Dedicated entrances to the ICU may have video camera monitoring capability and telephone or intercom to allow communication between ICU staff and visitors, and a system to control access according to visitation and other hospital policies. Placing a waiting area or family lounge next to or near the unit entrance can be supportive for visitors, and in some ICUs, access to the unit is through the lounge. Ideally, a dedicated staff member receives visitors, supplies information, maintains the lounge environment, and controls access to the unit and patient rooms. If economic constraints place limits on such staffing, acceptable alternatives should be provided to meet the needs of visitors. Card-key access is a possibility for units with an open or “contract visiting” policy. A less satisfactory option is a buzzer system with telephone contact from outside the unit or from the lounge to an access-control desk within the unit.
To protect patient privacy, room design that limits obtrusive sightlines during care or procedures is desirable. Windows between rooms may compromise privacy. To address this problem, various window designs permit selective viewing by staff while nonetheless protecting patient privacy. These include curtains, adjustable blinds enclosed between two panes of glass, and systems that turn glass opaque when an electrical charge is applied to the glass pane.
Health Insurance Portability and Accountability Act guidelines prohibit the display of full patient names on room doors to protect patients’ privacy. The patient list/census board should not display identifiable patient information if the board is visible to the public. Similarly, personal health information displayed on bedside screens or unit workstations should be protected from unauthorized viewing by appropriate placement, as well as by the use of passwords and screen savers.
Space should be designated for patient safety technologies, such as bar-coding and radio frequency identification technology. Patient safety technology assures patient safety in identifying patients, medication and blood product administration, and in the processing of patient samples and supplies. Various locations on the unit to house patient safety technology scanners include, but are not limited to, the pneumatic tube system, exit points of the unit, near external laboratory processing stations, in the medication room, in the patient room, or on roaming laptop computer stations.
Unit efficiency and patient safety depend on effective communication. All ICUs should have an intercommunication system that links workstations, patient rooms or modules, physician on-call rooms, conference rooms, and the staff lounge. Supply areas and the visitors’ lounge may be included in the system. When appropriate, links to other key departments, such as blood bank, pharmacy, and clinical laboratories, should be included. The system should be as quiet as possible. Communication equipment may include nurse call (intercom) systems, telephones and pagers, fax machines, and technologies such as pneumatic tube stations and dumbwaiters.
Information Technology. With the increased reliance on information technology in critical care, provision for wireless or wired data ports at the patient bedside and throughout the unit is becoming more important. Adequate data ports and an appropriate number of terminals or workstations must be provided, each with sufficient countertop space, and placed to promote efficiency and protect patient confidentiality. Local area networks, wireless technology, handheld documentation devices, and other technologies may be required.
Rapidly changing technology and styles of interfacing pose formidable design challenges. The design must address workflow, patient confidentiality, future needs, staff preferences, interfaces with the main hospital information system, unit-based information technology needs, and other factors, including the fact that members of the care team may need access to data entry and other information simultaneously, at the patient bedside and in other zones.
Voice Communication. Multiple telephone lines and extensions can eliminate the need to wait for a telephone and provide a more efficient method of routing calls to staff members. Wireless telephone options may enhance communication between administrative and clinical staff. Telephone extensions should be located adjacent to computer workstations, and ringers should employ soft tones. If designated “sound-proofed” areas are provided for telephone use, glass should enable staff to view patients and unit activities. In addition to standard telephone service for each ICU, there should be a mechanism for emergency internal and external communications during power failures.
Personnel Tracking. Voice paging systems raise the noise level on the unit and may add to stress. Personnel tracking and nonemergency communications may employ visual displays (numeric or color-coded lights) that eliminate unnecessary noise. The system may include pagers and wired or wireless hands-free phones. Alphanumeric pagers are frequently used to display information rapidly to unit staff. Pagers should be switched to “vibrate” mode to reduce noise, decrease the risk of medical errors, and enhance the healing environment. Wireless earpieces and similar technology may allow medical staff personnel to communicate with one another while working with their hands and without leaving the patient bedside. Mobile technology may increase efficiency by freeing medical staff from the constraints of a fixed location. Studies of cellular telephone interference with medical equipment suggest that cellular telephone use may now be appropriate in most ICUs. One option is to designate one or more areas that are safe for cellular telephone use.
Document Transmission. Facsimile machines and Web-enabled scanners are a quick and efficient means of communication. Scanners connected straight to the Internet permit rapid dissemination of vital medical information to other departments or healthcare facilities. Scanners are becoming more common; designers should strongly consider providing dedicated space.
Materials and finishes can help to create a healing environment by controlling noise and reducing the spread of pathogens. Critical care units have been found to be above recommended decibel levels. Critically ill patients may be more sensitive to noise than staff, and increased noise levels can disrupt sleep and increase perception of pain. Alarms, movement of equipment and chairs, and other unit activities all add to patients’ perceptions of noise, and conversations conducted at what staff perceive to be an acceptable volume are often disturbing to patients, and may constitute a breach of privacy. Select materials that minimize noise, not only in patient rooms, but throughout the unit. To enhance infection control, materials and finishes throughout the unit should be easy to maintain and clean, and deter the growth and spread of pathogens.
Surfaces. Assume that cleaning processes and standards will not always be followed perfectly, and that surfaces are at risk of accidental spills and high-impact damage. Avoid the use of laminates in clinical areas – they provide sites for mold growth. Avoid surfaces or areas that trap water. Key aspects to achieve desirable surface features include smooth finishes free from fissures, open joints, or crevices that can retain or permit the passage of dirt. Select ceiling materials that can be cleaned thoroughly with routine house-cleaning equipment. Acoustical ceilings, if used, should be non-friable and should conform to the Centers for Disease Control and Prevention and hospital infection control policies. When monolithic ceilings are used, they should be smooth and free from fissures, joints, and crevices where dust and particles could lodge. Finish walls with materials that can be easily cleaned. If wall coverings are used, the texture should be consistent with hospital infection control policies. Flooring, made of seamless, resilient sheet goods, should extend up the wall a short distance and be coved to form a smooth junction with the wall. Carpets should be free from edges that create hazards for wheelchairs, walkers, carts, or equipment. There is a body of literature discussing infection control considerations as it relates to flooring options.
Casework or Millwork. Casework can be either fixed or moveable. Counters and cabinets are either casework (metal) or millwork (wood) and should be constructed to resist damage from the movement of beds and medical devices. Countertops should be made of solid surface materials, and joints should be impervious to penetration by liquids. Backsplashes should be high enough to prevent water from splashing on the wall, and designed to prevent moisture from collecting.
Hand hygiene is an important part of infection control, and hand-washing stations should be readily accessible throughout the unit. The 2010 FGI Guidelines describe two systems, one that uses water and one that is water-free. The first provides a sink with hot and cold water, a faucet with easy on-off and temperature-mixing capabilities, cleansing agents, and a means for drying hands. The second uses a waterless, antiseptic rub to reduce the number of microorganisms present on the hands. Sinks on the unit may dispense both waterless products and soap. Waterless systems can be used for cleaning hands that are not visibly soiled. Visibly soiled hands must be cleaned with soap and water, using hand-washing procedures described in current Centers for Disease Control and Prevention Guidelines.
Sinks throughout the unit should be free-standing, have an offset drain to prevent splashing of the contents of the plumbing trap, be deep enough to prevent splashing, and designed for excellent drainage; water should not sit on counters or flat surfaces but should drain back into the sink. Areas around plumbing fixtures should be sealed, moisture resistant, and designed with splash protection. Dry work areas and counters should be located out of the splash range of the sink. Joints at walls and floors should be covered or tightly sealed. There should be no spaces that could harbor pests or allow the growth of pathogens.
The ICU design should provide adequate storage for all equipment, supplies, reference materials, and other items in current use, and plan for future needs. Storage is needed for personal items belonging to staff, patients, and visitors. Corridors should be kept clear to enhance both workplace safety and to present a calm, well-ordered workplace; carts, supplies, and equipment may not be kept in the path of egress or emergency access. Equipment and supplies should be stored as close as possible to where they are used. Separate storage should be provided for equipment used with patients in isolation, and for clean and soiled supplies and equipment.
Ref: Thompson DR, Hamilton DK, Cadenhead CD, Swoboda SM, Schwindel SM, Anderson DC, Schmitz EV, St Andre AC, Axon DC, Harrell JW, Harvey MA, Howard A, Kaufman DC, Petersen C, Guidelines for intensive care unit design, Crit Care Med. 2012 May;40(5):1586-600.