INTENSIVE CARE UNIT

What is an ICU?

 Intensive care unit are specially nursing unit designed,

equipped and staffed with specially skilled personnel for
treating very critically ill patients or those requiring
specialized care and equipment.
CORE COMPONENTS OF AN ICU

CONSTANT MONITORING

RAPID SKILLED INTERVENTION

MULTI DISCIPLINARY TEAM WORK

History
 In 1854, Florence Nightingale left for the Crimean War, where
the necessity to separate seriously wounded soldiers from less-
seriously wounded was observed. Nightingale reduced mortality
from 40% to 2% on the battlefield, creating the concept of
intensive care.
 In 1950, anaesthesiologist Peter Safar established the concept of
"Advanced Support of Life," keeping patients sedated and
ventilated in an intensive care environment. Safar is considered
the first intensivist.
 LEVELS OF ICU CARE   

 LEVEL I – PROVIDES MONITORING, OBSERVATION AND SHORT

TERM VENTILATION. 

 LEVEL II – PROVIDES OBSERVATION, MONITORING & LONG

TERM VENTILATION WITH RESIDENT DOCTORS. 

 LEVEL III – PROVIDES ALL ASPECTS OF INTENSIVE CARE

INCLUDING INVASIVE HAEMO DYNAMIC MONITORING &
DIALYSIS. 
FUNCTIONS
 To concentrate in one centralized area the critically ill patients for close
observation and skilled nursing care by specially trained personnel
 To enhance the physicians ability to treat acutely ill patients through the
use of centralized and highly skilled personnel and equipment.
 To utilize equipment and highly trained personnel more effectively and
economically
 The surgical intensive care unit in particular provides care of post
surgical patients who develop complications and require close nursing
observation and care.
 The medical intensive care unit provides care for emergency patients
suffering from coma , shock, respiratory and other medical problems.
Types

 Neonatal intensive care unit (NICU)

 Pediatric intensive care unit (PICU) 
 Special Care Nursery (SCN)
 Coronary Care Unit (CCU)
 Neuro Intensive Care Unit (NICU)
 Burn Wounds Intensive Care Unit (BWICU) 
 Trauma Intensive care Unit (TICU)
 Respiratory Intensive Care Unit (RICU) 
 Geriatric Intensive care unit (GICU)
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. 
 DESIGNING AN ICU  

 THE TEAM SHOULD CONSIST OF AN INTENSIVE CARE

DIRECTOR,  NURSING ADMINISTRATORS &
SUPERVISORS,  HOSPITAL ADMINISTRATORS, AN
ARCHITECT, ENGINEERS (Electrical, Civil,
Bioengineering, Electronics etc) , ENVIRONMENTAL
ENGINEERS, INTERIOR DESIGNERS, STAFF NURSES,
PHYSICIANS, PATIENTS AND FAMILIES MAY BE
ASKED FOR COMMENTS. 
 DESIGN
 PNEUMATICS - V 
 
P – PATIENT CARE
N- NURSING 
E- EATING (Clean area for food preparation & delivery)
U- UNCLEAN (Dirty linen & equipment)
M- MEDICATION STORAGE 
A – ADMINISTRATION (CLERKING & STATIONARY)
T – TEACHING
 I – INFECTION CONTROL & ELIMINATION (STERILIZATION &
DISINFECTION) 
C – CLEAN AREA 
S-STORAGE
VISITORS
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 Personnel
 NURSE PATIENT RATIO – 3: 1. 
 ICU NURSE MANAGER 
AN RN (REGISTERED NURSE) WITH A BSN OR
PREFERABLY AN MSN DEGREE. CERTIFICATION IN
CRITICAL CARE OR  EQUIVALENT GRADUATE
EDUCATION WITH AT LEAST 2 YRS EXPERIENCE
WORKING IN A CRITICAL CARE UNIT.
 SPACE REQUIREMENTS
 BED STRENGTH :-
• Ideally 12 to 16 beds per ICU.
• 3 to 5 beds for 100 hospital beds for level III ICU
• In CMC – 68 ICU Beds, 60 Nursery beds, 43 HDU beds 

 BED SPACE & BEDS:-

• 150-200sqft per open bed with 8ft in between beds
• 225-250sqft per bed if in a single room
• Single room with anteroom(20ft) for hand washing, gowning etc
 ACCESSORIES  

 3 OXYGEN OUTLETS, 3 SUCTION OUTLETS (GASTRIC, TRACHEAL &

UNDERWATER SEAL), TWO COMPRESSED AIR OUTLETS AND 16
POWER OUTLETS PER BED. 
 STORAGE BY EACH BEDSIDE (BUILT IN / ALCOVE). 
 HAND RINSE SOLUTION BY EACH BEDSIDE. 
 EQUIPMENT SHELF AT THE HEAD END 
 HOOKS & DEVICES TO HANG INFUSIONS / BLOOD BAGS –
SUSPENDED FROM THE CEILING WITH A SLIDING RAIL TO
POSITION 
 INFUSION PUMPS TO BE MOUNTED ON STANDS / POLES. 
 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.
TECHNICAL SPACE FOR A LAB,
BLOOD GAS ANALYSER etc. 
   RELATIVES’ WAITING ROOM WITH A TELEPHONE, TV, BEVERAGE
FACILITIES etc. 
 ENVIRONMENT

 SIGNALS & ALARMS – ADD TO THE SENSORY OVERLOAD; NEED

TO BE MODULATED.
   FLOOR COVERINGS AND CEILING WITH SOUND ABSORPTION
PROPERTIES. 
 DOORWAYS – OFFSET TO MINIMISE SOUND TRANSMISSION. 
 LIGHT & SOFT MUSIC (EXCEPT 10 PM TO 6 AM). 
 LIGHTING – FOCUSSED & CENTRAL LIGHTING. 
 AIRCONDITIONING (SPLIT / CENTRAL) – 25 + OR – 2 DEGREES
CENTIGRADE. 
 CLEANING – VACUUM CLEANING & WET MOPPING OF THE
FLOOR. FUMIGATION IS NO LONGER RECOMMENDED.
 NATURAL ILLUMINATION AND VIEW - WINDOWS ARE AN
IMPORTANT ASPECT OF SENSORY ORIENTATION; HELPS TO
REINFORCE DAY/NIGHT ORIENTATION.
 ACCESSORIES

 3 OXYGEN OUTLETS, 3 SUCTION OUTLETS (GASTRIC,

TRACHEAL & UNDERWATER SEAL), TWO COMPRESSED
AIR OUTLETS AND 16 POWER OUTLETS PER BED. 
 STORAGE BY EACH BEDSIDE (BUILT IN / ALCOVE). 
 HAND RINSE SOLUTION BY EACH BEDSIDE.
  EQUIPMENT SHELF AT THE HEAD END (MIND THE
HEIGHT OF THE CARE GIVER).
  HOOKS & DEVICES TO HANG INFUSIONS / BLOOD BAGS –
SUSPENDED FROM THE CEILING WITH A SLIDING RAIL
TO POSITION. 
 INFUSION PUMPS TO BE MOUNTED ON STANDS / POLES. 
 UTILITIES

 ELECTRICAL – ADEQUATE SOCKETS (5AMPS & 15 AMPS),

GENERATOR SUPPLY & BATTERY BACK UP. 
 MEDICAL GAS & VACUUM PIPELINE – COLOUR CODED
AND NOT INTERCHANGEABLE. 
 WATER FROM A CERTIFIED SOURCE ESPECIALLY IF USED
FOR HAEMODIALYSIS. 
 HANDWASHING AREAS – UNINTERRUPTED WATER
SUPPLY, DISPOSABLE PAPER TOWELS / HAND DRIER. (NO
CLOTH TOWELS PLEASE) 
 TELEPHONES & COMPUTERS FOR COMMUNICATION. 
 STERILISING AREA – LARGE WATER BOILER / GEYSER &
EXHAUST FANS. 
 WORK AREAS AND STORAGE FOR CRITICAL SUPPLIES
SHOULD BE LOCATED IMMEDIATELY ADJACENT TO EACH
ICU. 
 EQUIPMENTS

DEFIBRILATOR DIALYSIS
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PACEMAKERS TRACHEOSTOMY
NEONATAL INTENSIVE CARE UNIT PAEDIATRIC INTENSIVE CARE UNIT
POLICIES & PROTOCOLS  

 ADMISSION, DISCHARGE &  WITHDRAWAL OF SUPPORT

 LEGAL & ETHICAL GUIDELINES & MLC POLICIES
 STANDING ORDERS. 

INFECTION CONTROL 

 SURVEILLANCE  

 STERILIZATION & DISINFECTION 

 QUALITY CONTROL & AUDITING 

PROBLEMS AND ISSUES
 Code blue is a term used in hospitals to announce an emergency such 
as a cardiac arrest. Inadvanced countries in patient rooms and other 
strategic areas of the hospital, there is a button marked CODE BLUE 
which when activated sets off a distinguished emergency alarm signal 
both at the nurses station & at the telephone operators room.
 The telephone operator goes on public address sys announcing three 
times giving the location of the emergency.