CONCEPT OF CRITICAL CARE

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CONCEPT OF CRITICAL CARE

• PRESENTED BY-
• JASPREET KAUR SODHI
• MSc.FINAL YEAR

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INTRODUCTION

• The intensive care unit is not merely a room or
  series of room filled with patients attached to
  interventional technology it is the home of an
  organization the intensive care team.

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THE INTENSIVE CARE TEAM.

• This team
• Doctor
• Nurses
• Therapists
• Nutritionists
• Chaplains and other support staff, builds an
  environment for healing or dying.

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CRITICAL CARE NURSING

• Critical care nursing is that specialty within
  nursing that deals specifically with human
  responses to life-threatening problems.

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CRITICAL CARE NURSING

• Critical care nursing is that specialty within
  nursing that deals specifically with human
  responses to life-threatening problems.

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SEVEN Cs OF CRITICAL CARE

• Compassion
• Communication (with patient and family).
• Consideration (to patients, relatives and
  colleagues) and avoidance of Conflict.
• Comfort prevention of suffering
• Carefulness (avoidance of injury)
• Consistency
• Closure (ethics and withdrawal of care).

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CRITICAL CARE NURSE

• A critical care nurse is a licensed professional
  nurse who is responsible for ensuring that
  acutely and critically ill patients and their
  families receive optimal care .

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CRITICAL CARE UNIT

• Critical care unit is a specially designed and
  equipped facility staffed by skilled personnel to
  provide effective and safe care for dependent
  patients with a life threatening problem.

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THE AIM OF THE CRITICAL CARE-

• is to see that one provides a care such that
  patient improves and survives the acute illness
  or tides over the acute exacerbation of the
  chronic illness.

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THE EVOLUTION OF CRITICAL CARE

• Forty years of development in critical care and
  critical care nursing has given rise to a
  recognized speciality in nursing practice .
• Critical care units have evolved over the last
  four decades in response to medical advances .

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HISTORICAL PRESPECTIVES

• Florence nightingale recognized the need to
  consider the severity of illness in bed
  allocation of patients and placed the seriously
  ill patients near the nurses station.
• 1923, John Hopkins University Hospital developed
  a special care unit for neurosurgical patients .
• Modern medicines boomed to its higher ladder
  after world war 2

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Bennett, D. et al. BMJ 19993181468-1470
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Bennett, D. et al. BMJ 19993181468-1470
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Bennett, D. et al. BMJ 19993181468-1470
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HISTORICAL PRESPECTIVES

• As surgical techniques advanced it became
  necessary that post operative patient required
  careful monitoring and this came about the
  recovery room.
• In 1950, the epidemic of poliomyelitis
  necessitated thousands of patients requiring
  respiratory assist devices and intensive nursing
  care.
• At the same time came about newer horizons in
  cardiothoracic surgery, with refinements in
  intraoperative membrane oxygen techniques.

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HISTORICAL PRESPECTIVES

• In 1953, Manchester Memorial Hospital opened a
  four bedded unit at Philadelphia was started.
• By 1957, there were 20 units in USA and
• In 1958,the number increased to 150.

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CONTEXTUAL FORCES

• The expansion of American hospital system and
  hospital insurance.
• Architectural, hospital changes towards private
  and semi private accommodations.
• Reallocations for direct patient care
  responsibility and creations of new forms of
  care.
• During 1970s,the term critical care unit came
  into existence which covered all types of special
  care

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TYPES OF ICUs

• There are two types of ICUs,
• An open -. In this type, physicians admit,
  treat and discharge and
• A closed in this type, the admission, discharge
  and referral policies are under the control of
  intensivists.

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ICUS CAN BE CLASSIFIED AS

• Level I This can be referred as high dependency
  is where close monitoring, resuscitation, and
  short term ventilation lt24hrs has to be
  performed.
• Level II Can be located in general hospital,
  undertake more prolonged ventilation. Must have
  resident doctors, nurses, access to pathology,
  radiology, etc.
• Level III Located in a major tertiary hospital,
  which is a referral hospital. It should provide
  all aspects of intensive care required.

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STAFFING

• Large hospital requires bigger team.

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Medical staff

• Carrier intensivists are the best senior medical
• Staff to be appointed to the ICU.
• He/she will be the director.
• Less preferred are other specialists viz. From
  Anaesthesia, medicine and chest who have clinical
  Commitment elsewhere.
• Junior staff are intensive care trainees and
  trainees on deputation from other disciplines.

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NURSING STAFF

• The major teaching tertiary care ICU will require
  trained nurses in critical care.
• It may be ideal to have an in house training
  programme for critical Care nursing.
• The number of nurses ideally required for such
  units is 11 ratio.
• In complex situations they may require two
  nurses per patient.
• The number of trained nurses should be also
  worked out by the type of ICU, the workload and
  work statistics and type of patient load.

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UNIT DIRECTOR-

• Specific requirements for the unit director
  include the following
• Training, interest, and time availability to give
  clinical, administrative, and educational
  direction to the ICU.
• Board certification in critical care medicine.
• Time and commitment to maintain active and
  regular involvement in the care of patients in
  the unit.

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• Availability (either the director or a similarly
  qualified surrogate) to the unit 24 hrs a day, 7
  days a week for both clinical and administrative
  matters.
• Active involvement in local and/or national
  critical care societies.

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• Participation in continuing education programs in
  the field of critical care medicine.
• Hospital privileges to perform relevant invasive
  procedures.
• Active involvement as an advisor and participant
  in organizing care of the critically ill patient
  in the community as a whole.
• Active participation in the education of unit
  staff.
• Active participation in the review of the
  appropriate use of ICU resources in the hospital.

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NURSE MANAGER

• An RN (registered nurse) with a BSN (bachelor of
  science in nursing) or preferably an MSN (master
  of science in nursing) degree
• Certification in critical care or equivalent
  graduate education
• At least 2 yrs experience working in a critical
  care unit
• Experience with health information systems,
  quality improvement/risk management activities,
  and healthcare economics
• Ability to ensure that critical care nursing
  practice meets appropriate standards .
• Preparation to participate in the on-site
  education of critical care unit nursing staff

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NURSE MANAGER

• Ability to foster a cooperative atmosphere with
  regard to the training of nurses, physicians,
  pharmacists, respiratory therapists, and other
  personnel involved in the care of critical care
  unit patients
• Regular participation in ongoing continuing
  nursing education
• Knowledge about current advances in the field of
  critical care nursing
• Participation in strategic planning and redesign
  efforts

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Critical Care Unit nursing requirements-

• All patient care is carried out directly by or
  under supervision of a trained critical care
  nurse.
• All nurses working in critical care should
  complete a clinical/didactic critical care course
  before assuming full responsibility for patient
  care.
• Unit orientation is required before assuming
  responsibility for patient care.
• Nurse-to-patient ratios should be based on
  patient acuity according to written hospital
  policies.

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Critical Care Unit nursing requirements -

• All critical care nurses must participate in
  continuing education.
• An appropriate number of nurses should be trained
  in highly specialized techniques such as renal
  replacement therapy, intra-aortic balloon pump
  monitoring, and intracranial pressure monitoring.
  
• All nurses should be familiar with the
  indications for and complications of renal
  replacement therapy.

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RESPIRATORY CARE PERSONNEL REQUIREMENTS

• Respiratory care services should be available 24
  hrs a day, 7 days a week.
• An appropriate number of respiratory therapists
  with specialized training must be available to
  the unit at all times. Ideal levels of staffing
  should be based on acuity, using objective
  measures whenever possible.
• Therapists must undergo orientation to the unit
  before providing care to ICU patients.

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RESPIRATORY CARE PERSONNEL REQUIREMENTS

• The therapist must have expertise in the use of
  mechanical ventilators, including the various
  ventilatory modes.
• Proficiency in the transport of critically ill
  patients is required.
• Respiratory therapists should participate in
  continuing education and quality improvement
  related to their unit activities.

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• Ideally, 24-hr in-house coverage should be
  provided by intensivists who are dedicated to the
  care of ICU patients and do not have conflicting
  responsibilities.
• Ideal intensivist-to-patient ratios vary from ICU
  to ICU depending on the hospitals unique patient
  population. Hospitals should have guidelines for
  these ratios based on acuity, complexity, and
  safety considerations.
• The following physician subspecialists should be
  available and be able to provide bedside patient
  care within 30 mins

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PHYSICIAN SUBSPECIALISTS

• General surgeon or trauma surgeon
• Neurosurgeon
• Cardiovascular surgeon
• Obstetric-gynecologic surgeon
• Urologist
• Thoracic surgeon
• Vascular surgeon
• Anesthesiologist
• Cardiologist with interventional capabilities
• Pulmonologist

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PHYSICIAN SUBSPECIALISTS

• Gastroenterologist
• Hematologist
• Infectious disease specialist
• Nephrologist
• Neuroradiologist (with interventional capability)
  
• Pathologist
• Radiologist (with interventional capability)
• Neurologist
• Orthopedic surgeon

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S.NO. THERAPIST FUNCTION
1. Physiotherapists prevents and treat chest problems, assist mobilization, and prevent contractures in immobilized patients
2. Pharmacists A advise on potential drug interactions and side effects, and drug dosing in patients with liver or renal dysfunction
3. Dietitians Advise on nutritional requirements and feeds
4. Microbiologists Advise on treatment and infection control
5. Medical physics technicians Maintain equipment, including patient monitors, ventilators, haemofiltration machines, and blood gas analysers
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OTHER PERSONNEL

• A variety of other personnel may contribute
  significantly to the efficient operation of the
  ICU. These include-
• Unit clerks
• physical therapists
• occupational therapists
• Advanced practice nurses
• Physician assistants
• Dietary specialists, and
• Biomedical engineers.

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LABORATORY SERVICES

• A clinical laboratory should be available on a
  24-hr basis to provide basic hematologic,
  chemistry, blood gas, and toxicology analysis.
• Laboratory tests must be obtained in a timely
  manner, immediately in some instances. "STAT" or
  "bedside" laboratories adjacent to the ICU or
  rapid transport systems.

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Radiology and imaging services

• The diagnostic and therapeutic radiologic
  procedures should be immediately available to ICU
  patients, 24 hrs per day.
• Portable chest radiographs affect decision making
  in critically ill patients.

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ORGANIZATION OF ICU

• It requires intelligent planning.
• One must keep the need of the hospital and its
  location.
• One ICU may not cater to all needs.
• An institute may plan beds into multiple units
  under separate management by single discipline
  specialist viz. medical ICU, surgical ICU, CCU,
  burns ICU, trauma ICU, etc.

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ORGANIZATION OF ICU

• The number of ICU beds in a hospital ranges from
  1 to 10 per 100 total hospital beds.
• Multidisciplinary requires more beds than single
  speciality. ICUs with fewer than 4 beds are not
  cost effective and over 20 beds are unmanageable.
  
• ICU should be sited in close proximity to
  relevant areas viz. operating rooms, image logy,
  acute wards, emergency department.
• There should be sufficient number of lifts
  available to carry these critically ill patients
  to different areas.

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ORGANIZATIONAL MODELS FOR ICUs

• the open model allows many different members of
  the medical staff to manage patients in the ICU.
• the closed model is limited to ICU-certified
  physicians managing the care of all patients and
• the hybrid model, which combines aspects of open
  and closed models by staffing the ICU with an
  attending physician and/or team to work in tandem
  with primary physicians.

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DEFINITION OF INTENSIVE CARE UNIT EQUIPMENTS-

• Intensive care unit (ICU) equipment includes
  patient monitoring, respiratory and cardiac
  support, pain management, emergency resuscitation
  devices, and other life support equipment
  designed to care for patients who are seriously
  injured, have a critical or life-threatening
  illness, or have undergone a major surgical
  procedure, thereby requiring 24-hour care and
  monitoring.

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PURPOSE

• An ICU may be designed and equipped to provide
  care to patients with a range of conditions, or
  it may be designed and equipped to provide
  specialized care to patients with specific
  conditions

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DESCRIPTION

• Intensive care unit equipment includes-
• patient monitoring
• life support and emergency resuscitation devices
• diagnostic devices

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PATIENT MONITORING EQUIPMENTS

• Acute care physiologic monitoring system
• Pulse oximeter
• Intracranial pressure monitor
• Apnea monitor

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Bennett, D. et al. BMJ 19993181468-1470
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LIFE SUPPORT RESUSCITATIVE EQUIPMENTS

• VENTILATOR
• INFUSION PUMP
• CRASH CART
• INTRAAORTIC BALOON PUMP

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Bennett, D. et al. BMJ 19993181468-1470
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DIAGNOSTIC EQUIPMENTS

• MOBILE X-RAYS
• PORTABLE CLINICAL LAB. DEVICES
• BLOOD ANALYZER

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• DESIGN OF ICU

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• PHYSICAL SET UP OF 5 BEDDED ICU

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THERAPEUTIC ELEMENTS IN ICU ENVIORNMENT

• Window and art that provides natural views views
  of nature can reduce stress, hasten recovery,
  lower blood pressure and lower pain medication
  needs.
• Family participation ,including facilities for
  overnight stay and comfortable waiting rooms.

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THERAPEUTIC ELEMENTS IN ICU ENVIORNMENT

• Providng a measure of privacy and personal
  control through adjustable curtains and blinds
  ,accessible bed controls ,and TV ,VCR and CD
  players.
• Noise reduction through computerized pagers and
  silent alarms.
• Medical team continuity that allows one team to
  follow the patient through his or her entire stay.

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ICU TEAM

• ICU deign should be approached by
  multidisciplinary team consisting of -
• ICU MEDICAL DIRECTORS
• ICU NURSE MANAGER
• THE CHIEF ARCHITECT
• THE OPERATING ENGINEERING STAFF

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OTHER ADDITIONAL MEMBERS

• ENVIORNMENTAL ENGINEER
• INTERIOR DESIGNERS
• STAFF NURSES
• PHYSICIANS
• PATIENTS
• FAMILIES

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• THE CHIEF ARCHITECT -He must be experienced in
  hospital space programming and hospital
  functional planning.
• ENGINEER He should be experienced in the
  design of mechanical and electrical systems For
  hopitals,especially critical care unit.

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FLOOR PLAN AND DESIGN

• IT SHOULD BE BASED ON-
• Patient admission pattern
• Staff visitor traffic patterns
• Need for support facilities such a nursing
  station ,Storage, clerical space,
• Administrative educational requirements.
• Services that are unique to the individual
  institution.

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FLOOR PLAN AND DESIGN

• Eight to twelve beds per unit is considered best
  from a functional perspective .
• Each healthcare facility should consider the
  need for positive- and negative pressure
  isolation rooms within the ICU.
• This need will depend mainly upon patient
  population and State Department of Public Health
  requirements.

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FLOOR PLAN AND DESIGN

• Each intensive care unit should be a
  geographically distinct area within the hospital,
  when possible, 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 Radiology
  Department

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PATIENT AREAS.-

• Patients must be situated so that direct or
  indirect (e.g. by video monitor) visualization by
  healthcare providers is possible at all times.
  This permits the monitoring of patient status
  under both routine .and emergency circumstances.
  The preferred design is to allow a direct line of
  vision between the patient and the central
  nursing station.
• In ICUs with a modular design, patients should
  be visible from their respective nursing
  substations.
• Sliding glass doors and partitions facilitate
  this arrangement, and increase access to the room
  in emergency situations.

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RECOMMENDED NOISE RANGES

• Signals from patient call systems, alarms from
  monitoring equipment, and telephones add to the
  sensory overload in critical care units.
• The International Noise Council has recommended
  that noise levels in hospital acute care areas
• not exceed 45 dB(A) in the daytime,
• 40 dB(A) in the evening,
• 20 dB(A) at night.
• ?Notably, noise levels in most hospitals are
  between 50-70 dB(A) with occasional episodes
  above this range

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CENTRAL STATION

• A central nursing station should provide a
  comfortable area of sufficient size to
  accommodate all necessary staff functions.
• When an ICU is of a modular design, each nursing
  substation should be capable of providing most if
  not all functions of a central station.
• There must be adequate overhead and task
  lighting, and a wall mounted clock should be
  present.
• Adequate space for computer terminals and
  printers is essential when automated systems are
  in use.
• Patient records should be readily accessible .

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CENTRAL STATION

• Adequate surface space and seating for medical
  record charting by both physicians and nurses
  should be provided.
• Shelving, file cabinets and other storage for
  medical record forms must be located so that they
  are readily accessible by all personnel requiring
  their use.
• Although a secretarial area may be located
  separately from the central station, it should be
  easily accessible as well

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X-RAY VIEWING AREA.

• A separate room or distinct area near each ICU or
  ICU cluster should be designated for the viewing
  and storage of patient radiographs.
• An illuminated viewing box or carousel of
  appropriate size should be present to allow for
  the simultaneous viewing of serial radiographs.
• A "bright light" should also be available.

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WORK AREAS AND STORAGE

• Work areas and storage for critical supplies
  should be located within or immediately adjacent
  to each ICU.
• 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 sink with hot and
  cold running water.
• Countertops must be provided for medication
  preparation, and cabinets should be available for
  the storage of medications and supplies.

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RECEPTION AREA
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RECEPTIONIST AREA

• Each ICU or ICU cluster should have a
  receptionist area to control visitor access.
• Ideally, it should be located so that all
  visitors must pass by this area before entering.
• The receptionist should be linked with the
  ICU(s) by telephone and/or other
  intercommunication system.
• It is desirable to have a visitors' entrance
  separate from that used by healthcare
  professionals.
• The visitors' entrance should be securable if the
  need arises.

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Special Procedures Room.

• If a special procedures room is desired, it
  should be located within, or immediately adjacent
  to, the ICU.
• One special procedures room may serve several
  ICUs in close proximity.
• Consideration should be given to ease of access
  for patients transported from areas outside the
  ICU.
• Room size should be sufficient to accommodate
  necessary equipment and personnel.

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Special Procedures Room.

• Monitoring capabilities, equipment, support
  services, and safety considerations must be
  consistent with those provided in the ICU proper.
  
• Work surfaces and storage areas must be adequate
  enough to maintain all necessary supplies and
  permit the performance of all desired procedures
  without the need for healthcare personnel to
  leave the room

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Clean and Dirty Utility Rooms.

• Clean and dirty utility rooms must be separate
  rooms that lack interconnection.
• They must be adequately temperature controlled,
  and the air supply from the dirty utility room
  must be exhausted.
• Floors should be covered with materials without
  seams to facilitate cleaning.
• The clean utility room should be used for the
  storage of all clean and sterile supplies, and
  may also be used for the storage of clean linen.

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Clean and Dirty Utility Rooms.

• Shelving and cabinets for storage must be located
  high enough off the floor to allow easy access to
  the floor underneath for cleaning.
• The dirty utility room must contain a clinical
  sink and a hopper both with hot and cold mixing
  faucets.
• Separate covered containers must be provided for
  soiled linen and waste materials.
• There should be designated mechanisms for the
  disposal of items contaminated by body substances
  and fluids.
• Special containers should be provided for the
  disposal of needles and other sharp objects.

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Equipment Storage

• An area must be provided for the storage and
  securing of large patient care equipment items
  not in active use.
• Space should be adequate enough to provide easy
  access, easy location of desired equipment, and
  easy retrieval.
• Grounded electrical outlets should be provided
  within the storage area in sufficient numbers to
  permit recharging of battery operated items.

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Nourishment Preparation Area

• A patient nourishment preparation area should be
  identified and equipped with food preparation
  surfaces, an ice-making machine, a sink with hot
  and cold running water, a countertop stove and/or
  microwave oven, and a refrigerator.
• The refrigerator should not be used for the
  storage of laboratory specimens.
• A hand washing facility should be located in or
  near the area.

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Staff Lounge.

• A staff lounge must be available on or near each
  ICU or ICU cluster to provide a private,
  comfortable, and relaxing environment.
• Secured locker facilities, showers and toilets
  should be present.
• The area should include comfortable seating and
  adequate nourishment storage and preparation
  facilities, including a refrigerator, a
  countertop stove and/or microwave oven.
• The lounge must be linked to the ICU by telephone
  or intercommunication system, and emergency
  cardiac arrest alarms should be audible within.

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Conference Room.

• A conference room should be conveniently located
  for ICU physician and staff use.
• This room must 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 may have multiple purposes
  including continuing education, house staff
  education, or multidisciplinary patient care
  conferences.
• A conference room is ideal for the storage of
  medical and nursing reference materials and
  resources, VCRs, and computerized interactive and
  self-paced learning equipment.
• If the conference room is not large enough for
  educational activities, a classroom should also
  be provided nearby.

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Visitors' Lounge/Waiting Room.

• A visitors' lounge or waiting area should be
  provided near each ICU or ICU cluster.
• Visitor access should be controlled from the
  receptionist area. One and one-half to two seats
  per critical care bed are recommended.
• Public telephones (preferably with privacy
  enclosures) and dining facilities must be
  available to visitors.
• Television and/or music should be provided.
• Public toilet facilities and a drinking fountain
  should be located within the lounge area or
  immediately adjacent.

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Visitors' Lounge/Waiting Room.

• Warm colours, carpeting, indirect soft lighting,
  and windows are desirable .
• A variety of seating, including upright, lounge,
  and reclining chairs, is also desirable.
• Educational materials and lists of hospital and
  community-based support and resource services
  should be displayed.
• A separate family consultation room is strongly
  recommended.

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Patient Transportation Routes

• Patients transported to and from an ICU should be
  transported through corridors separate from those
  used by the visiting public.
• Patient privacy should be preserved and patient
  transportation should be rapid and unobstructed.
• When elevator transport is required, an oversized
  keyed elevator, separate from public access,
  should be provided.

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Supply and Service Corridors

• A perimeter corridor with easy entrance and exit
  should be provided for supplying and servicing
  each ICU.
• Removal of soiled items and waste should also be
  accomplished through this corridor.
• This helps to minimize any disruption of patient
  care activities and minimizes unnecessary noise.

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Supply and Service Corridors

• The corridor should be at least 8 feet in width.
• Doorways, openings, and passages into each ICU
  must be a minimum of 36 inches in width to allow
  easy and unobstructed movement of equipment and
  supplies.
• Floor coverings should be chosen to withstand
  heavy use and allow heavy wheeled equipment to be
  moved without difficulty .

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Patient Modules

• Ward-type icus should allow at least 225 square
  feet of clear floor area per bed.
• Icus with individual patient modules should
  allow at least 250 square feet per room (assuming
  one patient per room),
• Provide a minimum width of 15 feet, excluding
  ancillary spaces (anteroom, toilet, storage).

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Patient Modules

• Isolation rooms should each contain at least 250
  square feet of floor space plus an anteroom.
• Each anteroom should contain at least 20 square
  feet to accommodate hand-washing, gowning, and
  storage.
• If a toilet is provided, it must be private.

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Patient Modules

• A cardiac arrest/emergency alarm button must be
  present at every bedside within the ICU. The
  alarm should automatically sound in the hospital
  telecommunications center, central nursing
  station, ICU conference room, staff lounge, and
  any on-call rooms. The origin of these alarms
  must be discernable.
• Space and surfaces for computer terminals and
  patient charting should be incorporated into the
  design of each patient module as indicated.

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Patient Modules

• Storage must be provided for each patient's
  personal belongings, patient care supplies, linen
  and toiletries. Locking drawers and cabinets must
  be used if syringes and pharmaceuticals are
  stored at the bedside.
• Personal valuables should not be kept in the ICU.
  Rather, these should be held by Hospital Security
  until patient discharge.
• Every effort should be made to provide an
  environment that minimizes stress to patients and
  staff. Therefore, design should consider natural
  illumination and view.

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Patient Modules

• Windows are an important aspect of sensory
  orientation, and as many rooms as possible should
  have windows to reinforce day/night orientation .
• Drapes or shades of fireproof fabric can make
  attractive window coverings and serve to absorb
  sound.
• Window treatments should be durable and easy to
  clean, and a schedule for their cleaning must be
  established

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IMPROVING SENSORY ORIENTATION

• Additional approaches to improving sensory
  orientation for patients may include -
• the provision of a clock, calendar, bulletin
  board,
• pillow speaker connected to radio and
  television.
• Televisions must be out of reach of patients and
  operated by remote control.
• If possible, telephone service should be
  provided in each room.

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• Comfort considerations should include methods for
  establishing privacy for the patient. Shades,
  blinds, curtains, and doors should control the
  patient's contact with his/her surroundings.
• A supply of portable or folding chairs should be
  available to allow for family visits at the
  bedside. An additional comfort consideration is
  the choice of color scheme for the room, which
  should promote rest and have a calming effect.

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• To provide for visual interest, one or more walls
  within patient view may be selected for an accent
  color, texture, graphic design or picture .
• Advice from environmental engineers and designers
  should be sought to deinstitutionalize patient
  care areas as much as possible.

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Utilities

• Each intensive care unit must have -
• Electrical power,
• Water, oxygen,
• Compressed air,
• Vacuum, lighting,
• And environmental control systems
• that support the needs
  of the patients and critical care team under
  normal and emergency situations, and these must
  meet or exceed regulatory and accreditation
  agency codes and standards .

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ELECTRIC SUPPLY

• Grounded 110 volt electrical outlets with 30 amp
  circuit breakers should be located within a few
  feet of each patient's bed .
• Sixteen outlets per bed are desirable.
• Outlets at the head of the bed should be placed
  approximately 36 inches above the floor to
  facilitate connection,
• To discourage disconnection by pulling the power
  cord rather than the plug.
• Outlets at the sides and foot of the bed should
  be placed close to the floor to avoid tripping
  over electrical cords.

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Water Supply.

• The water supply must be from a certified source,
  especially if hemodialysis is to be performed.
• Zone stop valves must be installed on pipes
  entering each ICU to allow service to be turned
  off should line breaks occur.
• Hand-washing sinks deep and wide enough to
  prevent splashing, preferably equipped with
  elbow-, knee-, foot-, or sonar-operated faucets,
  must be available near the entrances to patient
  modules, or between every two patients in
  ward-type units.

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Lightning

• Total luminance should not exceed 30
  foot-candles .
• It is preferable to place lighting controls on
  variable-control dimmers located just outside of
  the room.
• Night lighting should not exceed 6.5 fc for
  continuous use or 19 fc for short periods.
• Separate lighting for emergencies and procedures
  should be located in the ceiling directly above
  the patient and should fully illuminate the
  patient with at least 150 fc shadow-free
• A patient reading light is desirable, and should
  be mounted

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Environmental Control Systems.

• A minimum of six total air changes per room per
  hour are required, with two air changes per hour
  composed of outside air.
• For rooms having toilets, the required toilet
  exhaust of 75 cubic feet per minute should be
  composed of outside air.
• Central air-conditioning systems and recirculated
  air must pass through appropriate filters.

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• Air-conditioning and heating should be provided
  with an emphasis on patient comfort.
• For critical care units having enclosed patient
  modules, the temperature should be adjustable
  within each module.

103
Computerized Charting

• These systems provide for "paperless" data
  management, order entry, and nurse and physician
  charting. If and when a decision is made to
  utilize this technology, it is important to
  integrate such a system fully with all ICU
  activities.
• Bedside terminals facilitate patient management
  by permitting nurses and physicians to remain at
  the bedside during the charting process.

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OTHER FACILITIES

• Voice Intercommunication Systems
• Satellite Laboratory
• Physician On-Call Rooms
• Administrative Offices

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• THANK YOU.