icu critical care environment

1. ICU ENVIRONMENT
PRESENTED
BY OSIRE JOHN ANDREW
MNS(Critical care), BNS, DIP. RN

2. Intensive Care Unit
 Types
 Specialized types of ICUs include:
 Neonatal intensive-care unit(NICU)
 Special Care Nursery (SCN)
 Pediatric intensive-care unit (PICU)
 Psychiatric intensive-care unit (PICU)
 Coronary care unit (CCU)
 Cardiac Surgery intensive-care unit (CSICU)
 Cardiovascular intensive-care unit (CVICU)
 Medical intensive-care unit (MICU)
 Medical Surgical intensive-care unit (MSICU)
 Surgical intensive-care unit (SICU)

3. LOCATION
• Should be a geographically distinct area within the hospital, with controlled access.
• No through traffic to other departments should occur. Supply and professional traffic
should be separated from public/visitor traffic.
 Location should be chosen so that the unit is adjacent to, or within direct elevator
travel to and from, the Emergency Department, Operating Room, Intermediate care
units, and the Radiology Department.

4. BED STRENGTH
• Ideally 8 to 12 beds
• larger areas – difficult to administer and smaller areas not being cost
effective
• 3 to 5 beds per 100 hospital beds for a level iii icu 2 to 20% of the total
number of hospital beds 1 isolation bed for every 10 icu beds

5.  BED SPACE & BEDS
• 150 – 200 square feet per open bed with 8 feet in between beds.
The beds should be 2.5 - 3 meters (7-9 feet) apart , to allow free
•Movement of staff and equipment, reducing risk of cross contamination.
• 225 – 250 square feet per bed if in a single room.

6.  INFRASTRUCTURE
• Patients must be situated so that direct or indirect (e.g By video
monitor) visualization by healthcare providers is possible at all times.
• The preferred design is to allow a direct line of vision between the
patient and the central nursing station.
• Modular design – sliding glass doors & partitions to facilitate visibility.

7. •Partitions
 Privacy partitions should be of material that is easily cleaned and should be
cleaned weekly and any time that it becomes soiled or contaminated. If curtains
are used, they should be changed weekly and between patients.

8. Central Station
 Provide a comfortable area of sufficient size to accommodate all
necessary staff functions. There must be adequate overhead and
task lighting, and a wall mounted clock should be present.
 Space for Adequate computer terminals and printers is essential

9. ENVIRONMENT
• SIGNALS & ALARMS –
Add to the sensory overload; need to be modulated.
• Floor coverings and ceiling with sound absorption properties.
• Doorways – offset to minimize sound transmission.
• Light & soft music (except 10 pm to 6 am).

10. In an ICU setting,
 Light and soft music can be played, but it's generally avoided
between 10 PM and 6 AM to minimize sleep disruption. This practice
is supported by research indicating music's positive impact on
patient outcomes, including reduced anxiety, pain, and improved
sleep quality, but also acknowledges the importance of undisturbed
rest during nighttime hours

11. Here's a more detailed look
 Positive Effects of Music:
 Studies have shown that music can lower heart rate, blood pressure,
and breathing rate, reduce pain and anxiety, and improve sleep
quality in ICU patients.
 Nighttime Considerations:
 Noise and light levels, especially during the night, can negatively
impact sleep and recovery in ICU patients. Therefore, it's generally
recommended to minimize auditory and visual stimulation during
these hours.

12. ADDITIONAL APPROACHES TO IMPROVING SENSORY ORIENTATION FOR
PATIENTS INCLUDE
 The provision of a clock, calendar, bulletin board, and/or pillow
speaker connected to radio and television.

13.  NATURAL ILLUMINATION AND VIEW - WINDOWS ARE AN IMPORTANT
 Aspect of sensory orientation;
 Helps to reinforce day/night orientation.
• Window treatments should be durable and easy to clean, and a schedule for
their cleaning must be established.

14. Work Areas and Storage
 Should be located within or immediately adjacent to each ICU.
 Receptionist Area.
It should be located so that all visitors must pass by this area before
entering It is desirable to have a visitors' entrance separate from that
used by healthcare professionals.

15. Medication preparation
 Medication prep areas should be separate from patient care areas
and should be maintained as a clean area

16.  THERE SHOULD BE A SEPARATE MEDICATION AREA OF AT LEAST 50
SQUARE FEET CONTAINING A REFRIGERATOR FOR
PHARMACEUTICALS, A DOUBLE LOCKING SAFE FOR CONTROLLED
SUBSTANCES, AND A TABLE TOP FOR PREPARATION OF DRUGS AND
INFUSIONS.

17.  X-ray Viewing Area.
 • Special Procedures Room.
 • Equipment Storage.
 • Nourishment Preparation Area.
 • Staff Lounge.
 • Conference Room.
 • Visitors' Lounge/Waiting Room.

18.  Physician On-Call Rooms should be available close to the ICU(s)
Toilet and shower facilities should be provided On-call rooms must
be linked to the ICU(s) by telephone and/or voice
intercommunication system cardiac arrest/emergency alarms must
be audible in these rooms

19. EQUIPMENT
 Mechanical ventilators to assist breathing through
• An endotracheal tube
• A tracheotomy cardiac monitors including
• Those with telemetry
• External pacemakers
• Defibrillators dialysis equipment for renal problems

20. E
quipment for the constant monitorin
g of bodily
 Functions intravenous lines
 Nasogastric tubes
 Suction pumps drains and catheters
 A wide array of drugs to treat the primary condition(s) of
hospitalization

21. Electrical Power
 Electrical service to each ICU should be provided by a separate
feeder connected to the main circuit breaker panel that serves the
branch circuits in the ICU.
 The main panel should also be connected to an emergency power
source that will quickly re-supply power in the event of power
interruption.
 It is critical that the ICU staff have easy access to the main panel in
case power must be interrupted for an electrical emergency.

22. Water Supply
 . The water supply must be from a certified source especially if hemodialysis is to be
performed
 Hand-washing sinks deep and wide enough to prevent splashing,
 Oxygen, Compressed Air two oxygen outlets per patient are required One
compressed air outlet per bed is required; two are desirable Connections for
oxygen and compressed air outlets must occur by keyed plugs to prevent the
accidental interchanging of gases
 Audible and visible low and high pressure alarms must be installed both in each
ICU

23. Lighting
 General overhead illumination plus light from the surroundings should be adequate
for routine nursing tasks, including charting create a soft lighting environment for
patient comfort.
 It is preferable to place lighting controls located just outside of the room.
 This permits changes in lighting at night from outside the room, allowing a minimum
disruption of sleep during patient observation.
 Separate lighting for emergencies and procedures should be located in the ceiling
directly above the patient

24. REFERENCES
 Guidelines for Intensive Care Unit Design – Crit Care Med 1995 Mar;
23(3):582- 588. John, G. Essentials of Critical Care, Edition IV, (2003),
Shakti Prints, Vellore. Worthley, L.I.G. Clinical Examination of the
Critically Ill Patient, Edition II, (2000), The Australasian Academy of
Critical Care Mediicne, South Australia.