divisional Hospitals,
State General hospitals & Rural Hospitals.
This operational guide includes information on various aspects that needs to be
addressed for ensuring quality critical care services and is divided into various
sections.

iv
This guideline will also act as a ready reckoner for different CCU and HDU related
activities like equipment procurement & maintenance and will be helpful to support the
Medical Officers & Nursing Personnel attached to CCUs & HDUs as well as Hospital
authority to run these highly specialized units smoothly.
This guideline also helps the trainers to conduct training programme for the Medical
Officers & Nursing Personnel.
This guideline has been developed by the following members of SLAC-CCU under
active guidance and support of Dr R. S. Shukla, IAS & Principal Secretary to the
Department of Health & FW, Mr. Onkar Singh Meena, IAS; Director, SPSRC & Secretary
to the Department of Health & FW, Dr. Biswa Ranjan Satpathy, Director of Health
Service & e.o. Secretary & Dr. Susanta Bandopadhyay, Director of Medical Education &
e.o. Secretary along
Prof. (Dr) Ashutosh Ghosh Prof. of Medicine and In charge Critical Care Medicine,
IPGMER
Prof (Dr) R.N. Pandey, HoD, Nephrology; IPGMER
Dr. Sukanta Seal, Joint Director, SPSRC
Dr. Sugata Dasgupta, Associate Professor, Department of Anaesthesiology & In-charge,
CCU – R G Kar MCH
Dr. Shubabrata Paul, In-charge, CCU – M R Bangur District Hospital
Dr. Suparno Paul, Technical Officer – SPSRC
And other Technical Officers and staffs of SPSRC
Strategic Planning & Sector Reform Cell (SPSRC)
Department of Health & Family welfare
Swasthya Bhavan
‘B’ Wing, Fourth Floor
GN-29; Sector – V
Salt Lake, Kolkata - 700091

Operational Guideline for CCU & HDU (Version 3.0) 1 | P a g e
I. Overview
1. Saving the life of the wage-earner of the family is very important. In some cases such
patients died due to lack of critical care support. In our state there were very few Critical
Care Units (CCU) in Govt. health system as well as private health care system. Over and
above, the cost of such service at private health system is not affordable for ordinary
citizen. So there was an urgent need to increase the availability and accessibility of the
patient related to CCU service.
2. On the other hand as per the norms of Medical Council of India, each Medical college
Hospital should have 1 CCU.
3. Reduction of the maternal mortality is also a priority issue of the National as well as
state programme. Some maternal deaths can be avoided with the CCU service.
4. Reduction of the mortality related to vector borne diseases particularly Malaria and
Japanese Encephalitis is also a priority issue of the national as well as state programmes.
Some deaths due to Malaria, AES and Japanese encephalitis can be avoided with the CCU
service. Also to counter Influenza pandemics like Bird flu & Swine flu in recent past.
5. In view of above, the state health system decided to have CCU services across the state.
In order to do so, proper planning was done so that there would be 1 Critical care unit
(CCU) within 50 km of the residence of any patient. This location identification was done
by using GIS mapping.
6. Ordinarily the CCU will be located in Each Medical college Hospital and District
hospital but in exceptional cases, it can be located at Sub-divisional/State general
Hospital also. The Dialysis unit will preferably be located in the same building, as close to
CCU as feasible and at least two portals for bedside dialysis will be provided in each
CCU.
7. Each 12 bedded CCU will have 1 four bedded ICU and 1 eight bedded HDU to begin
with and each 24 bedded CCU should have 1 eight bedded ICU and 1 sixteen bedded
HDU to begin with. Provision for future expansion planned accordingly.
8. In the second phase of planning, Department has decided to establish one 6 bedded
High Dependency Unit (HDU) as a sole unit in all of the Sub-division Hospitals and even
in some selected State General Hospitals & Rural Hospitals. These HDUs will act as a
primary stabilization unit for critically ill patients before sending to the higher centers as
well as to treat the critically ill patients by critical care trained Medical Officers & Nursing
Personnel. Provision for future plan of extension to become a full phased Critical Care
Unit also to be considered during planning to establish these units.

II. Goal
Set up of 72 Critical Care Units and High Dependency Units for treatment of critically ill
adult / pediatric patients phase wise in the Government sector within a distance of 50
kms from the residence of any patient.
III. Objectives
1. The foremost objective of the CCU project is to reduce the Out of Pocket
Expenditure of common people for providing emergency and critical care
treatment and ensuring quality and affordable Critical care and emergency
services 24X7 in secondary level hospitals
2. Reduction of the mortality / morbidity of the wage-earner of the family due to lack
of timely and affordable Critical Care support.
3. Ensure ‘Zero Delay’ in the initiation of treatment of acutely ill patients.
4. Provision of emergency medical treatment and critical care support to every
patient, so that they can be treated within the “golden hour”.
5. Reduction of the maternal mortality.
6. Reduction of the mortality related to vector borne diseases particularly Malaria,
Japanese encephalitis, AES, epidemic / pandemic diseases and disasters.
7. Establish at least one CCU or HDU within 50 Km from the residence of any patient
covering all over the state and minimizing the delay to reach appropriate
institution in an emergency situation.
8. To enhance the capacity of Secondary Tier Hospitals to handle critically ill patients
within their own set up and reduce the number of referral.
9. To increase the capability of Medical college & hospitals to handle their own
critically ill patients without referring them to private sector hospitals.
10. To reduce over congestion in Tertiary Care Hospitals.

IV. Strategies
1. Teaching hospitals:
1.1. CCU is a multispecialty unit catering to all critically ill adult patients. In
Teaching Hospitals, it will serve in addition to Specialty Intensive Care Units
(ICUs) e.g. Cardiac ICU, Respiratory ICU, Neuro ICU, PICU under Dept. of
Pediatrics and Neonates are cared in Neonatal ICU (NICU) or Sick Newborn
Care Unit (SNCU).
1.2. Augmentation of existing units (Mostly in Medical Colleges).
2. Non-teaching hospitals:
2.1. In all District Hospitals and others, CCU will serve as sole unit for critical care.
The PICU and NICU or SNCU are separate units meant for pediatric patients
and neonates respectively. In nonteaching hospitals, once CCU is fully
developed and adequate trained manpower is available, these units will be
extended to care pediatric patients also.
2.2. Set up of Six bedded High Dependency Units (HDU) in most of the Sub-
divisional Hospital and some selective State General Hospital & Rural
Hospitals.

V. Service package standards for CCU & HDU
1. Each CCU should have a minimum of 12 beds comprising of one Intensive care
unit (ICU) having 4 beds and one High Dependency Unit (HDU) or Step down
unit having 8 beds which includes recovery beds. HDU is less resource consuming
and serves relatively less sick patients stepping down from ICU or admitted
straight from outside CCU. One HDU bed is to be constructed as isolation bed
which has a flexibility to be used for full support as in ICU. All currently existing
ITUs or CCUs should have one HDU on priority basis.
2. In Step down Unit or HDU is an integral part of the full fledged CCU, the care
level is intermediate between ICU and wards (including Emergency Observation
Ward), usually located near / within the CCU complex. Following type of patients
may be kept there (a) Cases recovered from Critical illness; (b) Cases who are less
sick, not requiring invasive hemodynamic monitoring or invasive Mechanical
Ventilation; (c) Cases requiring close observation otherwise who may worsen. Size
should be at least 50 % of the main ICU. 1/3 of these Beds may be used as
palliative unit.
3. Each independent High Dependency Unit (HDU) established in different sub-
district level hospital should have a minimum capacity of 6 beds, the care level is at
par of the CCU but involving proportionately less human resources and supported
by less number of specialists. The primary target is to provide critical care to the
patients within the ‘Golden Hour’ and to stabilise the critically ill patients before
transferring to the nearest Critical Care Units for further treatment. Provision of
Invasive Mechanical Ventilation should also be provided here.
Details of Admission & discharge Protocol of CCU & HDU given later on.

VI. Operational steps for planning & rolling out CCUs
Elements of Critical Pathways - activities
1. Identification of location, no. of units and category of development
(new/augmentation)
2. Policy decision and issue of GO
3. Timeline
4. Funding: (a) Non-recurrent & (b) Recurrent
5. Unit Structure
6. Human Resources
7. Equipments and drugs
8. Operation and maintenance
9. HMIS including networking
VII. Design Team
1. At State Level – State Level Advisory Committee (SLAC-CCU) and Technical
Assistance and Support Team (TAST-CCU),
2. At Facility Level – a. Medical Superintendent / Superintendent, b. Physician, c.
Anesthetist, d. Engineers (Civil & Electrical) e. Nursing Superintendent,

VIII. Location
1. It has been decided that Critical care Units will be established at tertiary and
secondary care hospitals of the state in a phased manner tentatively as per table
given below so that there will be a CCU within 50 Km from the residence of any
patient.
Total 42 CCUs are already planned to be establish as per the following list,
1. NBMCH 12. MRBH 23. Tamluk DH 34. Kolkata MCH
2. Darjeeling DH 13. MSD MCH 24. Basirhat DH 35. NRSMCH
3. Malda MCH 14. ID&BG
25. Diamond
Harbour DH
36. CNMCH
4. Burdwan MCH 15. Purulia DH 26. Siliguri DH 37. RGKMCH
5. Balurghat DH 16. Srirampur SDH 27. Bankura MCH 38. SSKMH
6. Jalpaiguri DH 17. Midnapur MCH 28.Sagar Dutta MCH 39. Alipurduar SDH
7. Coochbehar DH 18. JNM Kalyani 29. Nandigram DH 40. Durgapur SDH
8. Suri DH 19. STM 30. Raiganj DH 41. Uluberia SDH
9. Howrah DH 20. Krishnanagar DH 31. Jhargram DH 42. Canning SDH
10. Chinsurah DH 21. Asansol DH 32. Bishnupur DH
11. Barasat DH 22. Rampurhat DH 33. Bolpur SDH
2. Government has also decided to establish 30 more High Dependency Units phase
wise which will have the potential to become a full phased 12 Bedded CCU in
future in different SDHs, SGHs & RHs.
HDUs are already planned to be establish as per the following list,
Sl No. Name of Hospitals Sl. No. Name of Hospitals
1. Bongaon SDH 16. Kandi SDH
2. Baruipur SDH 17. Jangipur SDH
3. Kakdwip SDH 18. Chanchal SDH
4. Amta RH 19. Gangarampur SDH
5. Arambagh SDH 20. Islampur SDH
6. Egra SDH 21. Mal SDH
7. Haldia SDH 22. Birpara SGH
8. Contai SDH 23. Kalimpong SDH
9. Ghatal SDH 24. Kurseong SDH
10. Khatra SDH 25. Mathabhanga SDH
11. Raghunathpur SDH 26. Dinhata SDH
12. Katwa SDH 27. Karimpur RH
13. Kalna SDH 28. Digha SGH
14. Tehatta SDH 29. Vidyasagar SGH
15. Ranaghat SDH 30. Baghajatin SGH

IX. Human Resource Standards
1. Patient admitted in Critical care unit (CCU) and High Dependency Unit (HDU)
will be treated following a multi- disciplinary approach but a particular patient
will be admitted under a particular Specialist Doctor/Faculty (Consultant) of
concerned discipline who is the bed in- charge (BIC).
2. Each unit will be manned by a dedicated earmarked core team of personnel
consisting of; (i) Trained Medical Officer (CCU); (ii) Trained nursing staff (CCU);
(iii) Medical Technologist (MT-CCU); and (iv) GDA / sweeper. The core team
will be supported by the Anesthetists.
3. Each unit should be manned by at least one CCU trained Medical Officer in all 6 &
12 bedded unit and two CCU trained Medical Officer in all 24 bedded unit in each
of the three daily eight hour shift. In case of Nursing Personnel provision should
be made for presence of at least one trained Nursing Personnel for a 6 bedded
HDU, at least two trained Nursing Personnel for a 12 bedded CCU and three
trained Nursing Personnel for a 24 bedded CCU per eight hour shift.
4. In case of CCUs situated in any Medical College Hospitals, CCU should run with
the help of PGTs of Medicine & Anesthesia Department.
5. One of the Medical Officers of CCUs / HDUs will be in-charge and will assist the
Medical Superintendent-cum-vice-principal (MSVP) / Superintendent in
administrative matters.
6. In case of acute scarcity of trained Medical Officers (mainly in HDU), Emergency
Medical Officers who already have undergone training for “Advance Life Support
and Management of commonly encountered emergency situation (cardio-
respiratory & Head Injury)” may be given duty in the HDU in case of emergent
situation under active supervision of on duty Physician & Anesthetist of that
period of time.
7. Essential requirement may be varied depending on the performance of the
individual unit. More number of human resources may be required in case of
admission of more critical cases in the individual unit.
8. This norm is applicable for any type of hospitals.
9. In case of selection, any candidate with any kind of training/experience in CCU
will be given preference but the Medical Officer / Nursing Personnel should
undergo the requisite training for CCUs as per norms.
10. Provision of male nurse is also recommended.

11. GDA / Sweeper may be outsourced depending on the issuance of respective
Government order.
* CCU trained means Medical Officers getting 48 days’ CCU training and Nursing Personnel
getting 18 days’ CCU training in the designated Hospitals.
12. Job responsibilities of manpower
Sl. No. Category Brief Job description
1. Medical Officer
Supportive care and baseline management on 8hr shifting
duty including equipment handling and basic pathological
/ biochemical tests utilizing equipment present in the CCU
/ HDU.
One of the CCU / HDU MOs will act as In Charge and will
discharge additional administrative duties
2. Nursing In Charge
Supervisory, Logistics management, Regular reporting,
duty roster of nursing staffs
3. Nurse
Patient care on 8 hr shifting duty including equipment
handling and basic pathological / biochemical tests
utilizing equipment present in the CCU / HDU as
following,
i) General Nursing Care
ii) Basic Life Support
iii) Assisting Advanced Life Support
iv) Airway Suction & Nebulisation
v) Simple blood testing like Blood Glucose by glucometer
vi) ECG
vii) Monitoring – a) Clinical parameters, b) Multichannel
monitors, c) Ventilator parameters
viii) Maintenance of different charts
ix) Maintenance of records, statistics & reporting
x) Sampling body fluids
xi) Managing requisitions for tests,
xii) Maintenance and keeping ready stocks of drugs,
equipment, consumables etc.

4. MT ( Critical Care )
Assisting patient care on 8 hr shifting duty including
equipment handling and basic pathological / biochemical
tests utilizing equipment present in the CCU / HDU as
following,
i) Basic Life Support
ii) Chest physiotherapy
iii)Oxygen therapy including handling oxygen manifold &
centralized oxygen supply
iv)Assisting Advanced life support
v) Assisting MOs performing different procedures
vi)Assisting bedside dialysis (where available) in
collaboration with dialysis technician
vii) Blood sampling by peripheral venipuncture
viii) Assisting USG / Echocardiography (if available) / X-
ray procedure
ix) Basic blood test by Biochemical analyser / Cell counter
/ Glucometer / Arterial blood gas analyser / Electrolyte
analyser present in the CCU / HDU
x) Maintenance of all equipment present in the CCU /
HDU – preventive and to certain extent remedial
xiii) Monitoring – a) Clinical parameters, b) Multichannel
monitors, c) Ventilator parameters
xi) Computation & clerking
5. General Duty Attendant
General duty, loading/unloading, stretcher bearer,
Messenger
6. Sweeper Cleaning & sweeping
13. Points to be noted regarding Human Resource Standards :
i. Patients in the CCU / HDU should be admitted under respective Bed-in-charges of
different Departments of the hospital. CCU Trained Medical Officers will be
responsible for initial critical care management and daily treatment of the admitted
patients in consultation with the respective BICs.
ii. On duty specialist BIC one each from Medicine and Anesthesiology will be given
extra responsibility as Supervising Officer to supervise patient care of the entire
unit and they will be consulted upon by the MOs as & when required.
iii. MSVPs / Superintendents will allot the duty of the specialists and keep liaison
with the entire unit.
iv. Specialists of different disciplines will take care of patients admitted in CCU
under them as Visiting and on referral during day–on-call, as they do usually in
other wards.

v. In case of Tertiary care hospitals Staff pattern is same except specialists will be
replaced by faculty and Gradually MOs will be replaced by Postgraduate trainees
of Medicine & Anesthesiology on a rotation basis as part of their training for the
respective courses.
2. Necessary posts for (i) Medical Officer (CCU); (ii) Nursing staff (CCU); (iii) Medical
Technologist (MT-CCU); and (iv) GDA / sweeper already created. Contractual
posts for (i) Medical officer (CCU); (ii) Nursing staff (CCU); (iii) Medical
Technologist (MT-CCU); and (iv) GDA / sweeper may be created/recruited under
the NPCDCS/NVBDCP as per programme norm depending on the situation.
3. Sweepers may be outsourced from external agencies as per Government norms and
Government sanction orders.

X. Standard Operating Procedures (Content)
Standard Operating Procedure for CCU & HDU contained the following topics,
1. Clinical Protocols on Admission/ Discharge/ Shifting of patient, Management and
monitoring of patient & Infection Control will need to be formulated.
2. Guideline regarding supervision, monitoring, equipment management, equipment
handling, reporting, financing & accounting, training plan of Medical Officers &
Nursing personnel.
3. Technical aspects to establish a Critical Care or High Dependency Unit.
4. Standard and essential list of equipment, medicine & consumables.

XI. State & District level Supervision & Monitoring
1. It has also been decided that the Joint. DHS (P&D) will act as State Nodal Officer
and Dy CMOH-I will act as District Nodal Officer of planning & implementation
of Critical care Units at state and district level respectively. The Joint. Director
(SPSRC) will act as the Joint-convener of State Level Advisory Committee.
2. The State and District Nodal Officers will work in close liaison with the members
of State level Advisory Committee of CCU, Technical Assistance & support Team
of CCU, Principals/MSVPs/ Deputy Superintendent of the different Medical
College Hospitals and Superintendent of District / Sub-divisional Hospitals.
One appointed officer from Swasthya Bhavan (SPSRC) will act as State liaison
officer for this programme and will render technical assistance to the State &
District Nodal officers.
3. Checklist for monitoring quality of care like i) Errors, ii) Adverse drug reaction, iii)
performance of individual staff etc. will be formulated and circulated shortly.
4. Monitoring teams will be formed involving Critical Care Specialists, Physicians,
Anesthetists from different Medical College Hospitals and District or Sub-district
level hospitals for regular visit to the functional CCUs / HDUs and provide
supportive supervision and on-site hands on training including sensitization to the
Medical & para medical staffs present there as per need.
5. Each member of the monitoring team will be responsibile for 3-4 designated units
and they will make liaison with their respective units and make fix periodic visit
to these units. They will also make regular off-site supervision and monitoring of
these units and provide remote assistance regarding some patient related and
technical issues.
6. Each monitoring team will be provided a prescribed reporting format to report
after every visit. Those reports will be analyzed in the SLAC – CCU or TAST –
CCU meeting for providing further recommendation to the Department regarding
quality up gradation of the functional CCUs & HDUs.

XII. Hospital level Supervision & Monitoring
1. One trained MO among the MOs working at CCU / HDU will act as Medical
Officer In charge of the unit and responsible for duty distribution of the Medical
Officers, logistics management within the unit and regular compilation of monthly
report.
2. One Nursing personnel will be designated as Nursing – in – charge by hospital
authority. She will be responsible for making duty roster for Nursing personnel
working in the CCU / HDU, store management, regular indent and compilation of
monthly report.
3. One specialist each from the Dept. of Medicine and Anesthesiology of the
respective hospital, selected by respective MSVPs / Superintendents, will act as
Supervising Officer and make overall supervision regarding patient care &
technical issues.
4. One Assistant Superintendent (Non-Medical) will act as Hospital level liaison
officer for respective CCUs / HDUs. They are responsible for daily logistics
management, regular updating of patient related information electronically and
regular monthly reporting.
5. Assistant Superintendent (Non-Medical) should give at least one daily round in
the respective CCU / HDU.
6. MSVP / Superintendent of the respective hospital should give at least one weekly
round with respective Supervising Officers; Assistant Superintendent (Non-
Medical) responsible for CCU related activities and Nursing Superintendent in the
respective CCU / HDUs.
7. Regular round (at least twice daily) by Bed-in-charges in the CCU / HDU should
be mandatory, if patients present under their treatment.
8. A Hospital level monitoring committee will be formed for periodic monitoring of
CCU / HDU activity with the following persons,
a. MSVP / Superintendent of the hospital as Chairman of the committee
b. MO in charge of the respective CCU / HDU as Convener
c. Supervising Officer (Physician) of that unit as member
d. Supervising Officer (Anesthetist) of the unit as member
e. Nursing in charge of the respective CCU / HDU as member
f. All CCU trained MOs attached to the unit as member
g. Assistant superintendent responsible for CCU / HDU related activity as
member

h. Deputy Superintendent as member (in case of Medical College Hospitals)
i. Dy CMOH 1 (as District Nodal Officer for CCU) of that District as invitee
member
9. This Hospital level monitoring committee will meet monthly (preferably at a pre-
fixed date in every month) and analyses all CCU / HDU related activities
including monthly report analysis, logistics review, gap analysis and problem
identification.

XIII. Equipment Management
1. Equipment including Laboratory equipment present in the CCU & HDU should be
primarily handled by on duty Medical Officer & Nursing staffs. If MT – CCU is
present, then he/she will act as a helping hand for utilizing these equipment.
2. Laboratory equipment, designated for CCU / HDU should be kept in the
respective CCU / HDU only and not in the general laboratory of the hospital as
these equipment should be available 24 x 7 for the patients admitted in CCU /
HDU.
3. Laboratory equipment may also be utilized for the other patients of the hospital. In
that case, respective laboratory technician of that hospital may perform the tests
with permission of the on duty Medical Officer of the CCU / HDU.
4. Portable X-ray present in the CCU / HDU will be operated by X-ray technician,
present in that hospital.
5. Maintenance of the equipments and indent for repairing these equipments will be
the joint responsibility of the MO in Charge & Nursing in charge. In case of
malfunctioning of any equipment, they should inform the respective companies in
prescribed format at the earliest and properly follow up the repairing work. This
is also the responsibility of Nursing in charge to inform the hospital authority
regarding the renewal of Annual Maintenance Contract well prior to the expiry of
the on going contract.

XIV. Reporting
1. All patient admission and discharge should be recorded in on line software (off
line recording may also possible). Recording should be the responsibility of on
duty Medical Officers and Nursing Personnel. Data entry operator may be
provided by MSVP / Superintendent, if available in the hospital.
2. At the end of the month, report should be compiled in the prescribed Excel format
and soft copy will be sent to Swasthya Bhavan within the 7th of the next month.
Compilation of the monthly report will be the joint responsibility of MO in charge,
Nursing in charge and Assistant Superintendent responsible for CCU / HDU
related activities.
3. All CCU / HDU should be provided at least one computer, one printer, one flat
bed scanner and suitable Internet connection for this purpose. Provision may be
done by the local hospital authority or centrally.

XV. Financing & Accounting
1. There is a budget provision under National Programme for Control of Diabetes,
Cardio-vascular Diseases & Stroke (NPCDCS) to establish CCU.
2. There is a budget provision under National Vector borne Disease Control
Programme (NVBDCP) to establish ‘paediatric ICU’ for Japanese Encephalitis.
3. For development, operation & maintenance of critical care units, particularly to
meet- up the recurrent expenditure proposal shall be incorporated in the State
NHM PIP under NHM additionalities.
4. Other sources of fund like State Budget, BRGF, 13th Finance commission Grant,
MP LAD/MLA LAD also be provided to meet the non-recurrent expenditure like
construction, purchase of equipment etc.

XVI. Training of Staffs for CCU
1. Medical Officer will be imparted a short training of 8 weeks (48 working day),
covering major fundamentals. The Department already starts a Post Graduate
Certification course in critical care under WBUHS.
2. Nursing Staff will be imparted a Short training of 6 weeks: 3 weeks (18 working days)
at Training centre + 3 Weeks. on site. In presence of the CCU trained Medical Officers.
3. Paramedic: Minimum qualification will be a recognized Diploma in Critical Care
Technology.

XVII. Plan of training for MOs & Nursing Personnel on
Critical Care
A. Primary Training Plan for Medical Officers
1. Training Centers for Medical Officers: At present, Department of Critical Care
Medicine of IPGMER and SSKMH Kolkata is designated as Main training center.
Different Medical College Hospitals act are designated as CCU training centers
under the guidance of main training center. Some District Hospitals like M R
Bangur Hospital, Howrah District Hospital also designated as training centers
under the guidance of main training centre.
2. Duration: Eight weeks (48 working days)
3. Number of trainees: 10 - 15 per batch
4. Learning objectives: After completion the trainee will achieve (a) Proficiency in
recognition and initial management of problems commonly encountered in an
CCU; (b) Efficiency in resuscitation of critically ill patient; (c) Appropriate
monitoring of different parameters & their interpretation; and (d) Capacity to
identify troubles- both patient and device related and perform basic
troubleshooting
5. Training methodologies: Lectures, Demonstrations, Practical (Hands-on Training).
Trainee will have to perform shifting duty at each training center.
6. Curriculum:
6.1. Specific credentials (Training method: Hands-on): (a) CPR – BLS (Basic Life
Support); (b) CPR – ALS (Advanced Life Support) : Intubation/ Mechanical
Ventilation / Defibrillation / Temporary pacing / Application of
cardiovascular drugs- Antiarrythmics / Vasopressors /Inotropes etc.
6.2. Procedural skills (Training method: Hands-on): (a) Maintenance of open
airway in a non-intubated patient; (b) AMBU Mask ventilation; (c) Tracheal
intubation : Trans-oral, Trans-nasal; (d) ICTD ( Chest Drain ); (e) Cardioversion;
(f) Transcutaneous temporary pacing; (g) Insertion of CV cath. (Central Venous
Catheter); (h) Tracheostomy (i) Changing Tracheostomy Tube.
During training, hands on training will be given preceded by a lecture and followed
by a test.

7. Following subjects will be incorporated in the 48 days’ training session.
7.1. An overview of critical care: The basic do’s and don’ts and Basic Idea regarding
the whole Training programme
7.2. Approach to respiratory failure
7.3. Cardiopulmonary resuscitation (BLS)
7.4. Cardiopulmonary Resuscitation (ACLS)
7.5. Haemodynamic drugs in critical care
7.6. Maintenance of an open airway (Chin lift / jaw thrust / Suction /
Oropharyngeal & nasopharyngeal tubes) / Mask ventilation / Using AMBU /
Using Breathing Circuit in emergency
7.7. Tracheal intubation using direct laryngoscope (Endotracheal Tube /
Laryngoscope)
7.8. Rescue oxygenation (LMA / Combitube / Cricothyrotomy)
7.9. Arterial Blood Gas analysis – approach, interpretation & application
7.10. Oxygen therapy, Humidification and inhalational therapies
7.11. Invasive Ventilation: Basic concepts & Basic modes
7.12. Invasive Ventilation: Indication, Criteria, Monitoring & Troubleshooting
7.13. Invasive Ventilation: Weaning and tracheostomy
7.14. Disease specific ventilation : ARDS and restrictive diseases
7.15. Disease specific ventilation : Severe Obstructive Airway diseases
7.16. Management of commonly encountered arrhythmias in the general Critical
Care Unit (including defibrillation)
7.17. Acute Coronary Syndrome
7.18. Approach to cardiogenic shock & acute heart failure
7.19. Noninvasive ventilation
7.20. Principle of Renal Replacement Therapy
7.21. Approach to shock
7.22. Central venous pressure and arterial blood pressure monitoring
7.23. Intravenous fluids in critical care (Including evidence based comparison
between colloids & crystalloids)
7.24. Transfusion practices in critical care
7.25. Pulse oximetry & Capnometry: its implications in critical care
7.26. Surviving sepsis campaign for management of severe sepsis and septic shock
7.27. Hospital acquired infections and infection control practices in critical care
7.28. Antibiotic policies in Critical care Unit
7.29. Management of seizures
7.30. Diagnosis and management of cerebrovascular accidents (CVA)
7.31. Approach to peripheral neuropathic and neuromuscular diseases in critical care
7.32. Meningitis and encephalitis
7.33. Approach to liver failure
7.34. Approach to acute pancreatitis
7.35. Pneumonia
7.36. COPD and Asthma exacerbations

7.37. Venous thromboembolism and Thromboprophylaxis in CCU
7.38. Sedation and analgesia in Critical Care
7.39. Glycaemic control in Critical Care (along with management of hyperglycemic
crises)
7.40. Approach to common obstetric complications encountered in CCU
7.41. General management of major trauma including head injury (with special
reference to District Hospitals)
7.42. General management of burns (with special reference to District Hospitals)
7.43. Practical aspects of renal replacement therapy
7.44. Approach to acute and acute on chronic renal failure
7.45. Critical care Nutrition
7.46. Approach to poisonings and drug overdoses
7.47. Snake bite
7.48. End of life, Brain death and medicolegal issues in critical care
7.49. PRACTICAL HANDS ON TRAINING - GROUPWISE
Preferably, training on topics 7.1 – 7.20 will be given centrally within a duration of 6
working days’ training programme. During this period, trainee of all training centers will
be given training (both theoretical & hands-on) at a state level training centre. Critical care
Training Centre of Bijoygarh SGH may be utilized for this purpose.
Training regarding rest of the topics i.e. 7.21 – 7.49 will be given in the peripheral training
centers. Preferably, maximum 1-2 topics will be covered in a single day along with
practical session covering at least 50% of the total working days. Trainee MOs will be
given rotational duty in the respective CCUs of the training centers in presence of regular
MOs of that CCU for better sensitization and training in real time scenario.
8. Logbook: Each trainee will have to maintain a log book recording performance of
duty, specific credentials, lectures & demonstrations attended, procedures
performed and rotational training as performed. It is to be signed by the Unit /
Departmental Head / Training in charge.
9. Post training evaluation & Certification: Only oral and practical tests. On
completion of successful training, duly signed by the Head of the Institute and
DME/DHS.

B. Short Term Training for Specialist Medical Officers
1. A short term sensitization training may be planned for Specialist Medical Officers
who already have degree / diploma in Anaesthesia & General Medicine / Bed-in-
charges (under local order).
2. Duration: 8 working days divided in two phases (4 day each) at a interval of 3-4
wks.
3. Number of trainees: 15-20 per batch
4. Training Centre: Preferably training will be given at Department of Critical Care
Medicine of IPGMER and SSKMH, North Bengal MCH, R G Kar MCH and Critical
Care Training Center of Bijoygarh SGH
5. Learning objectives: After completion the trainee will achieve (a) Efficiency in
resuscitation of critically ill patient; (b) Capacity to handle different CCU related
devices, (c) Capacity to identify troubles- both patient and device related and
perform basic troubleshooting, (d) Capacity to give technical support to Medical
Officers & Nursing personnel present in CCU & HDU and (e) Capacity to give
sensitization training to other Medical Officers and Nursing personnel.
6. Training methodologies: Lectures, Demonstrations, Practical (Hands-on Training).
7. Curriculum:
The following topics will be covered in whole training programme. Maximum 3-4
topics will be covered in a single day. 50% of the topics will be covered in 1st part
of the training programme and rest of the topics will be covered in 2nd part.
7.1. BLS and ACLS
7.2. Shock
7.3. Colloid and Crystalloid resuscitation
7.4. Hemodynamic drugs
7.5. Hemodynamic monitoring (Arterial blood pressure and central venous
pressure)
7.6. Acute respiratory failure
7.7. Pulse oximetry and Capnometry
7.8. Oxygen, Humidification and Inhalational therapies
7.9. Noninvasive Ventilation
7.10. Invasive Ventilation (Basic concepts + Basic modes + Weaning)
7.11. Disease specific ventilation (ARDS + Severe airway obstructive disorders)
7.12. Arterial Blood Gas analysis

7.13. Acute Kidney Injury
7.14. Dyselectrolytemias in critical care
7.15. Transfusion practices in critical care
7.16. Sepsis
7.17. Hospital acquired infections and infection control practices in critical care
7.18. Antibiotic policies in critical care
7.19. Sedation and analgesia in critical care
7.20. Glycaemic control in Critical care
7.21. Venous thromboembolism and thromboprophylaxis in Critical Care
7.22. Major trauma including Traumatic brain injury
7.23. Critical Care Nutrition
7.24. Hands on training of different equipment used in CCUs & HDUs

C. Plan of training for Nursing Staff on CCU
1. Training Centers: Department of Critical Care Medicine of IPGMER and SSKMH
Kolkata is designated as Main training center. Different Medical College Hospitals
are designated as CCU training centers for Nursing staffs under the guidance of
main training center. Some District Hospitals like M R Bangur Hospital, Howrah
District Hospital are also designated as training centers under the guidance of
main training centre. Rotational exposure for 2 days each at pediatric ICU where
available.
2. Duration: Three weeks (18 working days) at the Training Centre and three weeks
post-placement consolidation under guidance of trained MOs in the individual
CCU / HDUs.
3. Number of trainees: 15 - 20 per batch
4. Learning objectives: After completion, in addition to routine usual nursing care
the trainee will be able to perform (a) Appropriate monitoring of critically ill
patients (Including ECG interpretation and ventilator parameters monitoring),
detect troubles, report it to on duty MOs and troubleshoot themselves to certain
extent. They will maintain all charts at bedside; (b) Feeding patients (Enteral /
Parenteral) properly avoiding aspiration lung injury in case of enteral feed; (c)
Preventing pressure sore; (d) Capacity to assist / perform chest physiotherapy
including airway toileting & aerosol therapy; (e) Continuous infusion of different
lifesaving medicines; (f) Implement infection prevention protocols including
sterilization of instruments & devices; (g) Performing ECG and (h) Assist or
cooperate patient care activities with that of Medical Technologist (MT) (Critical
Care) and MOs.
5. Training methodologies: Lectures, Demonstrations, practical (Hands-on
Training). Trainee will have to perform shifting duty at each training centre. Grand
round with consultant, MOs and medical technologists
6. Curriculum:
6.1. Specific credentials (Training method: Hands-on): Basic Life Support (BLS)
6.2.Procedural skills (Training method: Hands-on): (a) Insertion of peripheral
venous catheter; (b) Endotracheal suction & collecting sample for microbiological
study
6.3. Cognitive skills:
(a) Recognition of (12 sessions of Lecture/Demonstration): (i) Respiratory Failure;

(ii) Oxygen therapy; (iii) Mechanical Ventilation – Invasive; (iv) Mechanical
ventilation – Noninvasive; (v) Fluid and Electrolyte Disorders; (vi) Sepsis; (vii)
Shock / Hypotension; (viii) Normal ECG interpretation & pattern identification
of common ECG abnormalities in intensive care; (ix) Cardiovascular medicines
– Vasopressors, inotropes, common antiarrhythmics, antihypertensives,
antiischaemic drugs, antiplatelets, anticoagulants; (x) Aspiration Lung Injury,
ARDS, Cardiogenic pulmonary edema; (xi) Communication skill : with CCU
staff, patient, relatives of patients and administrators
(b) Application of (10 sessions of Lecture/Demonstration): (i) Bedside assessment
– Clinical/ on multichannel monitor / ventilator parameters/ glucometry /
common lab reports and maintaining charts; (ii)Troubleshooting & reporting to
MOs and MT. Detection of problems include clinical, blood gas related (SPO2,
ETCO2), mechanical ventilatory, electrocardiographic, hemodynamic – CVP/
NIBP ) and identification of true & false alarms; (iii) Chest physiotherapy
including airway toileting & nebulisation; (iv) Application of infusion pump –
both syringe and rapid; (v) Nutrition : Different diets, enteral and parenteral
feeding , methods of feeding, prevention of aspiration; (vi) Prevention of
infection in CCU : Application of protocols – universal, room sterilization,
disposal of wastes, sterilization of instruments and device related policies; (vii)
Prevention of bedsore or pressure sore; (viii) ECG machine handling and
performing ECG; (ix) Appraisal of errors.
7. Logbook : Each trainee will have to maintain a log book recording performance of
duty, specific credentials, lectures & demonstrations attended, procedures performed
and rotational training as performed. It is to be signed by the Unit / Dept. Head.
8. Post training evaluation & Certification: Only oral and practical tests. On completion
of successful training, duly signed by the Head of the Institute and DME/DHS.

XVIII. Technical aspects & other logistics for CCU / HDU
A. CIVIL CONSTRUCTION:
• Position & access: More centrally located and close to Dialysis unit, OT, Emergency
and Radiology.
• Preferably on 1st floor, otherwise Electric elevator is must for patient
transportation. In the ground floor dust contamination & chance of infection are
more.
• Front Gate – Single entry/exit, 2 barriers before patient care area. One emergency
exit – separate as appropriate, No thoroughfare.
• Floor space for Patient care area: 100 – 125 Sq. Ft. / Bed. 20% extra space for
cubicle type.
• Head end: 2 Ft. away from the wall.
• Isolation cubicle: 1 in HDU or Step Down Unit, This cubicle will be glass walled
with clear glass.
• Additional Space: 100 – 150% of Pt. care area
• Approximate area requirement for establish a 6 bedded unit is 1500 sq ft, for a 12
bedded unit is 2500 sq ft, and for a 24 bedded unit is 3500 sq ft.
• Additional Rooms :
1. Residents Room, 2. Nurses Room, 3. Room for Nurse In-charge, 4. Room for
Doctor In Charge / Director, 5. Storage, 6. Laboratory, 7. Reception, 8. Waiting Lounge,
9. Wash areas – Linen/ Equipment, 10. Pantry, 11. Shoe racks 12.
Office/Library/Conference room
• Wall Rack @ height of 5 ft from floor for keeping Multichannel Monitors size 1½ ft
X 1 ft (if rack not provided with the Multi-channel Monitors).
• Wall fixed rack in lab room ‘L’ shaped to keep machines.
• Wall fixed rack in Store.
• Coving at the junction of wall with floor for better cleaning.
• Wall should be fitted with tiles up to the height of 6ft.
• Hole in the walls for cleaning purpose is essential with proper drainage system.
• Wash basins one each in the rooms of Medical Officer & Nursing Personnel.
• One Wash basin is required in Lab room.
• A common hand wash area is to be provided with deep sink and elbow operated
taps.
• Floor with large marble plates (No visible junction in between) / Vitrified
• anti-skid floor tiles.
• Marble plated / wooden semicircular or half squire or L-shaped Central Work
station with inside rack. Wooden work station with drawers is preferred as its
position can be shifted if needed.
• Rack beside Nursing Station for emergency medicine cum equipment store.
• False ceiling (if required) will be made of fire proof material to conceal central A/C

ducts and certain other cables (False ceiling should be avoided as far as possible).
• Windows 2 piece Sliding with clear glasses.
• Screen (avoid cotton material) should be available for all Doors and Windows.
• Drinking water supply is must (may be through water purifiers).
• In wash area an area of 5ft X 3 ft should be guarded with ½ ft high cement wall
with proper drainage system for linen cleaning purpose.
• All the doors should have self-closing property.
• Colour of the ceiling should be white.
• Colours of the walls are either light cream or off-white or light pesta or any light
colour except white (colour of ceiling).
• Beds are separated by Screen fitted stands. The screen also should be light
coloured and preferably made by easily washable material.
• Annual Maintenance of the whole Unit from civil part is must.
• Arrangement of Pipeline for dialysis with two portals in CCU should be provided
for future use.
B. ELECTRICAL CONSTRUCTION:
• 12 Electric Points of which 4 may be near the floor, 4 on each side of the patient.
• Electric outlets/Inlets should be common 5/15 amp pins. Should have pins to
accommodate all standard electric pins /sockets. Adapters should be discouraged.
• UPS Power back-up is essential for at least 50% of bed side Electrical points and at
least one emergency light per bed..
• Voltage stabiliser for the entire unit.
• Total load per bed is 3 KV.
• AC should be of split type. Centralised AC should be avoided as far as possible.
• Laboratory room requires 4 electrical boards in equidistance with 3 plug points in
each of whom 1 must be of 15 amps.
• At least one electrical extension board with earthing should be supplied to each
room
• Wall Hanging fan is essential on the head end of the patient on the wall at 8 ft
height from floor
• Wearing should be of concealed type with fire retardant wires
• One calling bell in each room with switch outside the complex (outside Buffer zone)
should be there.
• Additional electric board to be established on the wall at the back of central work
station for charging equipment. That board will be of same specification as earlier,
number of boards should be at least 2 with 4 plug points on each board.
• At least one computer board is must in Nursing station / MO room / Conference
room with provision for teleconferencing.
• Annual Maintenance of the whole Unit from electrical part is must.

C. ENVIRONMENTAL:
• Fully A/C – Controlling – Temp. / Humidity. Preferably Split A/C.
• Temperature maintained = 16 – 250 Celsius
• Humidity should be <70%
• Minimum of six total air changes /room/hour with two changes/ hour by outside
air
• Re-circulated air must pass through appropriate filter : HEPA filter
D. CENTRALISED LAMINAR FLOW:
• Compressed air outlet = 1 per bed
• Oxygen outlet = 1 per bed
• Vacuum outlet= 1 per bed for suction
• With alarm system
E. WHERE TRILAMINAR FLOW NOT AVAILABLE:
i) Oxygen:
• Preferably through pipeline with manifold room at the same floor. Manifold
should contain at least 6 cylinders in two rows (6x6) for 12 bedded unit and at least 4
cylinders in two rows (4x4) for 6 bedded unit.
• One point at head end of each bed.
• Oxygen supply key is to be established on the pipeline at least two in number, one
just outside CCU and other at manifold room.
• Additional 2 Jumbo Cylinders with MOX Adapter are to be supplied to each room
as back-up for ventilators. Additional medium/ small size cylinders are to be supplied as
back up for non-ventilated patients.
• Flow meter with Humidifier is essential for each port
ii) Suction:
• Can be performed by suction machine in CMS Category too. (1/4 H.P.)
• In case of suction machine, ratio should be 1 / bed.
iii) Lacking compressed air supply – Ventilators to run by inbuilt compressor or turbine,

F. LIGHTING:
• Spot light for procedures will be required over each bed.
• Overhead lighting of at least 20. Candle ft.
• Overhead lighting by one twin tube set, box covered with transparent glass
• In conference room lighting should be concealed type
G. NOISE CONTROL:
• Noise level is to be ideally under 45 dB - daytime, 40 dB - evening and 20 dB -
night
H. BIO-MEDICAL WASTE DISPOSAL & POLLUTION CONTROL:
• Four covered bins – colour coded –(Yellow, blue, Red, Black)
• Adequate wash basins.
• Adequate no. of toilets.

XIX. Standard List of Equipment
Equipment required in each CCU will be divided in two groups – Major equipment &
Ancillary equipment. Equipment belonging to CMS Category will be purchased from
CMS approved firms by respective hospital authority or District authority. Major Non
CMS category items will be purchased by WBMSCL or Individual hospital authority (if
permitted by financial power and fund available) and Ancillary Non CMS category items
will be purchased by respective CMOH or Hospital authority.
The standard list of equipment & furniture are given below.
Item number for CMS items are given as per 2014-15 catalogue. Respective units should
check CMS list before placing order.
[These are the essential requirement required to make a unit functional smoothly
depending on the bed strength of the respective units. This is an indicative list only; the
requirement may vary depending on the functionality of the respective unit. Hospital
authority may take decision to make available requisite number & nature of equipment
depending on the functional status of the unit and periodic assessment by unit level or
State level monitoring teams.]
1. Major equipment recommended for each Critical Care Units present in
Medical College Hospitals & M R Bangur Hospital,
Sl
No.
Name of
Equipment
CAT no. (if any)
Required no. of equipment (1/3rd
Beds designated for ICU and 2/3rd
Beds designated for step down)
1.
Biphasic External
Defibrillator
x
For every 12 bed 1 no is required i.e.
Total 2 (Extra 1 may be required, if any
part of the unit is situated at a separate
place)
2.
Blood Gas &
Electrolyte
Analyzer
THS - 151 1 no. for whole unit
3.
USG Machine
(Optional)
x
This will be provided later on with
provision of ECHO compatible probe
and related software (depending on
the requirement assessed for
individual unit)
4. Ripple Mattress x
Requirement as per total no. of
functional beds available.
5.
Ventilator-
Standard
x
Requirement is equal to the no. of
functional ICU beds available and 25%
of functional beds available at Step
down area or HDU area
6.
Non Invasive BI-
PAP Ventilator
x
Requirement is 25% of the total

7.
Portable X Ray
Machine
XR 19 (d) 1 no. for whole unit
8.
Automated Cell
Counter
x 1 no. for whole unit
9.
Microbial
Culture Machine
x
1 no. for whole unit (May be re-located
from the peripheral Hospitals where
this equipment is underutilized)
10. Fogger Machine x 2 no. for whole unit
11. Trilaminar Flow x
1 no. for whole unit if Centralised
oxygen supply not available.
12.
Rapid Infusion
Pump
x
13. Pulse Generator x 2 no. for whole unit
14.
Electrolyte
Analyser
1 no. for whole unit
15. Nebulizer ME 27
16.
Syringe Infusion
Pump
AN 54
17. ECG Machine THS 93 2 no. for whole unit
18.
Semi Auto
Analyzer
CL 120 1 no. for whole unit
19. Over bed Table SNS 678
20. ICU Bed
FUHC1D22E3N00003
/ SHF 47 / SHF 122
21.
Multi-Channel
Monitor *
AN 68 (a) / AN 68 (b)
2. Major equipment recommended for each 12 Bedded Critical Care Unit
(CCU)
Sl
No.
Name of
Equipment
CAT no. (if any)
Beds designated for HDU)
1.
Biphasic External
Defibrillator
2.
Blood Gas &
Electrolyte
Analyzer
3.
USG Machine with
Echo compatible
probe
x
Optional (depending on the
requirement assessed for individual
unit)
5.
Ventilator-
Standard
x
5 (3 Ventilator will be supplied
initially) Ventilator number may be
increased depending on the
requirement assessed for individual
unit
6. Non Invasive BI- x 3 no. for whole unit

PAP Ventilator
7.
Portable X Ray
Machine
8.
Automated Cell
Counter
Converted to Centralised oxygen
supply from mini-manifold
11.
Rapid Infusion
Pump
12. Pulse Generator x
Not required initially but later on
may be made available depending on
the requirement assessed for
individual unit
13.
Electrolyte
Analyser
14. Nebulizer ME 27 8 no. for whole unit
15.
Syringe Infusion
Pump
AN 54
18. ICU Bed
FUHC1D22E3N00003
/ SHF 47 / SHF 122
19.
Multi Channel
Monitor *
AN 68 (a) / AN 68 (b)
20.
Semi Auto
Analyzer
3. Major equipment recommended for each 6 – 12 Bedded High
Dependency Unit (HDU)
Sl
No.
Name of
Equipment
CAT no. (if any)
Beds designated for step down)
1.
Biphasic External
Defibrillator
2.
Blood Gas &
Electrolyte
Analyzer
3.
USG Machine with
Echo compatible
probe
x
Not required initially but later on
may be made available depending
on the requirement assessed for
individual unit
5. Ventilator - Adult AN - 63
2 no. to be supplied initially. Later
on, at least 1 Ventilator per unit may
be supplied as per same
specification supplied to CCUs.

6.
Non Invasive BI-
PAP Ventilator
7.
Portable X Ray
Machine
8.
Automated Cell
Counter
Converted to Centralised oxygen
supply from mini-manifold
11.
Rapid Infusion
Pump
12.
Electrolyte
Analyser
13. Nebulizer ME 27 4 no. for whole unit
14.
Syringe Infusion
Pump
AN 54
17. ICU Bed
FUHC1D22E3N00003
/ SHF 47 / SHF 122
18.
Multi-Channel
Monitor *
AN 68 (a) /AN 68 (b)
19.
Semi Auto
Analyzer
Specification of Multi Channel Monitor (CMS listed item):
AN 68 (a) : Monitors, Multichannel Monitor With Battery Back Up Facility With 10.4” To 12.1"
(TFT Touch Screen) Display Specifically Includes Measuring ECG, SpO2, NIBP, CO (Cardiac
Output), Thermodilution, Temperature With EtCO2, 2 Invasive Pressure Monitor
AN 68 (b) : Monitors, Multichannel Monitor With Battery Back Up Facility With 10.4” To 12.1"
(TFT Touch Screen) Display Specifically Includes Measuring ECG, SpO2, NIBP, Temperature With
EtCO2, 2 Invasive Pressure Monitor
*AN 68 (a) monitor may be purchased as AN 68 (a) monitors have the extra facility for monitoring
Cardiac Output. Otherwise AN 68 (b) will be sufficient for ICU / HDU.
The above mentioned equipment are initial requirement to run a unit. The number of the
equipment may be varied depending on the requirement assessed for individual unit by
Unit level monitoring committee and State level monitoring committee.
Specification of Ventilator (Adult) (CMS listed item):
A) User friendly. B) Adequate Alarms: Gas Supply Failure, Oxygen Concentration, Apnea, Set
Minute Volume Alarm, Expired Minute Volume Alarm with Adult And Pediatric Scales. C)
Modes of Ventilation : Volume Controlled, Volume Controlled And Sigh Pressure Controlled
Pressure Support Ventilation, SIMV, SIMV + Pressure Support, CPAP, Manual Ventilation, PEEP
Humidifier. D) I : E Ratio From 1 : 4 To 4 :1. E) After Sale Service Should Be Adequate.

4. Ancillary equipment (CMS Items) recommended for each unit
(Number depending on the bed strength as per following list):
Sl
no.
Item Description
Requirement for a
6 - <12 bedded
unit
Requirement for
a 12 - <18
bedded unit
Requirement for
a 18 – 24 or more
bedded unit
1. Trolley 3 5 5
2. AMBU – Bag & Mask 3 6 6
3. Laryngoscope with Blade 2 2 3
4. Glucometer 2 4 4
5. Emergency Medicine tray 2 3 4
6. Refrigerator 1 1 1
7. Instrument sterilizer 1 1 1
8. Emergency light 2 5 6
9. X- Ray View box 1 2 2
10. Suction machine 3 5 8
11. Portable spot light 2 2 4
12. Stethoscope
Equal to no. of
beds
Equal to no. of
beds
Equal to no. of
beds
13. Instrument tray 5 10 12
14. Scissors 2 4 4
15. Drip Stand
Double to no. of
beds
Double to no. of
beds
Double to no. of
beds
16. Needle Destroyer 1 1 1
17. Cut Down Set 2 4 4
i. Instrument tray 2 4 4
ii. Sponge Holding Forceps 2 4 4
iii. Mosquito Artery Forceps 6 12 12
iv. Scissors 2 4 4
v. Venesection Hook 2 4 4
vi. Allies' Tissue Forceps 4 8 8
vii. Needle Holder 2 4 4
viii. Scalpel Blade No 15 2 4 4
ix. B. P. Handle 2 4 4
x. Silk 50 100 100
18. Tracheostomy Set 1 3 3
iii. Mosquito Artery Forceps 2 6 6
iv. Scissors 1 3 3
v. Allies' Tissue Forceps 2 6 6
vi. Needle Holder 1 3 3
vii. B. P. Handle 1 3 3
viii. Tracheostomy tube 1 1 1
19. L. P. Set 1 1 1
20. Oxygen Cylinder Medium 20 30 30
21.
Oxygen Cylinder Large
(‘D’ type)
20 30 30

5. Ancillary equipment (Non-CMS Items) recommended for each unit
(Number depending on the bed strength as per following list):
Sl no. Item Description
Requirement
for a 6 - <12
bedded unit
Requirement
for a 12 - <18
bedded unit
Requirement for
a 18 – 24 or more
bedded unit
1. Ophthalmoscope 1 1 1
2. Heater 1 1 1
3. Computer 1 1 1
4. Tablet Crusher 1 1 1
5. Magnifying glass 1 1 1
6. Sleepers 20 50 50
7. Hand wash dispenser
Equal to no.
of beds
Equal to no.
of beds
Equal to no. of
beds
8. Medicine Box
Equal to no.
of beds
Equal to no.
of beds
Equal to no. of
beds
9. Torch 2 2 2
10. Kidney Tray 10 20 30
11. Tracheostomy Set 1 3 3
i. Tracheostomy Hook (Double) 2 6 6
ii. Tracheostomy Hook (Single) 2 6 6
iii. Scalpel Blade No 15 1 3 3
12. L. P. Set 1 1 1
i. L. P. Needle 1 2 2
6. Furniture (CMS Items) recommended for each unit (Number
depending on the bed strength as per following list):
Sl
no.
Item Description Cat No.
Requirement
for a 6 - <12
bedded unit
Requirement
for a 12 - <18
bedded unit
Requirement
for a 18 – 24
or more
bedded unit
1. Steel Rack GHF 1 3 6 8
2. Chair with arms FRW10(B) 5 10 12
3. High stool FRW21(B)
Equal to no.
of beds
Equal to no. of
beds
Equal to no.
of beds
4. Stool FRW27(B)
Equal to no.
of beds
Equal to no. of
beds
Equal to no.
of beds
5. Towel Rack FRW 28(B) 2 3 3
6. Long Table for wards FRW 29(B) 1 2 2
7. Bench without arms FRW3(B) 2 4 4
8. Table small wooden FRW32(B) 1 2 3
9. F. C. Armed Chair FRW42 2 4 4
10. Composite computer unit FRW47 1 1 1
11. Ward locker GHF 17
Equal to no.
of beds
Equal to no. of
beds
Equal to no.
of beds
12. Ward Screen GHF18
Equal to no.
of beds
Equal to no. of
beds
Equal to no.
of beds
13. Instrument cabinet SHF 12 2 2 4
14. Strecher Trolley SHF 31(a) 2 2 4

7. Furniture (Non-CMS Items) recommended for each unit (Number
depending on the bed strength as per following list):
Sl
no.
Item Description
Requirement
for a 6 - 12
bedded unit
Requirement
for a 12 - 18
bedded unit
Requirement
for a 18 – 24
or more
bedded unit
1 Steel Almirah without locker 2 4 6
2 Rack open all sides 2 4 6
3 Steel Locker Cabinet 8 chamber 2 4 6

XX. Standard List of Medicine & Consumables
The standard medicines & consumables should be available in each Critical Care Unit and
High Dependency Units. Medicine belong to CMS Category (CAT items) will be
purchased from CMS approved firms. Non CMS category items will be purchased from
outside preferably through Fair price Medicine Shop.
The standard list of medicine & consumables are given below. Some are included in CMS
catalogue and some are non-CMS. Respective units should check CMS list before
procurement.
The amount of medicines & consumables given here are based on assumption and to help
budgeting, it may vary from unit to unit depending on the Bed occupancy Rate, Bed
Turnover Rate, Av. Length of Stay and type of patient admitted. Proper requirement will
be ascertained after functioning of the respective CCU & proper medicine audit done by
the hospital authority.
The following drugs and consumables should be available in every unit and the amount
mentioned in the following lists may be maintained as buffer stock as far as possible.
These are the essential requirement required to make a unit functional smoothly
depending on the bed strength of the respective units. This is an indicative list only;
authority of the individual unit may take local decision to make inclusion of new drugs
and consumables depending on the patient status, treatment modality and periodic
assessment of the requirement by unit level or State level monitoring teams.
1. Basic Requirement of Medicines:
Sl
No
Name of Medicine
Buffer stock to
be maintained
for a 6 - <12
bedded unit
(In Pc)
Buffer stock to
be maintained
for a 12 - <18
bedded unit
(In Pc)
Buffer stock to
be maintained
for 18 – 24 or
more bedded
unit
(In Pc)
1. Inf Paracetamol 4 8 16
2. Inj Adenosine 6 12 24
3. Inj Adrenalin 24 48 96
4. Inj Amikacin 500 mg 120 240 480
5. Inj Aminophyllin 250 mg 60 120 240
6. Inj Amoxyclav 1.2g 90 180 360
7. Inj Atracurium 2 4 8
8. Inj Atropine 48 96 192
9. Inj Calcium Gluconate 6 12 24
10. Inj Ceftazidime 1gm 60 120 240

11. Inj Cefepime 1gm 60 120 240
12. Inj Ceftriaxone 1gm 120 240 480
13. Inj Chlorpromazine 18 36 72
14. Inj Ciprofloxacin 100 ml bottle 120 240 480
15. Inj Clindamycin 600 mg 24 48 96
16. Inj Dexamethasone 120 240 480
17. Inj Dextran 40 4 8 16
18. Inj Dextrose 10% 48 96 192
19. Inj Dextrose 25% 8 16 32
20. Inj Dextrose 5% 72 144 288
21. Inj Diazepam 30 60 120
22. Inj Diclofenac Na 24 48 96
23. Inj Dicyclomine 36 72 144
24. Inj Digoxin 24 48 96
25. Inj Dobutamine 48 96 192
26. Inj Dopamine 200 mg 48 96 192
27. Inj Enoxaparine 20U 24 48 96
28. Inj Enoxaparine 40U 24 48 96
29. Inj Hydroxyethyle starch 12 24 48
30. Inj Frusemide 72 144 288
31. Inj Glycopyrrolate 12 24 48
32. Inj Haloperidol 6 12 24
33. Inj Human Albumin 20% 5 10 20
34. Inj
Hydrocortisone Na
Succinate
48 96 192
35. Inj Hydroxy ethyl cellulose 6% 5 10 20
36. Inj Levofloxacin 100 ml 30 60 120
37. Inj Insulin Soluble 5 10 20
38. Inj
NPH Combination 30:70
Human variety
4 8 16
39. Inj Isophane Insulin 4 8 16
40. Inj Labetalol 10mg/2ml 2 4 8
41. Inj Ligno+Adre 2 4 8
42. Inj Ligno 4% 2 4 8
43. Inj Lignocard 0.2% 2 4 8
44. Inj Ligno 2% 2 4 8
45. Inj LMWH 25000 2 4 8
46. Inj Mag Sulph 10% 20 40 80

47. Inj Mannitol 20% 30 60 120
48. Inj Meropenem 1gm 100 200 400
49. Inj Methyl Prednisolone 40mg 6 12 24
50. Inj Methyl Prednisolone 1gm 6 12 24
51. Inj Methyl Prednisolone 125mg 6 12 24
52. Inj Metronidazole 100ml 180 360 720
53. Inj Midazolam 10mg/2ml 12 24 48
54. Inj Neostigmine 2 4 8
55. Inj Netilmicin 25mg 10 20 40
56. Inj Nitroglycerine 25mg/5ml 10 20 40
57. Inj Ondansetron 4mg/2ml 60 120 240
58. Inj Pancuronium 2 4 8
59. Inj Paracetamol 10 20 40
60. Inj Phenobarbitone 10 20 40
61. Inj
Piperacillin+Tazobactum
4.5gm
100 200 400
62. Inj KCl 12 24 48
63. Inj Protamine Sulphate 1 2 4
64. Inj Ranitidine 100 200 400
65. Inj Salbutamol 24 48 96
66. Inj Sodi-Bi-Carb 24 48 96
67. Inj DNS 24 48 96
68. Inj NS 3% 10 20 40
69. Inj NS 0.9% 100 200 400
70. Inj RL 200 400 800
71. Inj Nor Adrenalin 20 40 80
72. Inj Theo+Eto 24 48 96
73. Inj Thyroxin 50 1 2 4
74. Inj Tramadol 20 40 80
75. Inj Tranexamic Acid 12 24 48
76. Inj Vancomycin 20 40 80
77. Inj Vit-K 12 24 48
78. Inj Vit B Complex 60 120 240
79. Inj Tigecycline 10 20 40
80. Inj Linezolid 20 40 80
81. Inj Meropenem + Sulbactum 20 40 80
82. Inj Colistine 1 MIU 10 20 40
83. Inj Pantoprazole 40 100 200 400

84. Inj Phenytoin 100mg 20 40 80
85. Lot Glutaraldehyde 2% 2 4 8
86. Lot Povidone Iodine 5% 4 8 16
87. Neb Ipratroprium 100 200 400
88. Neb Salbutamol 100 200 400
89. Neb Budesonide 100 200 400
90. Oin Lignocaine 2% 4 8 16
91. Oin Mupirocin 2% 4 8 16
92. Oin Nadifloxacin 1% 2 4 8
93. Oin Povidone Iodine 5% 4 8 16
94. Oin White Soft Paraffin 1kg 1 1 2
95. Syr KCl 2 4 8
96. Tab Acyclovir 400 mg 25 50 100
97. Tab Amlodipin 5 mg 60 120 240
98. Tab Captopril 25 mg 60 120 240
99. Tab Carbimazole 5 mg 12 24 48
100. Tab Clarythromycin 500mg 24 48 96
101. Tab Alprazolam 0.25mg 60 120 240
102. Tab Digoxin 0.25mg 10 20 40
103. Tab Fluconazole 200mg 10 20 40
104. Tab Itraconazole 100 mg 5 10 20
105. Tab Levodopa + Carbidopa 30 60 120
106. Tab Losartan Potassium 25 mg 50 100 200
107. Tab Losartan Potassium 50 mg 50 100 200
108. Tab Verapamil 50 100 200
109. Tab N Acetyl Cystine 50 100 200

2. Basic Requirement of Consumables:
Sl
No.
Name of Consumables
Buffer stock to be
maintained for a 6
- <12 bedded unit
(In Pc)
Buffer stock to
be maintained
for a 12 - <18
bedded unit
(In Pc)
Buffer stock to be
maintained for 18
– 24 or more
bedded unit
(In Pc)
1. 3 way I.V. Stopcock 20 40 60
2. ABG Cal. Solution 1 2 2
3. ABG Cassette 40 60 80
4. ABG Paper Roll 3 5 6
5. Adhesive Plaster 5 8 10
6. B. T. Set 30 45 60
7. Bed Pan
Equal to no. of
beds
Equal to no. of
beds
Equal to no. of
beds
8.
Bed Sheet 2/bed for 2 days
each week
14 x no. of beds 14 x no. of beds 14 x no. of beds
9. Binasal Oxygen Cannula 20 40 60
10. Bi-pap Mask (Reusable)
Equal to no. of Bi-
PAP available
Equal to no. of
Bi-PAP
available
Equal to no. of Bi-
PAP available
11. Blanket 2 x no. of beds 2 x no. of beds 2 x no. of beds
12. Canvas for Stretcher 4 6 6
13. Chlorhexidine Hand Rub 6 9 12
14.
Chlorhexidine Mouth
Wash
20 30 40
15. Closed Suction System 10 15 20
16. Coaxial Bain Circuit 3 5 6
17. Cotton Roll 1 2 2
18. Crepe Bandage 10 x 5 10 20 30
19. Crepe Bandage 15 x 5 10 20 30
20. CVP Manometer 20 30 40
21.
Diaper (Adult/Paediatric)
Packet of 10
4 packet 6 packet 8 packet
22. Disposable blood Lancet 100 150 200
23. Disposable Cap 100 150 200
24.
Disposable Chest Drain
Tube with Trocher
3 4 6
25. Disposable Chest Leads 100 150 200
26. Disposable Mask 100 150 200
27. Disposable Plastic Apron 20 30 40
28. Disposable Syringe 10ml 100 150 200

33. Dynaplast 4 6 8
34. E. T. Tube 15 23 30
35. E.T. Suction Catheter 10 15 20
36. ECG Gel 3 5 6
37. ECG Paper Roll 4 6 8
38. Foley’s Catheter 30 45 60
39. Glucometer strips 100 150 200
40. Hand Care 100 150 200
41. Hand Towel 12 18 24
42. Hum + Bact Filter 10 15 20
43. I.V. Saline Set 100 150 200
44. Incentive Spirometer 15 23 30
45. Insulin Syringe 100 150 200
46. Jelco No 16G 50 75 100
47. Jelco No 18G 50 75 100
48. Jelco No 20G 50 75 100
49. Jelco No 22G 20 30 40
50. Jelco No 24G 15 23 30
51. Laryngeal Mask airway 5 8 10
52. Measuring Tape 2 3 4
53. Micropore Adhesive 10 15 20
54. Molina Sheet (Packet) 10 15 20
55. Mucous Extractor 10 15 20
56. Nebulisation Kit 20 30 40
57. Nebulisation Mask 30 45 60
58. Oro-pharyngeal Airway
Equal to no. of
beds
Equal to no. of
beds
Equal to no. of
beds
59. Oxygen Mask 20 30 40
60. P. M. Line 20 30 40
61. Paraffin Gauge Sterilized 50 75 100
62. Pillow
Equal to no. of
beds
Equal to no. of
beds
Equal to no. of
beds
63. Plastic Bag For Waste Bin 100 200 400
64. Rolled Bandage (Dozen) 10 20 30
65. Rubber Cloth (in meter) 4 meter 8 meter 12 meter

66. Ryle's Tube 30 45 60
67.
Sanitary Towels in PKTs of
10
10 10 10
68. Spirit 5 Bottle 10 Bottle 15 Bottle
69. Sputum Mug
Equal to no. of
beds
Equal to no. of
beds
Equal to no. of
beds
70. Sterile Gauge 100 200 400
71.
Subclavian Catheter
Introduction Set
10 15 20
72. Surgical Gloves 6.0 50 75 100
76. T-Piece Connector 6 9 12
77. Tracheostomy Tube 4 6 8
78. Urine Pot (Female)
Equal to no. of
beds
Equal to no. of
beds
Equal to no. of
beds
79. Urine Pot (Male)
Equal to no. of
beds
Equal to no. of
beds
Equal to no. of
beds
80. Urobag 20 40 50
81. Urometer 20 40 50
82. Ventilator Circuit
1.5 x No. of
ventilator available
1.5 x No. of
ventilator
available
1.5 x No. of
ventilator available
83. Venturi Mask 6 9 12
84. Water Sealed Drain Bag 3 4 6

XXI. Essential Tests to be done in CCU or HDU 24x7
− Arrangement should be available in every CCU and HDU to perform the following
tests 24 x 7, as these tests are essential to treat a critically ill patient successfully.
These tests should be preferably done by the Laboratory equipment kept in the
CCU / HDU and if technician is not available, then these emergency tests should
be done by on-duty Medical Officer / Nursing Personnel.
− This list is not an exhaustive one and new tests may be included in this list
depending on the local requirement and functional status of the respective unit.
− Hospital level committee should monitor this and make periodical review
regarding the inclusion of the new tests.
− Laboratory equipment supplied for the respective CCU / HDU should be kept at
the laboratory attached with CCU / HDU to ensure the 24x7 availability, not in the
other places of the hospital.
− Regular availability of the necessary consumables / reagents should be ensured by
the respective Hospital authority along with maintaining the necessary buffer
stocks and it is the responsibility of MO in charge & Nursing in charge of the unit
to make aware the respective hospital authority regarding the stock position of the
necessary consumables / reagents as well as the functional status of the
equipment.
− Appropriate quantity of consumables / reagents should be available in the store of
CCU / HDU, so that these are never out of stock at the time of emergency.
Name of the essential tests to be done 24x7,
1. Arterial Blood Gas Analysis
2. Blood Count
3. Hemoglobin estimation
4. Sugar (Capillary Blood sugar)
5. Urea
6. Creatinine
7. Electrolytes (Na+, K+ etc.)
8. Liver function Test (optional)
9. Antigen Test for Malaria
10. ECG
11. X-ray

XXII. Cost Analysis – 12 Bedded CCU
The Approximate financial requirement of this project is as below:
(This is a standard requirement for help of the budgeting. Practically this is varied
depending on the establishment of the individual unit.)
A. Approximate One Time Expenditure of CCU
Sl.
No.
Head of Expenditure Amount
1. Infrastructural Requirement (civil &
electrical)
7,500,000.00
2. Major Equipment – CMS items 6,216,709.00
3. Major Equipment – Non CMS items 11,220,032.00
4. Ancilliary Equipment – CMS items 437,238.00
5. Ancilliary Equipment – Non CMS items 67,575.00
6. Furniture – CMS items 230,720.00
7. Furniture – Non CMS items 73,511.00
Total One Time Expenditure 25,745,785.00
Therefore approximately Two Crore Fifty Seven Lakh Forty Five Thousand Seven
Hundred and Eighty Five Rupees is required as One Time Expenditure.
B. Approximate Annual Recurrent Expenditure of CCU
Sl Head of Expenditure Amount
1. Consumables – CMS Items 1,677,523.00
2. Consumables – Non CMS Items 3,058,775.00
3. Medicine – CMS Items 10,365,268.00
4. Medicine – Non CMS Items 4,163,068.00
Total Recurrent Expenditure 19,264,634.00
Therefore approximately One Crore Ninety Two Lakh Sixty Four Thousand Six
Hundred Thirty Four Rupees will be required as annual Recurrent Expenditure.

XXIII. Cost Analysis – 6 Bedded HDU
The Approximate financial requirement of each 6 Bedded HDU is as below:
(This is a standard requirement for help of the budgeting. Practically this is varied
depending on the establishment of the individual unit.)
I. Approximate One Time Expenditure - for a 6 Bedded HDU
Sl.
No.
1. Infrastructural Requirement (civil &
electrical)
2,500,000.00
2. Major Equipment – CMS items 3,129,423.00
3. Major Equipment – Non CMS items 5,850,366.00
4. Ancilliary Equipment – CMS items 286,484.00
5. Ancilliary Equipment – Non CMS items 67,575.00
6. Furniture – CMS items 169,244.00
Total One Time Expenditure 12,003,092.00
Therefore approximately One Crore Twenty Lakh Three Thousand Ninety Two
Rupees required as One Time Expenditure for each HDU.
II. Approximate Annual Recurrent Expenditure - for a 6 Bedded HDU
Sl
No.
1. Consumables – CMS Items 838,761.00
2. Consumables – Non CMS Items 1,529,387.00
3. Medicine – CMS Items 5,182,634.00
4. Medicine – Non CMS Items 2,081,534.00
Total Recurrent Expenditure 9,632,316.00
Therefore aprroximately Ninety Six Lakh Thirty Two Thousand Three Hundred
Sixteen Rupees required as annual Recurrent Expenditure for each HDU.

XXIV. Protocol for Infection control in Critical Care
settings
Hospital acquired infections (HAIs) is a major safety concern for both health care
providers and the patients. Considering morbidity, mortality, increased length of stay
and the cost, efforts should be made to make the Critical care Unit as safe as possible by
preventing such infections.
These short guidelines have been developed for health care personnel involved in patient
care in critical care areas and for persons responsible for surveillance and control of
infections in hospital.
A. Patient at risk of nosocomial infections
There are patients, therapy and environment related risk factors for the development of
nosocomial infections.
2. Age more than 70 years
3. High severity score
4. Shock
5. Major trauma
6. Renal failure
7. Coma
8. Prior antibiotics
9. Mechanical ventilation
10. Immunocompromised – including drugs affecting the immune system (steroids,
chemotherapy)
11. Indwelling catheters
12. The exposure to multiple invasive devices and procedures
13. ICU stay >3 days
14. Malnutrition
B. Factors related to inappropriate practices in CCU / HDU
• Inadequate Hand washing facilities
• Frequent contact with patients by health-care personnel.
• Patient close together
• Lack of isolation facilities
• No separation of clean & dirty areas
• Excessive and non-judicious antibiotic use

• Inadequate decontamination of items & equipments
• Inadequate cleaning of environment
C. Common CCU acquired infections
• Ventilator Associated Pneuomonia (VAP) & Tracheobronchitis (VAT)
• Non VAP / VAT
• IV line associated or Catheter Related Blood Stream Infection( CRBSI)
• UTI associated with Foley’s Catheter
• Skin & skin structure related infections following necrosis of skin
• Surgical site infection
• Nutritional therapy related Total Parenteral Nutrition (TPN)
D. Sources of Cross-Infection in the CCU
• Hands of staff and attendants (via two-bowl handwashing and common towels or
no handwashing)
• Assisted ventilation equipment;
• Suction and drainage bottles
• I.V. lines – central and peripheral;
• Urinary catheters
• Wounds and wound dressings;
• Disinfectant containers;
• Dressing trolleys (on which disinfectants jars/bottles are stored)
E. Strategies To Reduce Infections In CCU / HDU
1. Room sterilization
2. Isolation
3. Universal protocol
4. Device related protocol
5. Equipment sterilization
6. Disposal of waste
7. Procedural

1. Room sterilization :
i. Cleaning : Floor wash with available antiseptic ( e.g. Phenyl ) in the morning
and evening , if not once per shift.
ii. Fumigation :
• For a general critical care unit it is not mandatory in ideal
situation. But as we are far from reaching ideal and clean condition, it is
better to undergo fumigation i.e. sterilization by aerosolized disinfectant.
• Target frequency - at an interval of 3 months. Mostly difficult to get
CCU/HDU vacant because of continuous high turnover of patients.
Alternative strategy is to fumigate at the earliest possible time when it can
be rendered vacant for a short period. In CCU – each subunit is to be
fumigated one by one. For example, if HDU is rendered vacant first, patient
care is continued in ICU being shut off from HDU and vice versa.
• Materials used : Hydrogen Peroxide : Preferred, required room closure for 2
hrs), Device used : Fogger machine.
Formaldehyde :
For each cubic metre of volume of the room, 20 ml Formaldehyde (40%
solution) added in 20ml of water is placed in a kidney tray in the centre of
the room. The kidney tray is placed beside the vent of a fan to promote
dispersal. Ensure that the fan is switched on after the personnel leave the
room. Contact time required is 6 hours. Example (GRH) Operation Theatre
Volume = L×B×H = 180 cubic metres Formaldehyde required for fumigation
= 20 ml for 1 cubic metre = So 3600 ml of formaldehyde required.
2. Isolation : Of highly infectious cases in isolation cubicle as constructed at least
one in HDU. Examples of cases – Chicken Pox, Measles, HIV, Influenza
(particularly epidemic & pandemic cases e.g. Swine Flu, Bird Flu), Dengue.

3. Universal protocol : Hand hygiene & Barrier protection:
i. Hand hygiene:
• Hands are the most common vehicle of transmission of organisms and
therefore sinks should be provided for proper hand washing in every CCU /
HDU.
• All visitors and staff should wash their hands before direct contact with
patients.
• Aseptic hand wash or alcohol based hand rub should be performed:
− Before entering the ICU.
− Before performing any invasive procedure including peripheral cannula
insertion and removal.
− Before every use of multidose vials.
− Before administration of iv fluids or medications/drugs
− Routine hand wash should be performed:
− Before and after any contact with the patient
− After touching environmental surfaces
− Whenever soiled.
How to perform a successful hand wash,
• Wash hands with soap and water when they are soiled or visibly dirty with blood
or other body fluids. Liquid soap is preferred as it better reaches hand creases and
nails and webs.Wet your hands, apply soap and then scrub them vigorously for at
least 15 s. Cover all surfaces of the hands and fingers, wash with water and then
dry thoroughly using a disposable towel
• Use an alcohol-based hand rub e.g. 0.5% chlorhexidine with 70% w/v ethanol, if
hands are not visibly dirty. A combination of chlorhexidine and alcohol is ideal as
they cover Gram-positive and Gram-negative organisms, viruses, mycobacteria
and fungi. Chlorhexidine also has residual activity.
• During surgical hand preparation, all hand jewelries (e.g. rings, watches,
bangles and bracelets) must be removed
• Finger nails should be trimmed to <0.5 cm with no nail polish or artificial nails

• Avoid wearing long sleeves, ties should be tucked in, house coats are
discouraged.
ii. Barrier protection
• Sleeper, Cap, Mask, Gown.
• Mandatory in isolation cubicle with additional protection in case of
epidemic / pandemic.
• Sleeper although not required in ideal hospital situation, is to be followed
out in our CCUs/HDUs.
• Cap, mask and gown are mandatory while coming in close contact e.g.
airway toileting, airway procedures – intubation, tracheotomy, Putting a
central line, lumber puncture, putting a chest drain etc. when there is chance
of spillage of tissue of patient .
• Otherwise, all barrier protections are stringently followed in Surgical ICUs
particularly specility ICUS like NS – ICU, CTVS - ICU.
iii. Details of Personal protective equipments or barrier protection
a) Gloves:
Sterile gloves should be worn after hand hygiene according to need (e.g., sterile for
procedures using aseptic technique such as insertion of central venous catheter and non-
sterile for procedures such as emptying urinary drainage bags, insertion of peripheral IV
catheters, contact with contaminated surfaces or equipment)
• Clean, non-sterile gloves are safe for touching blood, other body fluids,
contaminated items and any other potentially infectious materials
• Change gloves between tasks and procedures in the same patient especially when
moving from a contaminated body area to a clean body area
• Never wear the same pair of gloves for the care of more than one patient
• Remove gloves after caring for a patient
• Practice hand hygiene whenever gloves are removed.
• Wear gloves for handling respiratory secretions or objects contaminated with
respiratory secretions of any patient.
• Change gloves and decontaminate hands, as above:

− Between contacts with different patients.
− After handling respiratory secretions or objects contaminated with secretions
from one patient.
− Before contact with object, or environmental surface.
− Between contacts with a contaminated body site and the respiratory tract of,
or respiratory device on, the same patient.
b) Gown:
• Wear a gown to prevent soiling of clothing and skin during procedures that are
likely to generate splashes of blood, body fluids, secretions or excretions; or when
exposure to respiratory secretions from a patient is anticipated, and change it after
soiling occurs and before providing care to another patient
• Plastic aprons may be worn when contact with patient body fluids is anticipated;
• The sterile gown is required only for aseptic procedures and for the rest, a clean,
non-sterile gown is sufficient
• Remove the soiled gown as soon as possible, with care to avoid contamination.
c) Mask / Eye protection:
• Wear a mask (Disposable high-efficiency filter masks) and adequate eye protection
to protect mucous membranes of the eyes, nose and mouth during procedures and
patient care activities that are likely to generate splashes/sprays of blood and body
fluids, etc.
• Patients, relatives and health care workers (HCWs) presenting with respiratory
symptoms should also use masks (e.g. cough).

4. Device related protocol :
Daily check list is to be maintained in the format as enclosed in the Annexure.
• Peripheral venous catheter :
− Change after every 3 days. If patient comes with PV Cath – in case coming
from Emergency OPD – change immediately and if from the ward – 1st.
change after 24 hrs. Avoid insertion in legs.
• Central venous catheter :
− Not to be changed routinely. Fresh replacement is done in case of
strongly suspected / documented CV cath related infection by C/s test or
mechanical problems like blockage / kinking. When indicated fresh
insertion is done on the opposite side.
• IV Drip set :
− Needs to be changed daily.
• Ryle's tube :
− In case of malfunction or after every 5 – 7 days to avoid formation of
biofilm and thereby preventing pneumonia.
• Tracheostomy tube:
− 1st change 48 hrs. of insertion and every after 24 hrs thereafter.
• Foley's catheter :
− Not to be changed routinely. Bladder wash is also abandoned except in
selected urosurgical conditions. In case of catheter block by sediment,
controlled catheter wash may be cautiously tried avoiding bladder wash.
These are to avoid vesico ureteral reflux and UTI – sepsis.
− Change is indicated in case of malfunctioning catheter or infection
strongly suspected / documented by culture.
− Closed system with two bags - Storage & collecting is preferred.
• Arterial Catheter and Pulmonary Arterial Catheter:
− These catheters need not to be changed routinely.

5. Equipment sterilization
i. Ventilator Circuit:
• For a particular patient on ventilator no tubing is routinely changed. Changed
only when it is visibly contaminated or malfunctioning.
• Disposable tubes are disposed off after a single use.
• Reusable tubes & water traps are sterilized before applying on a new patient – by
2% Glutaraldehyde (Cidex) solution for ½ hour. It kills all microbes including
HIV.
• Bacterial Filters - Disposables are for single use. Reusables are to be autoclaved.
• Humidifier is sterilized along with reusable tubes in 2% Glutaraldehyde
solution.
• High efficiency heat & Moisture Exchanger Filter(HMEF) when used as an
alternative to inbuilt humidifier, is to be changed after every 3 days.
ii. Endotracheal suction Catheters:
• Closed suction catheters that incorporate a protective sleeve do not need to be
changed every 72 hours. Studies have demonstrated these can safely be used on
the same patient until the device is contaminated or malfunctions.
• More often, disposable suction catheters are used for respiratory tract suctioning.
This device should be discarded after each use.
• The water used for flushing the catheter after each suction must be sterile and
changed every time.
• Suction catheters must not be shared between patients. pa
iii. Endotracheal Tubes:
Preferably Disposable endotracheal tubes should be used.
iv. Ambu-bags:
These are used for resuscitation. Ambu-bags are extremely difficult to disinfect and
become contaminated very quickly:
• Heat is the most reliable method of disinfection; 2% glutaraldehyde is a less
acceptable method.
• The bags must be rinsed thoroughly in sterile water after immersion in
glutaraldehyde. This will reduce the risk of chemical irritation, which can itself
precipitate respiratory infection.

v. Oxygen Delivery masks:
These can be disposable or reusable;
• Wash thoroughly.
• Soak in alcohol for 10 minutes or soak in chlorine (500 ppm), rinse, dry and store.
• Disposable oxygen delivery masks should be preferred in critical care settings.
vi. Suction & drainage bottles:
These are usually disposable, with a self-sealing inner container held in a clear
plastic outer container.
Non-disposable bottles:
• Must be changed every 24 hours (or sooner if full).
• The contents may be emptied down the toilet.
• Must be rinsed and autoclaved.
• Do not leave fluids standing in suction bottles.
6. Disposal of waste :
− Disposal protocol should be followed differently for general waste (concern is
not more than household waste), cytotoxic waste, pharmaceutical waste,
chemical waste and radioactive waste.
− For blood spillage in the unit, cleaning should be done at the earliest with
paper towels followed by water and detergents.
− Laboratory spillage should be absorbed on to paper towels and disposed of as
clinical waste. The contaminated surfaces should be treated with 2.0-2.5%
sodium hypochlorite, left for 1 h and cleaned again with paper towels that are
disposed of as clinical waste.
− It has been observed that HBV and HCV in dry blood remain infectious even
when exposed to external environment for up to a week and 16 h respectively.
− Implications remain the same even if blood is invisible or not present in
sufficient quantity. Considering this glucometers should be cleaned and
disinfected filter every use to avoid contamination

ICU and HDU guideliness from MOH&FW.pdf

ICU and HDU guideliness from MOH&FW.pdf

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ICU and HDU guideliness from MOH&FW.pdf