Organization of Critical Care unit

1. ORGANIZATION OF
CRITICAL CARE UNIT
Mr. Kuldeep Vyas
M.Sc. Community Health Nursing

2. DESIGN CONSIDERATION
• Critical Care Unit is a vital
arena in the hospital and
organization of a critical care
unit is a strategically planned
process

3. • The bed strength , the types of
patients, and services intended to
decide the ICU needs in terms of
floor space, equipment, monitors,
manpower etc
• The NABH and the Indian Society of
Critical Care Medicine follow
minimum set criteria

4. BED STRENGTH
• In order to provide effective care
the ICU should have 6 to 14 beds
• The ICU with large number of beds
has to be divided into PODS
containing 10-15 beds with
sufficient staffs, devoted medical
registrar and intensive care
specialist

5. ICU PODS

6. LOCATION
• The CCU has to be ideally located
in a separate area with easy
accessibility to the emergency
department, operation Room,
radiology department,
catheterization lab and blood
bank

7. • The unit must have sufficient big
lift, ramps and a wide corridor
that can be facilitate smooth
transfer in and out of the
patients
• The ICU should have a single
entry and exit with an anteroom

8. • There should be provision for
emergency exits in case of
disasters

9. FLOOR SPACE
• The recommendation varies
from country to country

10. • Floor space: 125 to 150 sq ft per
patient is recommended. It may
vary up to 250 per sq ft
• The floor space for a separate
room should be much higher at
least 300 ft2 per patient

11. • The bed space between two
beds should be 4 – 4.5 sq ft
• The beds are separated with a
removable partition
• The head end should have
enough space for easy patient
access for intubation or
resuscitation

12. • Two bigger rooms or two
separate rooms should be
available for patients requiring
isolation precaution or for the
immuno compromised patients

13. • The room should be big beside
procedures such as ECMO and
renal transplant therapy and for
those who have a large number
of gadgets attached to them

14. • 100 % to 150% extra space is
recommended for other than
patient care area for nurses
station, storage space and free
patient movement

15. OTHER FACILITIES
• An ICU should have storage
space for ventilators, monitors,
infusion pumps, room for
doctors office, nurses office,
toilets.

16. • Facility should be provided for
medical storage (gloves, medicines,
airways, suction tips, catheters,
Ryles tubes)
• Other facility to be provided are :
medicine preparation area,
equipment storage area, secretarial
and computation facility, clean linen
storage, seminar room with a small
library and dirty utility room

17. • An ideal ICU should have a clear
cut zoning with patient care
areas, support areas, dirty utility,
and toilet in other areas
• For movement of dirty utility
there should be a separate
pathway

18. • There may be provision of RO
purified water access within ICU
• There should be a minimum of
two to three oxygen outlets, two
to three vacuum outlets and one
to three compressed air outlets

19. • 16-18 electric outlets are
recommended
• There should be sufficient natural
lighting available. Wall mounted or
ceiling mounted pendent type
lights are preferable to save space
and for good illumination

20. • Hand washing facility should be
easily accessible. Isolation ICU
should have separate hand
washing facility

21. NURSES STATION
• There should be a central nurses
station with tele monitoring
devices. This will enable
monitoring of patients placed
ideally in a “C” or “L” fashion

22. ENVIRONMENTAL CRITERIA
• The ICU should be fully air
conditioned with control of
humidity and moisture.
• 12 air exchanges and 55% to 60%
humidity are recommended.
Laminar flow is preferable.

23. EQUIPMENT & SUPPLIES
• Equipment numbers and types
are decided based on the
existing standards of the country
and the type of services
provided

24. • There should be functional
systems in place to ensure the
safe and accurate functioning of
the machines and equipment.
• The monitors have to be
periodically calibrated

25. BASIC EQUIPMENT
REQUIREMENT
• The basic requirement needed to
organize a level III ICU is as
follows:

26. • Ventilators (one per bed) with at
least 40% of the ventilators
having built in non invasive
ventilation capability
• Non invasive ventilators
• Multichannel monitor with at
least two pressure monitoring
devices

27. • Defibrillators and Pace makers
• Infusion pumps/syringe pumps
(4-8 per bed)
• Fluid and bed warmers
• Portable transfer monitors
• Portable Ventilators (at least 1)
• Specialized beds

28. ICU ROOM

29. • Bedside trolleys, drug cart and
emergency cart
• Patient Lifting devices
• Portable X Ray machine
• Picture archiving & communication
system is preferable
• Bedside ultra sound and echo
machines

30. • Renal replacement therpay
• IABP or Ventricular Assist Device
• Bedside bronchoscopy machines

31. For every patient the following
monitors should be available:
• ECG Monitor
• Pressure Monitor
• Temperature Monitor
• End Tidal CO2 monitor
• Pulse Oximeter
• Non Invasive arterial pressure
monitoring

32. • Pulse Oximeter
• Bedside (ABG) lab and ECMO are
optional and may be available

33. • For safe handling and maintenance
of equipment the medical, nursing
and other allied health personnel
have to be trained periodically
• The various sizes of endotracheal
tubes, tracheostomy tips,
nasogastric tubes, airways, suction
tips & ICD tubes should be available

34. • Catheters, ECG leads, gloves,
gowns, masks, goggles, drugs, IV
fluids and refrigerator should be
available to store medications
• Adequate amount of
medications should be stored at
the bedside as well as in the
central stores

38. THANK YOU