Basic Principles of ICU

Basic Principles of ICU
Plan and Design Overall ICU floor plan and design should be based on the reception pattern of the patient, staff and visitor traffic patterns, and the need for supporting facilities such as nursing stations, storage, administrative space, administration and education requirements, and services that are unique to individual institutions , Eight to twelve beds per unit considered to be the best from a functional perspective. Each health facility should consider the need for positive and negative-pressure isolation rooms in the ICU. This need will depend primarily on the patient population and the State Department of Public Health requirements.
Each intensive care unit should be different geographic areas within the hospital, if possible, with controlled access. No through traffic to other departments should occur. Supply and professional traffic should be separated from the public / visitor traffic. The location should be chosen so that the unit is adjacent to, or in the elevator ride directly to and from, the Emergency Department, Operating Room, intermediate care unit, and Department of Radiology.

Area patients. 
Patients should be placed such that visualization directly or indirectly (for example with video monitor) by health care providers is possible at any time. This allows monitoring of patient status under both routine and emergency circumstances. The preferred design is to allow direct connection of vision among patients and nursing center station. In the ICU with a modular design, the patient should be visible from each nursing substation. The sliding glass doors and partitions facilitate this arrangement, and improving access to the room in an emergency situation. Signals from patient call systems, alarms from monitoring equipment, and telephone adds to the sensory overload in critical care units. Without prejudice to their importance or sense of urgency, the signal must be modulated to a level that will alert a member of staff, but given less dangerous. International Noise Council has recommended that noise levels in acute hospital care area does not exceed 45 dB (A) during the day, 40 dB (A) at night and 20 dB (A) at night. (A-weighted decibel scale filter out low frequency sounds and more closely represents the range of the human ear). Especially, the noise level in hospitals mostly between 50-70 dB (A) with occasional episodes above this range. For this reason, sound-absorbing floor coverings must be used, keep infection control, maintenance, and equipment necessary motion under consideration. The walls and ceilings must be made of material with high sound absorption capability. Ceiling soffets and baffels help reduce noise echoed. The door should be offset and not placed in symmetrically opposed positions, to reduce sound transmission. Counter, partitions and glass doors are also effective in reducing the noise level.
Central Station. A central nursing station should provide a convenient area of ​​sufficient size to accommodate all the functions necessary staff. When the ICU is of modular design, each nursing substation should be able to provide most if not all of the functions of a central station. There should be adequate overhead and task lighting, and wall mounted clock must be present. Enough space for computer terminals and printers are very important when the automated system is being used. Patient records should be readily accessible. Adequate space and seating surface to record medical records by doctors and nurses should be provided. Shelves, filing cabinets and other storage for medical record forms should be located so that they can be immediately accessed by all personnel who require their use. Although a secretarial area may be located separately from the central station, should be easily accessible as well.

X-ray area
A separate room or a different area near each ICU or ICU cluster should be designated for the display and storage of patient radiographs. An illuminated box to view or carousel of appropriate size should be present to allow simultaneous display serial radiographs. A "light" should also be available. Regional work and storage. Work area and storage for critical supplies should be placed within or immediately adjacent to each ICU. Niche must provide for storage and quick retrieval crash carts and portable monitor / defibrillator. There should be a separate drug area of ​​at least 50 square meters contain a refrigerator for medicines, safe double locking for controlled substances, and a sink with hot and cold running water. Countertops should be reserved for treatment preparation, and cabinets should be available for storage of medicines and supplies. If the area is enclosed, glass wall or wall should be used to allow visualization of the patient and ICU activities during medication preparation, and to allow monitoring of the area itself from the outside to ensure that only authorized employees are in. Receptionist Area. Each ICU or ICU cluster should have a reception area to control visitor access. Ideally, it should be in that all visitors must pass through this area before entering. The receptionist should be connected to the ICU (s) via telephone and / or other social systems. It is desirable to have visitors apart from those used by health professionals sign. The entrance visitors should securable if the need arises

Special Procedures Room
If the room is a special procedure to be desired, must be located within, or adjacent to, the ICU. One of the special procedures ICU can serve several near. Consideration should be given to the ease of access for patients transported from areas outside the ICU. The room size should be sufficient to accommodate the necessary equipment and personnel. Monitoring capabilities, equipment, support services, and safety considerations should be consistent with that given in the ICU right. Work surfaces and storage areas should be sufficient to keep all the equipment needed and allows the performance of all desired procedures without the need for healthcare personnel to leave the room.

Rooms are clean and soiled utility
Clean and dirty utility rooms should be separate rooms that do not have interconnecting. They must be sufficiently temperature controlled, and the supply of air from the dirty utility room should be discharged. The floor should be covered with material without seams for easy cleaning. Utility room cleaner should be used for storage of all equipment is clean and sterile, and can also be used for the storage of clean linen. Shelves and cabinets for storage should be located high enough off the floor to allow easy access to the lower floor for cleaning. Dirty utility room sink must contain both clinical and hopper with mixing hot and cold faucets. Separate closed containers must be provided for soiled linen and waste material. There should be appointed mechanism for disposal of items contaminated with body substances and liquids. Special containers should be provided for the disposal of needles and other sharp objects.

Storage equipment
An area must be provided for the storage and security of patient-care equipment items not in active use. Space must be sufficient to provide easy access, easy location of desired equipment, and easy retrieval. Grounded electrical outlets must be provided in a storage area in an amount sufficient to enable charging the battery operated items. Regional Food Preparation. A patient food preparation area must be identified and equipped with a food preparation surface, the ice-making machine, a sink with hot and cold water, a desk stove and / or microwave oven, and refrigerator. The refrigerator should not be used for storage of laboratory specimens. A hand washing facilities must be located in or near the area. Staff Lounge. A staff room must be provided on or near each ICU or ICU group to provide a private, comfortable, and relaxing environment. Safe locker facilities, showers and toilets must be present. That area must include comfortable seating and food storage and preparation of adequate facilities, including a refrigerator, stove table and / or microwaves. The lounge is to be attributed to the ICU by telephone or intercommunication system, and emergency cardiac arrest alarms should sound in. Conference Room. A meeting room should be located for the use of physicians and ICU staff. These rooms should be linked to each relevant ICU by telephone or other intercommunication system, and emergency cardiac arrest alarms should be audible in the room. The conference room can have several purposes, including continuing education, education housestaff, or conference multidisciplinary patient care. A conference room is ideal for storage of medical and nursing reference materials and resources, VCR, and computerized interactive learning and self-paced equipment. If the conference room is not big enough for education, classroom space must also be provided nearby.

Lounge visitors / Lounges.
A visitor reception area or waiting areas should be provided near each ICU or ICU cluster. Visitor access must be controlled from the reception area. One and one-half to two seats per bed critical care are recommended. Public telephone (preferably with privacy attachment) and eating facilities should be available to visitors. Television and / or music must be provided. Public toilet facilities and drinking fountains should be placed in the lounge area or nearby. Warm colors, carpeting, indirect soft lighting, and the desired window. Various seating, including upright, lounge, and a reclining chair, is also desirable. Educational materials and a list of hospital and community-based support and service resources should be displayed. A separate family room consultation is strongly recommended.
Patient Transport Routes. Patients are transported to and from the ICU should be transported via separate from those used by people visiting the corridor. Patient privacy must be maintained and must transport patients quickly and unobstructed. When the lift transportation costs, an oversized typing lift, separate from public access, should be provided.

Offers and Service Corridors
A perimeter corridor with easy entrance and exit should be provided for the provision of services and ICU respectively. Elimination of soiled items and waste must also be done through this corridor. This helps to minimize disruption to patient care activities and minimize unnecessary noise. The corridors must be at least 8 feet in width. Doors, openings, and the parts into each ICU should be a minimum of 36 inches wide to allow easy and unobstructed movement of equipment and supplies. Floor coverings should be chosen to withstand heavy use and allow the wheels of heavy equipment to be moved without difficulty

Patient Module
Module Patients should be designed to support all the functions necessary health. JCAHO requires floor space allocated to each bed enough to accommodate all the equipment and personnel that may be needed to meet patient care needs. Each State Department of Public Health should be consulted for specific guidance related to the size of area per bed, or the space required between the beds. Ward-type ICU should allow at least 225 square meters of floor space clear per bed. ICU patients with individual modules should allow at least 250 square meters per room (assuming one patient per room), and provide a minimum width of 15 meters, not including extra room (waiting room, toilet, storage). Each isolation room should contain at least 250 square meters of floor space plus a living room. Each waiting room must contain at least 20 square meters to accommodate handwashing, gowning, and storage. If toilets are provided, should be private. A key arrest / cardiac emergency alarm should be present on each side of the bed in the ICU. Automatic alarm should sound at the hospital telecommunications center, central nursing station, ICU conference room, staff lounge, and every on-call room. The origin of this alarm should be visible. Space and surfaces for computer terminals and charting the patient should be incorporated into the design of each patient module as indicated. Storage should be provided for the personal belongings of each patient, patient care supplies, linen and toiletries. Locking drawers and cabinets should be used if the syringe and the drugs are stored at the bedside. Personal valuables should not be kept in the ICU. Instead, it must be held by the Security Hospital until patient discharge. Every effort should be made to provide an environment that reduces stress on patients and staff. Therefore, the design should consider natural lighting and view. Windows is an important aspect of sensory orientation, and as much room as possible should have a window to strengthen the afternoon / evening orientation. Curtains or shades of flame resistant fabrics can create attractive window coverings and serves to absorb the sound. Window treatments should be durable and easy to clean, and a schedule for cleaning them should be established. If the blinds or shades not a viable option, considering the use of exterior overhangs, louvers, or colored or reflective glass to control lighting levels. If the window can not be provided in every room, an alternative option is to allow distant views of the outside windows or skylights. The incremental approach to improving sensory orientation to the patient may include the provision of a clock, calendar, bulletin board, and / or a pillow speaker connected to radio and television. Television should be out of the reach of patients and operated by remote control. If possible, telephone service should be provided in every room. Consideration convenience should include methods to set privacy for patients. Shades, blinds, curtains and doors should control patient contact with his / her surroundings. A supply of portable folding chairs or to be provided to enable a family visit at the bedside. One consideration is the selection of the added convenience of a color scheme for the room, which should promote rest and have a calming effect. To provide for visual interest, one or more walls in view of the patient can be selected to accent the color, texture design, graphic or image
engineers and designers must strive deinstitutionalize patient care areas as much as possible.

Utilities
Each intensive care unit must have electrical power, water, oxygen, compressed air, vacuum, lighting, and environmental control systems that support the needs of patients and a team of critical care under normal circumstances and emergency, and it must meet or exceed code regulatory bodies and accreditation and standards. A utility column (it gratis stand, ceiling mount, or floor mounted) is the preferred source of electrical power, oxygen, compressed air and vacuum, and must contain the controls for temperature and lighting. When appropriately placed, utilities column allows easy access to the patient's head to facilitate emergency airway management if necessary. If the utility column is not feasible, utility services may be provided on the head wall. Note: Technical codes, standards and regulations for hospital systems and utilities environment changing at a constant. It is important to contact the regulatory agencies and accreditation for up-to-date information before ICU designs completed.

Electrical Power.
Electric service to each ICU should be provided by a separate supplier connected to the main circuit breaker panel that serves the branch circuit in the ICU. The main panel should also be connected to the emergency power source that will quickly re-supply of electricity in case of power failures. Each outlet outlet or cluster in an ICU should be served by its own circuit breaker in the main panel. It is important that the ICU staff have easy access to the main panel in case of power must be disconnected for emergency power. Grounded 220VAC volt electrical outlet with a 30 amp circuit breaker must be placed within a few meters of each patient bed. Sixteen outlet per bed as desired. Outlet at the head of the bed should be placed about 36 inches above the floor to facilitate connections, and to prevent disconnection by pulling the power cord rather than the plug. Outlet on the side and foot of the bed should be placed close to the floor to avoid tripping over the power cord.

water supply
The water supply must be from a certified source, especially if hemodialysis is to be done. Stop valves must be installed on the pipe zone ICU admission each to enable this service is disabled should line breaks occur. Washing hands is deep and wide enough to prevent splashing sink, should be equipped with elbow, knee, foot, or sonar operated valves, should be available near the entrance to the patient module, or between any two patients on the ward-type unit. It is an essential component of general infection control measures. When the toilet is included in the module of patients, should be equipped with a bedpan cleaning equipment, including hot and cold water supply and spray heads with a foot control. In addition, when the restrooms are present, environmental control systems must be changed (see below).

Oxygen
Compressed Air and Vacuum central oxygen supplied. And compressed air must be provided at 50 to 55 psi of primary and backup tank, and the installation must follow the NFPA standard (24). At least two outlets per patient required oxygen. A compressed air outlet per bed is required; two desired. Connections for oxygen and compressed air outlet should happen by the spark plug to prevent accidental interchanging excited gas. Audible and visible alarm low and high pressure must be installed properly in each ICU and in the engineering field hospital. Guidelines shut-off valves must be found and identified in both areas to permit the supply disruptions in case of fire, excessive pressure, or for the purpose of improvement. Outlet vacuum least three per bed required. The vacuum system must maintain a minimum of 290 mm Hg vacuum at the outlet farthest from the vacuum pump. Audible and visual alarms should show a decrease in vacuum below 194 mm Hg.

Exposure
Overhead costs plus general illumination light from the surroundings should be adequate for routine nursing tasks, including charting, but it creates a soft lighting environment for patient comfort. Total exposure should not exceed 30 foot-candles (fc). It is better to put the lighting control on a variable-control dimmer is located just outside the room. This allows a change in lighting at night from outside the room, memungkinkanminimal sleep disturbances during the observation of the patient. Night lighting should not exceed 6.5 fc for continuous use or 19 fc for short periods. Separate lighting for emergencies and procedures to be placed in the ceiling directly above the patient and should be fully illuminate the patient with at least 150 fc shadow-free. A patient's desired reading lamp, and should be installed so it will not interfere with the operation of the bed or monitoring equipment. The lighting of the reading light should not exceed 30 fc.

Environmental Control Systems
Suitable and safe air quality must be maintained at all times. A minimum of six air changes per hour total per room is required, with two air changes per hour comprised of outside air. For room has a toilet, toilet exhaust required 75 cubic feet per minute should be composed of outside air. Central air conditioning systems and recirculated air must pass through the appropriate filter. Air- conditioning and heating should be given with an emphasis on patient comfort. For critical care units have closed patient module, the temperature must be set in each module.

physiological monitoring
Each module patients should monitor capabilities that include analysis and display one or more electrocardiographic leads, at least three fluid pressure, and acts directly or indirectly from the arterial oxygen levels. It should be displayed both in analog and digital format by providing a visual waveform and interpretation of numerical rate, and the values ​​of maximum / minimum and average accordingly. Each monitoring system should have the ability to record on paper at least two analog waveforms simultaneously in dual channel format. This does not happen at the bedside. Alarms should indicate critical values ​​by means of both audible and visual. Alarms must be easily audible and non-defeatable. Bedside monitoring equipment should be located to allow easy access and viewing, and must not interfere with visualization or access to the patient. Bedside nurse and / or monitor technician must be able to observe the status of each patient be monitored at a glance. This objective can be achieved either by a central monitoring station, or to a bedside monitor that allows the observation of more than one patient simultaneously. It should be noted that neither of these methods is intended to replace bedside observation. Weight-bearing surface that supports the monitoring equipment should be sturdy enough to withstand high levels of strain over time. It must be assumed that the monitoring equipment will increase the volume from time to time. Therefore, space and power facilities should be designed accordingly.

Electrocardiogram
One or more of lead electrocardiography should be displayed continuously. The level of computerization and waveform analysis must, at a minimum, recognize and alarm for asystole, ventricular tachycardia and fibrillation, and a preset maximum / minimum heart rate. Memory function to remember the arrhythmia been desired. Fluid pressure. Monitoring equipment must have the capacity for simultaneous pressure of two or more displays in analog format. In addition, maximum, minimum, and average values ​​should be displayed digitally. Alarms should indicate critical values ​​for the three parameters are digitally displayed.

breathing parameter
Each bedside station must have the ability to provide a continuous measure arterial oxygen levels. Pulse oximetry and transcutaneous p0 2 current measurements like oxygen monitoring modalities. End-tidal C0 2 or transcutaneous PC0 2 measurements can be used for monitoring carbon dioxide required. Monitoring of respiratory rate should be available for patients at risk for apnea.

Miscellaneous physiological parameters
The new monitoring system has the ability to record and display the temperature, respiratory rate, ST segment amplitude, non-invasive cardiac output, mixed venous oksigensaturasi, continuous EEG physiological parameters, and more. These parameters can be added to the monitoring capabilities required. Cardiac output and derived variables. Measurement bedside thermodilution cardiac output, and the availability of mathematical indices derived from the performance of hemodynamic and respiratory, has become almost universal in the ICU. It is felt by the practitioner care is most important to be a very valuable tool for patient management. The ability to provide these functions is strongly encouraged.

Computerized Charting Charting patients
Computerization is becoming increasingly popular in the ICU. This system provides data "paperless" management, order entry, and nurse and physician charting. If and when a decision is made to take advantage of this technology, it is important to fully integrate the system with all the activities of the ICU. Bedside Terminal facilitate patient management by enabling nurses and physicians to remain at the bedside during the process of charting. To minimize errors, monitored data can be saved automatically. In addition, when the system is properly connected to the existing hospital data systems, data retrieval (lab results, x-ray reports, etc.) can be done at the bedside. Remote data transmission capabilities (for the office, on-call room, etc.) desired to facilitate continuity in patient management. All ICU socially sound system must have a social system that provides a sound relationship between the central nursing station, patient modules, physician on-call rooms, conference rooms, and a staff lounge. Supply area and visitors lounge / reception area can also be included in the system. Where appropriate, the relationship to the main departments such as blood bank, pharmacy and clinical laboratory should be included. Some types of communications, such as personnel tracking and non-emergency calls, can best be achieved by using visual displays (eg numeric or color-coded lights) that eliminate unnecessary noise. In addition to standard telephone service to each ICU, which should provide a hospital-wide and external communication, there must be a mechanism for internal and external emergency communications when normal systems fail (eg during a power failure).

Laboratory
All ICUs must have available a 24-hour service clinical laboratory. When the service can not be provided by the central hospital labs, satellite labs within or adjacent to the ICU (s) must serve this function. Satellite facility must be able to provide minimum chemistry and hematology tests, including arterial blood gas analysis.

Physician On-Call Room
When in-house physician services provided on the basis of a 24-hour, on-call rooms should be available close to the ICU (s). Toilet and shower facilities should be provided. On-call rooms should be linked to the ICU (s) via telephone and / or socially sound system. In addition, cardiac arrest / emergency alarm should sound in the room.

Office administration
It is often desirable to have office space available adjacent to the ICU (s) for medical and nursing management and administrative personnel. These offices should be large enough to allow meetings and consultations with the ICU team members and / or the patient's family. Additional office space may be allocated to the development of staff personnel, clinical specialists, and social services, as applicable. The ability to put people near a May ICU facilitates an integrated team approach and broad-based to patient management.