Design specifications for intensive care units (ICU)

Purpose:

Design specifications for ICUs in intensive care units (ICUs) include existing ICUs and future ICU models. These design standards may not necessarily improve patient outcomes, but they can optimize the allocation of space and equipment resources.

3 Essential Design Features For Intensive Care Units | Shree Designs

1. Design team:

A. It should reflect the comprehensive needs of doctors, nurses, managers, and architectural technicians, as well as the needs of safety, fire prevention, and epidemic prevention

B. Designers should consider the design of ICUs from the patient sources of the hospital's ICU, expected bed occupancy rate, turnover rate, special functional needs (such as protection against infectious diseases, ventilation, etc.), support facilities (such as central laboratories, pharmacies, radiology departments, etc.) and future development space

C. The design team should include department directors, head nurses, hospital managers, architectural designers, technical engineers, and widely consult other doctors, nurses, and even patients, as well as ICU staff from other hospitals for their opinions and suggestions to ensure that the design meets the expected functions.

2. ICU overall plan and regional design

A. Pre-planning of ICU mode (comprehensive or multi-unit mode), number of beds (8-12 beds per unit in multi-unit ICU is recommended), visiting system, equipment requirements (number of nurse stations, number of storage rooms, number of equipment, number of staff, management and continuing education needs, etc.).

B. ICU should implement a controlled access system. Walking through and free entry and exit of ICU are not allowed. The passage for material supply and medical staff must be separated from the visiting passage.

C. The geographical location should be selected in a place with good lighting and ventilation as much as possible.

D. It should be as close as possible to elevators, emergency rooms, operating rooms, radiology departments, and laboratories.

2.1 Design of patient areas

The distribution of wards must ensure that patients are placed in direct visual range of staff at any time, indirect visual range (through visual monitors) in special cases, and patient safety in emergency situations.
The best design is that patients can be directly seen from the central nurse station, and in the multi-unit mode, the sub-nurse stations can directly see patients within the management range.
Sliding glass doors and partitions should meet the above requirements and facilitate rapid entry into the room in an emergency.
Patient call signals, monitoring equipment alarm signals and telephone ringing may worsen the rest environment in the ICU and may cause complaints in some cases. It should be set within a reasonable range (the International Noise Conference recommends that the noise level in the emergency treatment area should not exceed 45 decibels during the day, 40 decibels in the evening, and 20 decibels at night. The noise level in this area in most hospitals is 50-70 decibels).
Sound-absorbing materials should be selected for floor coverings, and the needs of infection control, cleaning and maintenance, and equipment movement should be considered. High sound-absorbing materials and structures should be selected for ceilings and walls. Cabinet glass doors and non-direct door designs are conducive to eliminating sound conduction and refraction and reducing noise levels.

2.2 Central Station

The central nurse station should provide comfortable working conditions that can meet the work needs of all employees. If it is a branch nurse station, each nurse station should be able to provide most of the functions of the central nurse station.
Provide sufficient lighting and wall clocks. If there are automated office conditions, sufficient space should be provided for computers and printers. Sufficient work surfaces and seats should be provided for doctors and nurses. Sufficient file racks should be provided to place all commonly used medical documents for easy access by staff at any time.

2.3 X-ray reading area

An area for reading and storing imaging materials should be provided, with a reading lamp of appropriate size and a bright light source.

2.4 Work area and storage room

It should be set up in or adjacent to the ICU, and a closet can be set up to store monitoring equipment.
The rescue vehicle and defibrillator are placed in a position where they can be moved quickly.
A separate medication area should be set up, including a refrigerator, a lockable cabinet for storing controlled drugs, and a sink with hot and cold water. The area should be at least 4.5m2. There should be enough countertops for preparing drugs and enough cabinets for storing drugs and instruments.
If it is a closable room, there should be a transparent glass wall so that patients can be observed during the preparation of drugs and to ensure that only authorized personnel are inside.

2.5 Reception area

Each ICU should have a reception area to control the entry of visitors to the ICU. The ideal location is that every visitor entering the ICU must pass through this area before entering the ICU.
The reception area and ICU should be connected by telephone or internal communication system.
It is best to separate the staff entrance from the visitor entrance. If necessary, the visitor entrance should be protected and safe.

2.6 Special operation room

If it is necessary to set up a special operation room, it should be located in the ICU or close to the ICU.
It should be considered that patients can enter quickly from inside and outside the ICU.
The area should be sufficient to place the necessary equipment, including a complete monitoring system, lockers, emergency support equipment, and safety considerations.
There should be sufficient working surfaces and storage to ensure that staff can complete all envisioned tasks without leaving the room.

2.7 Clean room and dirty room

The clean room and dirty room should be separated and cannot be connected. Both need to provide good temperature control.
The dirty room should have an air exhaust device. The floor should be seamless to facilitate cleaning.
The clean room is used to store clean and disinfected items. The lockers and shelves should be high enough from the ground to facilitate cleaning.
The dirty room should have hot and cold water sinks and floor drains, and covered containers should be placed separately to hold different wastes. There are designated containers for items contaminated by human tissue and body fluids. Special containers are provided for needles and other sharp objects.

2.8 Equipment Storage

An area must be provided to store large equipment that is not in use temporarily, and the space should be convenient for entry, storage and removal.
Provide sufficient sockets for charging and testing equipment.

2.9 Nutrition Preparation Area

A nutrition preparation area should be set up with an operating surface, refrigerator, microwave oven, hot and cold water sink, and ice maker. The refrigerator cannot be used to store experimental reagents.
The washbasin should be indoors.

2.10 Staff Rest Area

A comfortable and private resting environment should be provided in or adjacent to the ICU. There are locked cabinets, shower facilities, and toilets. Provide refrigerators, microwave ovens, food storage, and sufficient seating.
There is a telephone or internal communication equipment with the ICU. There should be an emergency alarm light inside.

2.11 Meeting Room

The location should be convenient for 1CU employees to use,
There is a telephone or internal communication equipment with the ICU. There should be emergency alarm lights inside.
Conference rooms may have multi-functional uses, such as internal learning, continuing education, multidisciplinary consultation, etc.
Ideal conference rooms should be able to store medical and nursing reference books and literature, computers, and Electronic teaching equipment.

2.12 Visitor lounge/waiting area

A visitor lounge or waiting area should be provided in or near each CU. The number of seats should be 1-2 times the number of beds. Public telephones and snacks, televisions and/or music equipment should be provided.
Public toilets and water dispensers should be provided.
Warm colors, non-direct sunlight, windows, and carpets should be considered. A variety of seats including long sofas, straight-back chairs, and recliners can be considered.
Popular science materials, hospital introductions, and community support materials should be provided. It is recommended to have a separate family discussion room to protect privacy.

2.13 Patient transfer channel

The channel for transferring patients in and out of the ICU should be separated from other public channels to ensure quick and unobstructed access.

ICU of the Future designed by the Critical Care Research Group, The Prince Charles Hospital — Critical Care Research Group

3. Design around beds

A. The purpose is to support all required treatment functions.

B. The floor space of each bed should be able to accommodate all equipment and personnel that may be necessary for the treatment of the patient. Each bed in a large ward-type ICU should be at least 20m2. Each unit of a partitioned ICU has a height of 24m2 and a width of at least 4.5m, excluding auxiliary facilities (toilets, anterooms, lockers). Each single-room ICU has a minimum of 24m2, including the anteroom. Each anteroom is at least 1.85m2, providing hand washing, changing clothes, and storage. If a toilet is provided, it must be for personal use.

C. A heartbeat stop/emergency alarm button must be installed next to each bed in the ICU. The alarm can be heard in any room in the ICU, such as the central nurse station, staff lounge, conference room, etc. The source of the alarm should be identifiable.

D. The design of bedside computer terminals and patient intercom systems should be considered.

E. Space should be provided for storing personal belongings and treatment equipment. If drugs and syringes are stored next to the bed, there should be a locked cabinet.

F. Every effort should be made to provide patients and staff with an environment that is as stress-free as possible. Therefore, the design of the ICU should take into account natural lighting and scenery. Install windows in as many rooms as possible so that patients can distinguish between day and night. Curtains made of fireproof materials can absorb sound, beautify the environment, and adjust light. The design of windows should consider durability and easy cleaning, and a regular cleaning schedule should be established.

G. Other facilities that should be provided to patients include clocks, calendars, or bulletin boards, and pillow speakers connected to radios/TVs. Televisions should be placed out of reach of patients and controlled by authorized personnel. If possible, telephones should be installed in every room.

H. Comfort considerations also include establishing privacy protection for patients. Curtains, doors, and screens can control the patient's contact with the surrounding environment. Folding chairs should be available at the bedside for family visits. The color of the room can also be considered to make the patient quiet and restful. Pictures can be placed on the walls visible to the patient.

4. Functional support facilities

A. Each CU should have a complete water, electricity, oxygen, compressed air, negative pressure suction, lighting and environmental control system to provide treatment for patients in normal and emergency situations. These facilities must meet or exceed the standards of the management agency.

B. A multifunctional column (self-supporting, ceiling-mounted or floor-mounted) is the best way, where power, oxygen, compressed air, negative pressure suction, temperature and light control can be obtained. The multifunctional column should be close to the patient's head for emergency airway management when needed. If the multifunctional column cannot be installed, the functional facilities should be installed on the wall close to the patient's head.

C. The configuration of functional support facilities should take into account the possibility of future upgrades, and the management department should be informed of the hospital's upgrade information in a timely manner during the design.

4.1 Power supply

The power supply of each CU should be an independent branch line, and the main power supply should have an emergency backup power supply for sudden power outages. Each socket in the ICU should have its own circuit breaker to ensure that the staff can quickly access it in an emergency
It is recommended to configure 16 sockets for each bed, and the bedside socket is 0.9m from the ground. The sockets beside and at the end of the bed should be close to the ground to prevent tripping over the wires.

4.2 Water source

Each CU should have a separate valve in case of a water pipe rupture.
The size of the sink should be such that water does not splash, and the faucet should have a switch controlled by elbow, knee, foot or automatic control. The location should be between two beds or at the entrance to the ward. The design of the sink is a key part of hospital infection control.
If there is a bathroom in the ward, there should be a bedpan cleaning device, including hot and cold water and a foot control head.

4.3 Oxygen, compressed air, and negative pressure suction device

Central oxygen and compressed air are used, and the oxygen and compressed air standards refer to relevant regulations.
Each bed requires at least 2 oxygen interfaces; 1 compressed air interface is required, preferably 2
Each CU and the hospital's general engineering room should have visible and audible high and low pressure alarm equipment.
Manual valves must be installed in all areas and their locations must be clearly indicated to be closed in case of fire, leakage, or repair.
Each bed has at least 3 negative pressure suction interfaces, and the terminal negative pressure is at least 290mmHg. There should be a visual alarm when the negative pressure is lower than 194mmHg.

4.4 Lighting

The usual overhead lighting and ambient light should be able to meet the needs of daily nursing operations, and should also create a good and soft resting environment for patients.
It is best to place the light adjustment device outside the ward to minimize disturbing the patient at night. The total lighting brightness during the day should be less than 30fc, the continuous lighting at night should be less than 6.5fc, and the short-term lighting should be less than 19fc.
Separate lighting used in emergencies and operations should be placed on the ceiling, and the lighting should be greater than 150fc.
Bedside reading lights should be designed, but they should not interfere with the movement of monitoring equipment and beds. Lighting is less than 30fc.

4.5 Environmental control system

Appropriate and safe air quality should be maintained at all times
At least 6 complete air exchanges per room per hour are required, including 2 air exchanges with the outside per hour.
The air in the central Air conditioning system and gas exchange system must be properly filtered.
The purpose of air conditioning and heating design is to make patients comfortable, and the temperature of each ward can be adjusted individually.

Patient and Family - ESICM

5. Design of physiological monitoring function

A. The monitoring capabilities of each bed include displaying and analyzing one or more ECG leads, at least two pressure monitoring, and direct or indirect arterial blood oxygen monitoring. These parameters should be able to provide visual waveforms, digital frequencies, high/low and average values in both digital and analog forms. Each monitoring device must have a paper recording function.

B. The alarm settings should be well set, visible and audible, and cannot be cleared immediately.

C. Bedside monitoring equipment should be easy to approach and view, and should not interfere with approaching and viewing patients. Bedside nurses and other staff should be able to scan and observe the patient's monitoring status. The monitoring status of all patients should be observed simultaneously through the central monitoring station or bedside monitor.

D. All monitoring equipment cannot replace bedside observation of patients.

The load-bearing capacity of the monitoring equipment placement, the equipment that may be added in the future, and the durability of the load-bearing structure should all be considered, and the corresponding space design and power load should all be considered.

5.1 ECG monitor

It can continuously display ECG waveforms with one or more leads.
Complete alarm settings and memory functions.
Pressure detection function is available as needed.
Respiratory function parameters include pulse gas saturation, ETCO2, respiratory rate, etc.
Cardiac output and hemodynamic monitoring.

6. Computerized design

A. Computerized patient data management is becoming more and more popular, providing paperless data management. Bedside terminals allow staff to obtain as much information as possible at the bedside, including medical orders, automatic recording of monitoring values, laboratory data, X-rays, various reports, etc., and can reduce errors.

B. It should have data portability (transmitted to offices, other departments, etc.)

7. Voice communication system

A. All ICUs should have internal communication equipment to provide voice communication between the central nurse station and wards, conference rooms, staff lounges and other locations. Visiting waiting areas and auxiliary areas should also be included in the system. Key departments such as blood banks, pharmacies, and laboratories should also be included when necessary.

B. Some communications can be visually enhanced to reduce noise.

C. In addition to the standard telephone system, each ICU should have internal and external emergency communication methods to prepare for the failure of conventional systems (such as power outages)

Critical Care Unit | Gleneagles Hospital Hong Kong

8. Laboratory

A. All ICUs should have 24-hour laboratory services.

B. When the hospital central laboratory cannot provide services at all times, a laboratory should be established in or adjacent to the ICU to provide the most needed biochemical tests, blood gas analysis, and blood analysis.

9. Doctor's waiting room

When the resident doctor is in the hospital 24 hours a day, a waiting room in or adjacent to the ICU should be provided. Provide toilets, bathrooms, telephones and/or internal communication system connections, and heartbeat mule and emergency alarms should also be connected.