basic ICU setting of IPD services . ideal ICU to be presented in working area.

1. Dr.Anjalatchi Muthukumaran
Vice principal Cum Nursing Supt.
ELMCH, ECON Era University
Intensive /critical care unit
ideal set up
training for health care professional

2. CRITICAL word denote that
 Crucial
 Crisis
 Emergency
 Serious
 Requiring immediate action
 Thorough and constant observation
 Total dependent (Oxford Dictionary)

3. Critical care meaning
 Critical Care Is A Term Used To Describe As The
Care Of Patients Who Are Extremely Ill And
Whose Clinical Condition Is Unstable Or
Potentially Unstable.

4. Critical care Unit
 It Is Defined As The Unit In Which
Comprehensive Care Of A Critically Ill Patient
Which Is Deemed To Recoverable Stage Is
Carried Out.

5. Critical care Nursing meaning
 It Refers To Those Comprehensive, Specialized
And Individualized Nursing Care Services Which
Are Rendered To Patients With Life Threatening
Conditions And Their Families.

6. Critical care technology means
 Continues cardiac monitoring of patients
 ECG monitoring
 Arterial Lines in site
 Oxygen Saturation support
 Ventilation support
 Intracranial Pressure Monitoring support
 Temperature monitoring
 Pulmonary Artery Catheter pressure monitoring
 IABP
 Extensive use of pharmaceuticals

7. ICU set UP

8. Ideal ICU patient Room

9. system

10. Types of ICU
General
 Medical Intensive Care Unit(MICU)
 Surgical Intensive Care Unit
 Medical Surgical Intensive Care Unit(MSICU)
Specialized
 Neonatal Intensive Care Unit(NICU)
 Special Care Nursery(SCN)
 Paediatric Intensive Care Unit(PICU)
 Coronary Care Unit(CCU)
 Cardiac Surgery Intensive Care Unit(CSICU)
 Neuro Surgery Intensive Care Unit(NSICU)
 Burn Intensive Care Unit(BICU)
 Trauma Intensive Care Unit

11. Multidisciplinary & Collaborative
approach to ICU care
 Medical & nursing directors : co-responsibility for ICU
management
 A team approach : doctors, nurses, R/T, pharmacist
 Use of standard, protocol, guideline consistent
approach to all issues
 Dedication to coordination and communication for all
aspects of ICU management
 Emphasis on research, education, ethical issues,
patient advocacy

12. CLASSIFICATION OF CRITICAL
CARE PATIENTS
 Level O : normal ward care
 Level 1: at risk of deteriorating , support from
critical care team
 Level 2 : more observation or intervention, single
failing organ or post operative care
 Level 3; advanced respiratory support or basic
respiratory support ,multiorgan failure

13. ORGANIZATION OF ICU
 DESIGN OF ICU :
 1. Should be at a geographically distinct area within the hospital, with
controlled access.
 2. There should be a single entry and exit. However, it is required to
have emergency exit points in case of emergency and disaster.
 3. There should not be any through traffic of goods or hospital staff.
Supply and professional traffic should be separated from public/visitor
traffic.
 4. Safe, easy, fast transport of a critically sick pt should be a priority in
planning its location. Therefore, the ICU should be located in close
proximity or ER, OT, trauma ward etc.
 5. Corridors, lifts and ramps should be spacious enough to provide easy
movement of bed/trolley of a critically sick patient. 6. Close, easy
proximity is also desirable to diagnostic facilities, blood bank, pharmacy
etc.

14. BED STRENGTH
 1. It is recommended that total bed strength in
ICU should be between 8-12 and not less than 6
or not more than 24 in any case.
 2. 3-5 beds per 100 hospital beds for a Level III
ICU or 2 to 20% of the total no of hospital beds.
 3. 1 isolation bed for every ICU beds.

15. BED AND ITS SPACE
 1. 150-200 sq.ft per open bed with 8 ft in
between beds.
 2. 225-250 sq.ft per bed if in a single room.
 3. Beds should be adjustable, no head board,
with side rails and wheels.
 4. Keep bed 2 ft away from head wall.

16. ACCESSORIES
 1. 3 O2 outlets, 3 suction outlets (gastric, tracheal and underwater seal),
2 compressed air outlets and 16 power outlets per bed.
 2. Storage by each bedside.
 3. Hand rinse solution by each bedside.
 4. Equipment shelf at the head end.
 5. Hooks and devices to hang infusions/ blood bags, extended from the
ceiling with a sliding rail to position.
 6. Infusion pumps to be mounted on stand or poles.
 7. Level II ICUs may require multi channel invasive monitors.
 8. ventilators, infusion pumps, portable X ray unit, fluid and bed
warmers, portable light, defibrillators, anaesthesia machines and difficult
airway management equipments are necessary.

17. Staffing pattern/manpower
 STAFFING :
 1. Medical Staff – the best senior medical staff to be
appointed as an Intensive Care Director or Intensivist.
Less preferred are other specialists from anaesthesia
/ medicine who has clinical commitment elsewhere.
Junior staff are intensive care trainers and trainees on
deputation from other disciplines.
 2. Nursing staff – The major teaching tertiary care
ICU requires trained nurses in critical care

18.  The no of nurses ideally required for such unit is 1:1 ratio,
however it might not be possible to have such members in
our set up.
 So 1 nurse for 2 patients is acceptable.
 The no of trained nurses should also be worked out by the
type of ICU, the workload and work statistics and type of
patient load.
 3.Allied Services – Respiratory services, Nutritionist,
Physiotherapist, Biomedical engineer, technicians,
computer programmer, clinical pharmacist, social worker /
counsellor and other support staff, guards and grade IV
workers

19. Design of icu summary
 For critically ill: unstable patients
 Level: I II III
 Bed strength: ideal 8-14
 Each pt. > 100 sq. ft. ( 125-150 desirable)
 Additional space = 100%
 10% isolation bed
 At least 2 barriers to enter ICU

20. Maintenance plan for ICU
 Only one entry and exit, emergency exit
 Proper fire extinguisher
 At least 2 ft. away from head wall
 Central nursing station: all pt.
 visible Environment requirements: Heating, ventilation, air-conditioning
system in ICU (HVAC system)
 Fully air-conditioned : 6 cycle/hr, 2 cycle outside air
 Temperature = 16-25 oC Prof. Dr. R S Mehta, BPKIHS 25
 Light: high illumination, 150 foot candle (fc), overhead light = 20fc, floor light
at night = 10fc
 Noise control: Under 45 dBA in day, <40 in evening, <20 in night. (watch
tick= 20 & normal conversation at 55)
 Furniture: solid, non-porous, stain resistant.
 Floor: easy to clean and non-slippery
 Wall= 4-5 ft. finished with tiles
 Ceiling: paint with soft color, no wire lines

21. Core Competencies
 Patient Care
 Medical Knowledge
 Professionalism & Ethics
 Interpersonal Communication Skills
 Practice-based Learning and Improvement
 Systems-based Practice
 Staff stressors: Nurses role is to decrease stress:
examining feeling about death, listen attentively to needs,
use touch therapy as applicable, family care, maintain
privacy, allow cultural practices as possible.

22. Nursing Organization Chart

23. Hospital administration –Nursing
dept

24. System to be monitor in ICU
Team