The unit support zone encompasses areas where administrative, logistic, and staff support functions are performed.
A variety of offices and conference spaces can be located within the unit but somewhat remote from the Patient Care Zone. This will reduce cross traffic with patients and family members yet provide an administrative area conducive to concentrated work.
The ICU may include a dedicated space for the interdisciplinary team to prepare “change-of-shift” reports. Some members of the interdisciplinary team may require office space for management, education, and clinical specialty purposes. If offices must be shared, consideration should be given to the need for occasional privacy. Office spaces should be large enough to include necessary equipment and comfortable furnishings. The unit should contain spaces for staff meetings and consultation with families. Many of these needs may occur simultaneously.
Multipurpose Conference Room. There is a need for larger meetings than can occur in individual offices. A large conference room or classroom proportionate with staff size can accommodate a variety of needs, including educational/training conferences, multidisciplinary staff meetings, formal didactic rounds and impromptu meetings, in-service education, or debriefings.
This room should have audiovisual equipment capable of upgrade and high-speed Internet connections. It should include an erasable marker board and “flipcharts,” flexible (expandable) table options, and comfortable seating, including a supply of stackable chairs for the occasional larger group. It should contain access to the hospital/health information system and picture archiving and communication system monitors, emergency cardiac arrest alarms, and a telephone or other intercommunication system linking to the ICU. It is preferable to designate a separate space for the staff lounge.
The design must consider how supplies will be delivered from central supply processing and bulk stores. Some institutions use satellite materials management locations dedicated to serving the ICUs. Dispensing machinery can track per-patient use of materials and thus help with billing. Floor space for this equipment needs to be provided. These spaces can include utility rooms, work rooms, supply rooms, and holding functions.
Supplies. Supplies of all kinds – whether linen, paper goods, patient care items, or administrative forms – are typically delivered to the unit immediately if required for patient treatment daily, or weekly. These may be transported via dedicated lifts. Supplies may arrive on carts or pallets. To control infection, boxes and containers should be opened outside the unit, and transferred to on-unit storage. If possible, circulation paths for supply carts should be segregated from clinical zones and family areas, both vertically (via elevators) and horizontally (via corridors or passageways).
Clean Utility/Workroom. A place is needed for storing all clean and sterile supplies, both disposable and reprocessed. It should be centrally located, easily accessed by multidisciplinary staff, segregated from the soiled utility room, and large enough to accommodate rolling carts (such as linen carts and IV medication pumps). The primary clean utility room may be supplemented by satellite work locations proximal to patient beds. If the unit is large or in a pod format, designers may want to provide multiple clean utility rooms and/or allocate dedicated linen storage space per pod. Providing alcoves for mobile bedside carts within rooms can reduce clutter outside rooms.
Clean utility/workrooms should contain a work counter and hand-washing station. Easy-to-clean shelving and storage cabinets should be off the floor and within easy reach. Security is a consideration, since syringes and sharps may be stored there.
Soiled Utility/Workroom. The soiled utility room should be physically separated from, and have no direct connection to, the clean utility/workroom. They may provide temporary storage for carts containing patient meal trays not yet collected by dietary personnel, and for used and soiled items that will be reprocessed or disposed of elsewhere. Holding spaces should be sized according to anticipated soiled materials volume, and organized to accommodate several categories of waste, including hazardous materials. Steps should be taken to reduce overall waste. Disposal procedures will vary by hospital.
The soiled utility room should include a hot and cold running water sink and clinical sink with a flushing rim feature, adequate countertop space, and space for cleaning supplies. A variety of containers, such as cans, bins, bags, and hampers, may be required to hold different categories of soiled materials, including linen, trash, and hazardous (red bag) waste. Because disposal of hazardous materials is becoming increasingly expensive, steps should be taken to reduce its volume.
Housekeeping. The unit should provide adequate storage space for housekeeping equipment and supplies, such as housekeeping carts, vacuums, buffers, mops, buckets, and ladders. To secure equipment, consider implementing a keypad or other control system.
ICU staff members need places to sleep, eat, relax, take care of personal needs, and store their belongings.
On-call Rooms. Short naps or sleep breaks may enable medical staff to function better and reduce errors. On-call rooms for members of the interdisciplinary team should be available as dictated by the functional program, preferably within or adjacent to the unit, or at a minimum, on the same floor. Separate rooms should be provided for men and women. Telephones or intercoms should link on-call rooms to the ICU, and cardiac arrest/emergency alarms must be audible. Computer access to patient medical records and picture archiving and communication systems would be ideal. Toilet and shower facilities should be provided, and these facilities should be accessible.
Staff Lounge. A staff lounge in or near the ICU should provide a private, comfortable, spacious, and relaxing environment. The lounge should include comfortable seating, a table with chairs for dining, and food storage and preparation facilities, including a large refrigerator, microwave oven, and coffee dispenser or coffee maker (52). Computer access is desirable, and an area for staff mailboxes should be included. Critical information for staff members may be displayed on bulletin board in the lounge or near staff restrooms.
The staff lounge should be linked to the ICU by telephone or intercom, andemergency cardiac arrest alarms must be audible. The room should be separated from public areas. If possible, windows to the outdoors should provide a view of nature. The lounge should be ventilated to remove food smells from patient care and public areas.
There are pros, cons, and precautions needed for including televisions for staff. Televisions may serve not only as entertainment, but also as a source of critical information during a public crisis or emergency situation. Televisions, if provided, should feature cable or satellite access.
Staff Restrooms. Restrooms clearly designated for staff and designed to meet accessible requirements should minimize time away from duty, yet ensure privacy. Toilets should not open directly into the staff lounge. If the unit is large or contains several pods, multiple staff restrooms should be considered. Separate male and female restrooms are recommended and should include a toilet, hand-washing sink, dispensers for soap and waterless hand cleaner, hand drying means, waste receptacle, and mirror. A storage cabinet and shelving would be helpful.
Lockers. A secure space for lockers for staff belongings may be allocated within or adjacent to the staff lounge. In larger facilities, these spaces may be designated for different segments of the staff or shared by more than one unit. Because many nurses or other staff may prefer to keep some belongings at the patient bedside or at work stations, designers should consider providing secure drawers or shelves at these locations.
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, 40: 1586-1600.