The Intensive Care Unit (ICU) is one of the vital and essential pillars of hospital centers. In this section, it is possible to provide the necessary medical services to patients who are in serious physical condition by using the equipment and advanced technology, and efficient and experienced human resources. Today, human life has undergone dramatic changes with the use of advanced tools and technology, but in parallel with this transformation, human beings have been exposed to new dangers (including traffic accidents and cancers).
It is obvious that by creating intensive care units, significant services can be provided to this group of patients and prevent them from causing more irreparable injuries.
For this reason, it is important to know the latest criteria and standards required for the establishment and management of this sector. Therefore, we decided to use the latest guidelines and available resources to describe the criteria required by the Intensive Care Unit (ICU) in 4 sections: physical space, facilities, medical equipment, and manpower.
The Intensive Care Unit (ICU) is a multidisciplinary medical unit that, based on scientific standards and regulations, does not compensate for the use of all equipment, facilities, medical technology, and necessary medicines for the treatment of patients with acute and threatening diseases or in case of injuries. has it.
The ICU should be able to provide a high level of treatment services to patients in the shortest time and with the best quality.
The ECU ward should be located in the main building of the hospital and its connection with other wards and units as well as access to it from other wards, especially the emergency room and operating room should be easily possible.
The ECU should be located on the ground floor or first floor of the hospital building and be connected to the emergency department and operating rooms. The following view shows the proper location of the ICU in the hospital complex.
Entrance doors must be of the control type and have the ability to be locked from the inside and can restrict entry for non-medical staff. Fan doors with a width of at least 100 cm can be used for the front entrance doors.
The general space of the ECU ward should be such that the rotation of the bed and its accessories, as well as the provision of medical services to patients, can be done easily and without space restrictions.
In terms of appearance, the ECU space can be created in four ways:
A - U pattern
B- Circular pattern
C - Linear pattern
D - L pattern
The choice of the pattern depends on the number of beds and the available space.
1- Pre-entrance space:
This space is located at the beginning of entering the ECU and provides the possibility of changing clothes (wearing guns and masks), changing shoes, and the initial control of the patient. It is better to predict the communication space of the companions with the ward in a separate entrance. The minimum space required in this section is 18 square meters (width 3 meters, length 6 meters) and shelves for vegan shoes should be provided in it.
2- Therapeutic spaces:
This space includes a bedside area - a special operating room - an isolated room and a nursing station.
A- Patient bed rest area:
For a standard ICU bed with dimensions (1 * 2), at least 240 cm of space on the sides should be considered - one meter above and one meter below the bed so that the minimum required space for the ICU unit is 12 square meters. However, due to the construction of new beds with larger dimensions, a space of 20 square meters is proposed. The space between the beds can be separated from each other by using prefabricated partitions. It is also necessary to place the equipment in such a way that patients can be transported easily. It is suggested that the patient leave the ward through a special door installed at the end of the bed.
B- Special operating room:
This room is located inside the ACU treatment area or adjacent to the ward and is used to avoid the additional transfer of patients to other paraclinical units. This room can be used for outpatient surgeries (such as catheters, etc.), ultrasound, echocardiography, etc. This room should be equipped with essential equipment such as a monitoring system - cardiopulmonary resuscitation equipment - sterile sets and other items so that staff does not need to leave the room during the procedures.
C - Isolated room:
The ECU unit must have at least one isolated room with the capacity to accommodate a patient bed and all the essential equipment of an ECU unit. The minimum space required for this room is 20 square meters and it is necessary to have a complete bathroom to meet all the needs of the patient without the need to leave the room. Isolated room is designed according to the type of disease:
1- Direct isolation: In this type, the patient has an infection and tries to prevent the infection from spreading to the environment and other people.
2- Reverse isolation: In this type, the patient is protected from the environment and infections that threaten him.
According to the latest CDC proposal, isolated rooms must be created by the separate definitions of each type of insulation and cannot be converted into each other.
The positive or negative airflow system is established depending on the type of insulation that is considered.
D- Nursing station:
In designing a nursing station, the important point is to have the most nobility and direct vision over patients. In this place, sufficient space should be provided for the establishment of a monitoring system, computer, desk for doctors and nursing staff, office supplies needed, shelves for storing papers, forms, and files, a sufficient number of chairs, telephone handsets, and other necessary equipment.
This area of the ICU is the location of the rooms where the necessary logistics and support activities are performed. The most important support units are as follows:
1- Treatment room:
The dimensions of this room should be at least 15 square meters and there should be enough space to install medicine shelves in it. In this room, the required drugs are stored and at each time after preparation and control by the relevant nurse are transferred to the treatment space and prescribed to patients. It is necessary to have a refrigerator to store some medicines and products. Installation of a ventilator and sink is another requirement of this room. Also, other medical consumables such as angiocatheter, catheter, ivory, tracheostomy tubes, sutures, thermometer ... are sufficiently stored in this room so that the ICU does not face a shortage of these items at any time.
2- Blood gas measuring chamber:
A space of 6 square meters is considered for placing a blood gas measuring device with a table - at least one chair and accessories for the device. The physical characteristics of this space are similar to the laboratory (floors and walls can be washed and have a floor washer). The noteworthy point is the temperature of this space that should be kept between 20-25 degrees in four seasons.
A room with dimensions of at least 10 square meters should be considered for keeping clean sheets and clothes - daily consumables and other items for consumption for a maximum of one week.
Note: Creating a large warehouse and long-term storage of various items and equipment is not recommended.
4- Washing room for contaminated equipment:
A room with dimensions of at least 10 square meters with tiles up to a height of 180 cm - equipped with a pair of sinks for washing and brushing of contaminated non-consumable medical supplies should be provided. After being transferred to the washing room, these devices are placed in a disinfectant solution and then washed by the relevant person and prepared for transfer to CSR. A ventilation installation is required for this room. Shelves for the temporary storage of equipment should also be provided. All personnel working in this room must be equipped with aprons, masks, goggles, and gloves. Therefore, the presence of these items in the tool washing room is mandatory.
5- T washing room:
A room with a space of 2 * 1 meters that is tiled up to the ceiling and has a pond with a wall of 30 cm and a place of hanging in it. Also, this chamber should have hot and cold water and, if possible, a shelf for storing detergents and cleaners. Ventilation installation is also necessary.
6- Storage room for contaminated clothes:
For this purpose, a room with a space of 1 x 2 meters with tiling and washability should be considered. In this room, contaminated clothes and sheets are transferred to the energy unit through a special outlet through special storage and observing hygienic points.
7- Restroom for nursing staff and resident doctor:
Two rooms with dimensions of at least 6 square meters should be considered for the temporary rest of staff and doctors.
8- Health services:
Existence of at least two sanitary services (Iranian and French) with sanitary conditions with the possibility of installing ventilation for every 6 beds required. A separate toilet for staff use should also be provided.