IUSS HEALTH
FACILITY GUIDES
Adult Critical Care Units
[DISCUSSION DRAFT 1]
5 June 2012
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Date
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Name
18th May 2012
Draft 1
E. Flemming
21st May 2012
Draft 1
E v d Schyf
26th May 2012
Draft 1
M Coetzer
28th May 2012
Draft 1
E v. d. Schyf
5th June 2012
Draft 1
E vd Schyf
3 Sept 2012
Draft
EVDs
INFORMATION
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Notes
Health facility guides.
Discussion document, draft 1, current, not binding, 18 May 2012
TITLE
Intensive care units
Description
Reference
Authors
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stakeholder’s
list
Endorsements
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Y/N
Correspondence
“Intensive care units” contains health facility guidance in five parts
covering the infrastructure norms and standards for intensive care units
for facilities providing regional, tertiary, central and national referral
services. It is to be read in conjunction with the full norms and standards
suite and covers policy and service context (Part A) planning and design
(Part B), room data (Part C), accommodation schedules, (Part D) and case
studies (Part E)
CSIR 59C1119 GWDMS
IUSS NandS task team 020 What does this refer to
Departments of Health or Departments of Health and Social Development
in the Eastern Cape, Free State, KwaZulu-Natal, Limpopo, Mpumalanga,
Northern Cape, North West, and Western Cape provinces.
Department of Public Works or Department of Transport and Public
Works in the Eastern Cape, KwaZulu-Natal, and Western Cape
The National Department of Health
The document is endorsed by the CSIR
Submitted to the IUSS Norms and Standards Working Group for
endorsement
N/A
Description:
By whom:
By when:
IUSS@csir.co.za Building Science and Technology, CSIR Built Environment
Box 395, PRETORIA, 0001, South Africa. Peta de Jager pdejager@csir.co.za
Accessing of these guides
This publication is received by the National Department of Health (NDoH), IUSS Steering Committee Chairman:
Dr Massoud Shaker.
Use of text, figures or illustrations from this report in any future documentation, media reports, publications,
competition entries and advertising or marketing material is solely at the discretion of the IUSS Steering
Committee and Working Group and should clearly reference the source. This publication may not be altered
without the express permission of the IUSS Steering Committee and Working Group. Feedback is welcome.
This document (or its updates) is available freely at www.iussonline.co.za
Disclaimer Is this a standard disclaimer?I have changed the wording
This is a discussion draft guidance document that has been development as part of the National Norms and
Standards for the South African National Department of Health for the benefit of professionals and staff
involved in the procurement, design, management and commissioning of healthcare infrastructure across both
public and private sectors. Use of the guideline as described in this document is at the risk of the implementing
agent/party, until endorsed by the National Health Council of the Department of Health.
Development status
The development process adopted by the IUSS team aims to consolidate information from a range of sources
and stakeholders including local and international literature, expert opinion, practice and expert group
workshop/s into a first level discussion status document. This will then be released for comment through the
iussonline website and through IUSS, national and provincial channels.
Feedback and further development will be consolidated into a second level development status document
which also will be released for comment and more rigorous technical review. Further feedback will be
incorporated into proposal status documents for formal submission to the Department of Health Technical
Review Committee. Approved documents will be submitted for formal ratification by the National Health
Council at which stage documents reach approved status. At all development stages documents may go
through various drafts and the final approved document will be assigned a version number. Documents may
be used at risk for project development at all development stages, but will only become mandatory in final
approved status.
Acknowledgements
This publication has been funded by the NDoH.
IUSS NandS task team 020 (Intensive care units): Edwina Fleming, Etha van der Schyf, Geoff Abbott, Magda
Coetzer and Nkhensani Baloyi
Table of Contents
PART A – POLICY AND SERVICE CONTEXT ......................................................................................................... 1
Overview ..................................................................................................................................................... 1
Policy context .............................................................................................................................................. 1
Service context ............................................................................................................................................ 2
PART B – PLANNING AND DESIGN .................................................................................................................... 3
Overview ..................................................................................................................................................... 3
OPERATIONAL FUNCTIOI NING OF AN INTENSIVE CARE UNIT ......................................................... 3
DETERMINING THE REQU IREMENTS OF AN INTEN SIVE CARE UNIT ............................................... 3
The zoning of the unit: ................................................................................................................................. 4
ICU Design Principles ................................................................................................................................... 5
PUBLIC SPACES .......................................................................................................................................... 6
Patient space ............................................................................................................................................... 8
PUBLIC SPACES ........................................................................................................................................... 16
CLINICAL SPACES ........................................................................................................................................ 17
CLINICAL SUPPORT SPACES ........................................................................................................................ 19
ADDITIONAL REQUIREMENTS .................................................................................................................... 21
STAFF SPACES ............................................................................................................................................ 22
ADDITIONAL ADMINISTRATIVE ACCOMMODATION REQUIREMENTS: ....................................................... 22
PART C – ACCOMMODATION SCHEDULES COULD WE DISCUSS ? ................................................................... 23
PART D – ROOM DATA ................................................................................................................................... 24
LIST OF ABBREVIATIONS ................................................................................................................................ 25
Table 1: Functional unit spaces ......................................................................................................................................................... 6
Table 2: Electrical mechanical support services ....................................................................................................................... 8
Table 3: Equipment specific to the Level of Care ................................................................................................................... 13
FIGURE 1: CLINICAL DEPARTMENTAL RELATIONSHIPS ......................................................................................... 4
Figure 2: ICU interdependent: public, clinical support and facility management diagram ................................... 5
Figure 3Unit Work process flow ....................................................................................................................................................... 7
Figure 4: Facility management inside the unit ........................................................................................................................... 7
Figure 5: Staff movement ..................................................................................................................................................................... 8
Figure 6: positioning of an ICU patient room ............................................................................................................................. 9
Figure 7: Staff Movement and equipment .................................................................................................................................... 9
Figure 8: Bed space from floor to ceiling ................................................................................................................................... 10
Figure 9: ICU Bed with ceiling mounted pendants ................................................................................................................ 11
Figure 10: Design with en-suite ablutions for High care or isolation .......................................................................... 16
PART A – Policy and Service Context
Overview
Intensive care units (ICU) are
dedicated units for critically ill
patients who require invasive life
support, high levels of medical
and nursing care and complex
treatment.
Intensive care units (ICU) are dedicated units for the management and care
of critically ill patients who are dependent on invasive life support, intensive
levels of medical and nursing care and complex treatment modalities.
The ICU is a dedicated highly specialised and technically sophisticated unit
in a hospital for the management of critically ill patients, specifically:
•
•
•
•
located,
designed,
staffed,
Furnished and equipped to fit the intended purpose.
High-care patient units provide intensive nursing care. The technical
requirements are less intensive and patients are not on life support systems.
The design and technical requirements for both ICU and High-care are similar. High care could be provided at
district levels of care. ICU care is provided at Regional and Tertiary hospitals
This document describes spaces that are unique to critical care units and is to be read in conjunction with the
full IUSS suite see IUSS documents map. It also describes variations required to hospital spaces and clarifies
requirements for these spaces, where appropriate. The document provides guidance on ICU units that admit
patients with dependency classification of level 2 or 3 as defined (xxxref). It excludes facilities for high-security
isolation ICU of burns patients. .
The appropriate size of the unit will be defined in the clinical profile for the facility. Examples of space
requirements for an 8-bed, 16-bed and 32-bed critical care unit are provided as part of the schedules of
accommodation. The example provided provides a basis for sizing facilities at the initial planning stages. The
final requirements should be determined based on the bed number and the expected acuity of patients,
Policy context
Service context:
The provision of ICU and High Care beds are defined as prescribed by the National Department of Health and
published as a Government Notice - R. 655 of 12th August 2011.The notice should be read in conjunction with
the National Health Act 61/2003: Regulations Relating to Categories of hospitals: No.34521
Abstracts: Categories of public hospitals
 District hospital “ (4) A district hospital may only provide the following specialist services
o (a) paediatric health services,
o b) obstetrics and gynaecology,
o (c) internal medicine; and
o (d) general surgery.”
**District hospitals may provide high-care beds only, no ventilation
 Regional hospital – “(d) short term ventilation in a critical care unit”
 Tertiary hospitals – “(c) provides intensive care services under the supervision of a specialist or
specialist Intensivist”
 Central hospitals - central referral services are provided in highly specialised units, require unique,
highly skilled and scarce personnel and at a small number of sites nationwide
 National referral services - refer to super-specialized national referral
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Service context
Determining number of ICU beds:
ICU beds should be calculated at 20% of acute adult surgical beds, or 2.3 of total adult beds. A bed occupancy
rate of 78-80 % should be targeted, due to cost and resource intensity.
Planning principles recommended for Intensive care units

For effective Intensive Care management ICU units should provide between 6 and 12 beds per unit.
ICU units with bed configurations outside of this parameter are uneconomical in terms of clinical
outcomes and management efficiency.

Intensive care at Regional hospitals provides for a general ICU and based on the bed numbers and the
burden of disease the beds could be divided into Medical and Surgical ICU’s. Tertiary hospitals provide
specialised intensive care for adult patients, and typically accommodates Surgical, Medicine, Coronary
care, Neuro, Trauma, Burns, and Isolation
Hours of operation:
ICU units operate 24 hours per day, seven days per week. Emergency admissions may be made at any time,
depending on availability of beds.
Patient visitors:
The visitor’s policy is determined by the Provincial Department of Health or the management of the facility. It
is common practice to have set visiting hours with a restriction on the number of visitors per patient and on
the age of children allowed into the units
Staff:
Access to the unit is restricted to staff allocated to the unit and to staff required to perform clinical or facility
management duties, this would include doctors, rehabilitative services, cleaning staff and delivery of supplies
to the unit. Visiting, teaching and volunteering activities may also take place within the ward.
A registered nurse to patient ratio of 1:1 is regarded as ideal, where this is not possible due to resource
constrictions a safe patient staff ratio should be developed.
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PART B – Planning and Design
Overview
The service and policy
context should be the
basic determinant of
planning and design
principles in the ICU
design.
Part A provides the national and provincial service and policy requirements as basic
determinant to meet the principles for ICU planning and design. Part B provides
departmental relationships and unit workflow diagrams as planning and design
illustrations to assist with the understanding of the dependencies and unit workflow
requirements. Part C provides suggested schedules of accommodation for a unit.
Part D provides the room data-sheets including some indicative equipment lists.
Case studies are provided for direction in part E of the document.
Parts C, D and E will demonstrate how the principles prescribed in Part B are applied
in working examples. Parts C or D if used as described will satisfy the principles
developed in Part B, but are not the only acceptable configurations.
Case studies (Part E) are for illustrative purposes to demonstrate solutions and
should not be adopted without appropriate contextual adaptation.
OPERATIONAL FUNCTIOINING OF AN INTENSIVE CARE UNIT
An intensive care unit manages inpatients who require assisted life support under intensive supervision of
specialist clinical staff. Admissions are associated with a serious life threatening status.
There is a close relationship between the ICU, the Medical Emergency Services and Hospitals wards from
where patients are admitted from and referred to as soon as the patient’s condition becomes independent of
life support.
Hours of operation:
An ICU operates 24 hours per day, seven days per week.
Patient visitors:
Visitors are allowed in the unit according to the hospital policy.
Staff:
Staff refers to unit-based nursing and medical staff that provides continuous care to patients in shifts, visiting
specialist and clinical staff who call to provide periodic or referral services to patients (such as medical doctors
and Rehabilitative sciences healthcare workers, this includes staff involved in teaching and volunteers who
may work in the unit.
It also refers to facility management staff and persons who provide support services (such as cleaning, food,
linen and maintenance services
DETERMINING THE REQUIREMENTS OF AN INTENSIVE CARE UNIT
Space
Space should provide for a highly complex and technologically intensive unit, planned to reduce bottle necks,
provide efficient human resource management by reducing walking distances for staff, related store rooms
should be close to the bed units and supervisory management and control should be central to the unit.,
clinical functions should be grouped in terms of the levels of type of services.
Due to the patient profile strict access control should be provided at the public entrance as well as the service
entrance to the unit. Space for family could be provided external to the unit with a dedicated visiting policy
.
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Size
The number of ICU beds is based on 20% of all clinical beds.
Environment
The unit support a stress reduced environment and should provide privacy and support to the patients and
their families. To this end walled cubicles would be an optimal choice.
Strict infection control principles should be adhered to in the planning of the unit
Noise adversely affects staff performance and leads to fatigue, work stress and could lead to distraction and
poor performance and communication. The impact on patients disturbs sleep, creates agitation and prolongs
patient stay.
This could be mitigated by providing acoustic architectural designs, sound absorbing ceilings and fabrics that
will increase sound absorption. The balance between reducing noise and providing privacy must maintain a
safe clinical environment.
The zoning of the unit:
The clinical profile of the unit requires an efficient functional relationship between clinical departments.
Departments that is essential to the function of the unit. These services provides complimentary clinical
support to emergency care patients and include Intensive care and Operating theatres, Radiology,
Laboratory services, Inpatient wards,. The zoning of these departments to the emergency unit could be
horizontal or vertical with the emphasis on rapid patient access.
FIGURE 1: CLINICAL DEPARTMENTAL RELATIONSHIPS
Intensive Care unit
Laboratory services
and Blood bank
Operating Theatre
Emergency Unit
Radiology
Hospital Pharmacy
Inpatient ward
Mortuary
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ICU Design Principles
The ICU should be a dedicated unit within the hospital and should be centrally located within an acute
hospital.. It should be adjacent to and or have access to imaging facilities and it should be easily accessible
to the operating theatres and the emergency unit.
The ICU requires direct links to the main hospital pharmacy. A pneumatic tube system should be provided
to support direct access to the hospital laboratory and the pharmacy. Computer technology will further
assist with electronic connectivity between points of service and the ICU.
Staff and unit facility traffic through the ICU should be strictly controlled and discouraged. The design
should separate clinical and non-clinical services. There should access a front entrance for patients,
clinical staff and visitors and another for .services and consumables
-Clinical staff should have direct visual observation of all the patients and the monitoring and ventilation
equipment.
Figure 2: ICU interdependent: public, clinical support and facility management diagram
High Care
Adult High Care units should be provided in proximity to the ICU units. This would allow for appropriate levels
of care for acutely ill patients who are able to breathe unsupported, but with high dependency on nursing
care.
High Care units could be provided in a general configuration or as a dedicated unit ( Neuro, Spinal care,
Trauma, Nephrology Pulmonology )
It should be adjacent to and or have access to imaging facilities and it should be easily accessible to the
operating theatres and the emergency unit.
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The unit requires direct links to the main hospital pharmacy. A pneumatic tube system should be
provided to support direct access to the hospital laboratory and the pharmacy. Computer technology will
further assist with electronic connectivity between points of service and the unit.
Staff and unit facility traffic through the unit should be strictly controlled and discouraged. The design
should separate clinical and non-clinical services. There should access a front entrance for patients,
clinical staff and visitors and another for .services and consumables
Access control should be provided at the public entrance as well as the service entrance to the unit.
Functional Relationships between the clinical and bed spaces
The functional relationships assist in the understanding of proximity of units and departments to each other.
Note: ICU/High Care Units should have at least one dedicated mobile x-ray machine within the unit.
Regional hospital ICU units should have a close relationship to the Operating theatre. X-rays may be on
the ground floor. The Emergency unit and OPD will have preference access to Radiography due to patient
volumes.
Tertiary and Central hospitals may have specialised investigative units e.g. Cardio Thoracic ICU should
have access to a Cath lab. The requirements will be described in the Operational Narrative
Table 1: Functional unit spaces
PUBLIC SPACES
Entrances, reception, visitors waiting and public ablutions
CLINICAL
Unit manager’s and Clinical Manager’s offices Nurses’ station, ward
reception, clinical administration,
PATIENT TREATMENT
ICU Cubicles for clinical patient management, no patient ablutions.
CLINICAL SUPPORT
High care patients require a shared assisted shower and a disabled
toilet
Meeting room, clinical stores, medicine rooms , laboratory room,
mobile x-ray
A bed and trolley wash facility
HOUSEKEEPING
Linen, stores, waste disposal, cleaner’s room, unit kitchen
STAFF
Staff rest room, clinical overnight accommodation
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Figure 3Unit Work process flow
Visitors and
patient access
control
Bed Units and
Isolation
Nurses’
station
Facility management and
Support Services
Support services
Note :
The unit Clerk provides administrative support to the nursing staff and provides receptionist functions to
the unit. In Regional Hospitals space for the clerk could be provided for at the nurses’ station.
In Tertiary hospitals it might be required that the clerk be placed outside the unit as a receptionist to
keep the public informed, but out of the unit unless required.
Figure 4: Facility management inside the unit
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Figure 5: Staff movement
Patient space
DESCRIPTION AND FUNCTION
The unit bed configuration should maximise the visual observation of the beds and the monitoring equipment
from the nurses’ station. It is proposed that 6-8 beds to a nurse’s station be regarded as optimal.
.The beds must be arranged so that the positioning conforms to the bed spacing requirements (stated
previously). ICU beds split can be divided into two separate units of 6-8 beds with shared facilities should there
be a need to rationalise space.
Location and relationship
The clinical support services and the patient should be easily observed from the nurse’s station.
. For specialised units that require more than 20sqm motivation in the narrative would be required
Table 2: Electrical mechanical support services
Level of Care
Bed Unit size
Ablutions
Isolation beds
Air management
Space for lazy boy
chairs in HC only
Wall services
Water outlets
District-High
care
4.6 x4.5sq per
bed
Assisted
shower
and
WC
Regional ICU and High care
Tertiary-ICU and High Care
4.6 x4.5sq per bed
4.5x4.5=20.25 sq. per bed
High Care only
High care only
+ pressure at
NS
HC
+ Pressure
2x units fitted +/_ with sliding
glass doors
Not applicable
2 wall mounted soft water
outlets for renal dialysis as well
as drainage points”
The specific requirements will be
provided in the operational
narrative
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Figure 6: positioning of an ICU patient room
The bed space should be a minimum of 20sq. in order to accommodate the equipment/furniture.
This will also allow:
o
staff access to the patient from all sides of the bed;
o
staff to maneuver the patient, themselves and equipment safely;
o
five members of staff to attend to the patient in an emergency situation;
o
two visitors to sit at the bedside.
Figure 7: Staff Movement and equipment
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Consider the placement of equipment in planning of the spaces
Figure 8: Bed space from floor to ceiling
NOTE: A floor to ceiling height of 3m is proposed. This should be communicated during the procurement of
pendants
Services to bed space
Bed services are distributed between the vertical floor pendants or ceiling suspended pendants with
articulated limbs. In all cases the service panels shall be positioned to allow unobtrusive access around the bed
and to the patient.
Hand wash basins must be provided with elbow taps and gooseneck outlet in each unit must be a moulded
unit that will provide a sealed wall cover. The standard fitted with a mirror, soap dispenser and paper towel
dispenser should be provided.
Ceiling-mounted pendants are preferred to floor-mounted pendants, floor mounted create clutter the space
around the bed and the floor, thereby hindering access to the patient and safety for staff and visitors. Ceiling
mounted pendants are easier to maintain and clean. These pendants are powered, enabling staff of all heights
to operate easily. Placement of the pendants should ensure convenient access by staff.
The ICU unit should provide at least 2 wall mounted “soft water outlets for renal dialysis as well as drainage
points” Applicable to Regional hospitals and higher or Not applicable to District hospitals.

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Un-switched socket outlets of 15 amps x14>20 on UPS
Oxygen Outlets x4 should be provided 2 on each side
Medical Air outlets 2 on each side
Vacuum 2 outlets on each side
Emergency nurse call system
Data point
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The following equipment attachments should be located on the pendant:
o
o
o
o
o
o
o
o
Computer with flat-screen monitor
Multi-parameter patient monitor
4x infusion pumps;
4x syringe pumps;
Examination light of good quality (for putting up drips, etc.)
Blood warmer (per ICU)
Feeding pump( Per ICU)
Ventilation and humidification equipment. (Per ICU)
Note:

Data points - up to four data outlets, one of which should be networked to the hospital’s patient
record system

All electrical power plugs should be connected to UPS support

UPS sockets should be colour-coded to differentiate them from one another.

Additional switched and shuttered sockets, connected to ring circuits, may be provided at the
bedhead for portable non-medical equipment. Isolated power supply

Plugs for other services should be positioned away from patient areas (Wall power outlet (“dirty”) for
mobile x-ray equipment (clearly marked))

Ventilators should be positioned on left as physician on patients’ right-hand side.

The pendant should be connected to an isolated power supply and provide an uninterruptable power
supply (UPS) to an agreed number of electrical outlets. IPS and UPS sockets should be colour-coded to
differentiate them from one another.
Figure 9: ICU Bed with ceiling mounted pendants
EQUIPMENT IN BED SPACE:
STANDARD EQUIPMENT
 counter, with sitting space for at least 3 people, above and under worktop storage space
 space for 2x telephones
 space for computer and printer
 space for nurse call panel
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space for fire alarm/smoke detection panel
access control (ward entrance and exit and dirty utility outside door)
space for digital X-ray monitor and keyboard
space for patient allocation board
wash hand basin, mirror, paper towel holder, soap dispenser and wall mounted waste paper bin
key cupboard
wall clock
pinning board
white board (small – for e.g. stock ordering notes)
power outlets and IT points
access to pneumatic system for laboratory samples (regional hospitals – dependant on hospital size;
tertiary hospitals as standard)
air conditioning : +- 24-27 deg. C
space for emergency trolley
space for oxygen cylinder on mobile stand
space for 3x observation trolleys or mobile NIBP machines
space to store and recharge HB- and glucose meters
space to store and recharge diagnostic sets
access to medical gas shut-off valves must be in visual control and within easy reach of the nursing
staff
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Table 3: Equipment specific to the Level of Care
The following equipment may be required at the bedside on an intermittent or continuous basis:
District HC
Visitors chair
Mobile X-ray machine
Regional ICU
Tertiary ICU
Haemodialysis machine
Invasive cardiac output
monitoring devices
Haemo-filtration machine;
Endoscopes (fibre-optic
light source
EEG machines;
Peritoneal dialysis
Electrocardiography
machines;
Eco-cardiograph machines;
Defibrillators;
Ultrasound machines
Vital sign monitors
Pressure (CPAP)/bi-level positive airway pressure
(BIPAP)): this may be mounted on the pendant
Vacuum dressings.
High and low pressure suction
units
Oxygen flow meters, mounted
diagnostic set
Blood warmer,
Intra-aortic balloon pump
Intravenous infusion devices (infusion and syringe
pumps
Inter-cranial pressure monitoring device
Warm air blanket unit
Note : All requirements listed for a district hospital would equally apply to regional and tertiary HC and ICU
units
A wall-mounted renal dialysis panel with water supply and drainage may be provided at some bed spaces
to facilitate haemodialysis. Alternatively, it may be more economical to supply potable water to small
water treatment units at the bed cardiograph space. The specification for the water quality should meet
the requirements of the Renal Society of SA Ref.no xxx(M&E doc on reverse osmosis
A clock with an elapsed time control should be clearly visible from each bed space.
The bed space should be a minimum of 20 sq. to accommodate the above Equipment/furniture. This will also
allow:
o
Staff access to the patient from all sides of the bed;
o
Staff to maneuver the patient themselves and equipment safely;
o
Five members of staff to attend to the patient in an emergency situation;
DESIGN CONSIDERATIONS:





Bed spaces should be capable of providing visual privacy and reasonable auditory privacy, when
required.
Bed spaces should have natural daylight and where possible outside views.
Artificial lighting should be dimmable but of sufficient strength to enable surgical interventions and
response to life-threatening situations at the bedside.
Lighting may be provided as part of the pendant system.
Glass walls (in the case of single-bed rooms) or partitions (in the case of multi-bed areas),with vertical
blinds
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CEILING -A ceiling height of 3 m in bed areas is recommended in order to accommodate pendants.
The position of overhead equipment requires careful consideration. The construction of the ceiling
should take account of weight-bearing requirements
TEMPERATURE – Unit temperature should be controlled between 24-27 degrees C.
Air management in the unit should provide a light positive air pressure of 40 to 100kPa ( kilo Pascal)
Cubicles (side 1,2 m wall, with sliding doors for isolation units only
Placement of wash hand basins should be at point of entry.
Patient hoist in HC is optional
All water and sewerage services should be positioned on outside walls.
Storage for surgical and clinical consumables should be located as part of the unit e.g. Pharmaceutical
Store with refrigerator, blood refrigerator and fluid/blood warmer, blood gas analyzer, Blood gas
analyzer may be placed at the nurses’ station.
NOISE LEVELS 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, and 20 dB(A) at night. Walls
and ceilings should be designed for sound absorption.
Paper Waste bins should be provided next to but lower than the hand-wash basin. One (1) for clinical
and the other for general waste,
Bed curtain rails and curtains should be provided each bed,
Clinical patient Chart board on wheels,
Nurse Call system at each bed connected to Nurses Station,
Bedside locker next to each bed,
Over-bed table
Remote control beds
Voice Intercommunication Systems
• All ICUs should have an intercommunication system that provides voice linkage between the
central nursing station, physician on-call rooms, conference rooms, and staff lounge.
• When appropriate, linkage to key departments such as theatre, blood bank, pharmacy and
clinical laboratories should be included
Fire alarm system: smoke detection: audible (check noise level). Accessible visible extinguisher (no
sprinklers)
Single Entry and Exit point to/from ICU
Escape route :patient, bed and equipment
A 2.5 m-wide unobstructed circulation space should be provided at the foot of each bed space. It is
imperative to maintain the required bed separation for infection control reasons and to aid
positioning of equipment.
Each bed space should include the following:








Five section, electric ICU beds should be provided
a ceiling-mounted twin-armed pendant to accommodate a range of equipment and for the provision
of medical gases and electrical and data connectivity;
enclosed storage for a small quantity of consumables; drugs storage (wall-mounted drugs cabinet or
within the patient’s bedside locker);
Project teams should select a curtain system that meets the following criteria:
Visual privacy must be achieved when the curtains are drawn;
Curtains should be fully retractable against the wall;
Density of the curtains should reduce the level of general noise transmitted and also improve the
level of auditory privacy,
Curtains should be easily movable. and removable
INTERVIEW ROOMS:
An interview/counseling room should be provided in each unit. The rooms should be in a quiet and private
location.
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Intensive care units [DISCUSSION DRAFT 1]
14
ISOLATION ROOMS/BARRIER NURSING:
Isolation rooms are used for patients with known infectious conditions that require full isolation or barrier
nursing to protect patients from infection. These rooms should have negative air pressure..
Single-bed cubicles are preferred with an entrance lobby for staff gowning up and down. Patients who require
barrier nursing or patients with Immuno-suppressed conditions should be nursed in positive air pressure.
Minimum area
-
20 m²
Minimum wall length of cubicle
1 bed per cubicle
-
5m
The space between the wall and the space at the bed-end should provide for at least 4,5m (600mm, at the bed
head for clinical access, 9,0mm for bed head circulation, 2m for the length of the bed and 1, 0 for bed end
circulation.
The bed space across should provide for a bilateral pendant with articulation of 2, 25m on both sides of the be
LOCATION AND RELATIONSHIPS
A specialist isolation unit will be provided at a Tertiary academic as per the operational narrative The unit will
be separate from other units, fitted with airlocks points of entry, negative air pressure and all equipment and
clinical interventions will be provided in this confined space.
SERVICES
 Hand wash basin with elbow taps and gooseneck outlets per unit with tiles above, mirror, soap
dispenser and paper towel dispenser Oxygen, medical gases, vacuum as indicated for ICU bed
 Air conditioning  Air pressure in each unit should have negative pressure for contagious patients and positive air
pressure for immune compromised patients where patient requires protection against the
environment.
 Where the isolation room is pressurised, an anteroom or airlock will be required for pressure
stabilisation.
CONSIDERATIONS (Most of these refer to specialised isolation unit)
 All surfaces must be impervious and designed for easy cleaning
 Glazed viewing panel to allow for patient observation into the room
 Single-bed rooms should be rectangular, not L-shaped, with an entrance wide enough to allow bulky
equipment to pass easily – at least a door and a half wide..
 The ventilation system should be designed to provide simultaneous source and protective isolation. A
balanced supply and extract ventilation to each isolation room the gowning lobby is, therefore,
proposed.
 The lobby, which functions as an airlock, requires a relatively high and balanced supply and extract air
change rate to be effective against airborne organisms moving between circulation areas and
isolation rooms.
 Ceilings and windows should be sealed. Doors should be tight-fitting, with seals to minimise air
transfer.
 Local temperature controls that are accessible to nursing staff and may require humidity within the
range 40–60% Rh, depending on the specialty.
 The precise number of isolation rooms will depend on the case mix of the critical care unit. For
example, units that routinely admit neutropenia haematology patients may require up to 50% of their
beds to be provided as isolation rooms with lobbies.
 No unit should, however, have less than 20% of their beds as isolation rooms.
INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT
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Intensive care units [DISCUSSION DRAFT 1]
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Figure 10: Design with en-suite ablutions for High care or isolation
PUBLIC SPACES
ICU access:
DESCRIPTION AND FUNCTION
A single entry is preferred to enable controlled access.
Waiting space for immediate family.
LOCATION AND RELATIONSHIPS
At the entrance to the facility
SERVICES
 The entrance for public access requires an intercom-controlled entry system or similar linked to the
reception desk and staff communication base(s).
 CCTV could be considered, with observation monitors at the reception desk and staff communication
base(s) to assist with identification of visitors out of visiting hours.
 .
CONSIDERATIONS
 Supply of consumables and supplies to the unit should be kept separate from the clinical functions.
 Where access control measures are in place, close-proximity cards rather than swipe cards or keypads
should be used, as they are easier to clean and offer better infection control.

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Intensive care units [DISCUSSION DRAFT 1]
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Visitors’ waiting area and associated facilities:
DESCRIPTION AND FUNCTION
On arrival, visitors will be admitted immediately to the appropriate clinical area or asked to wait in the waiting
area. There should be a door between the waiting area and clinical areas, controlled by staff, to prevent
visitors wandering into clinical areas. A seating ratio of one and a half to two seats per critical care bed is
recommended. A nominal size of 10m² or 0.5m² per able bodied person to use the facility and one m² per
wheelchair dependent person can be assumed.
LOCATION AND RELATIONSHIPS
The waiting area should be at the front of the unit but separate to the clinical areas. The area should be
located adjacent to the entrance to the unit and observable from the reception area. The Waiting are requires
direct access to the circulation corridor and ready access to public amenities.
SERVICES
Vending machine and WCs should be available nearby.
CONSIDERATIONS
A separate visitors waiting room may be of value for those spending prolonged periods of time within the
vicinity of the critical care unit.
Requirements could include:
 Child play area
 Disable friendly ablution
 Waste paper / refuse bins
Reception desk:
Reception of visitors and clinical staff to the unit will depend on the level of care and the policy of the facility.
In HC units a clerk assist at the nurses’ station . In ICU units a clerk could duplicate as a reception desk to
screen access to the unit.
DESCRIPTION AND FUNCTION
The nurses’ station is where visitors report to the unit. A unit clerk will receive visitors and direct them
appropriately
LOCATION AND RELATIONSHIPS
The nurses’ station should provide visual observation of the entrance area.
SERVICES
Telephone point and plugs for a computer and data points
CONSIDERATIONS
Counter top and worktop.
The desk should have natural surveillance of the visitors' entrance and/or point of entry to clinical areas.
CLINICAL SPACES
Nurses’ station
DESCRIPTION AND FUNCTION
In High care units the nurses’ station is the administrative base for the unit and provides the enquiry point for
patients and visitors. It provides for the coordination of patient care, observation, writing up of clinical notes,
entering of data into computers, making and receiving of phone calls. The station must accommodate for
nurses, a ward clerk and doctors work space.
In an ICU unit the nurse’s station space is limited in that it has to accommodate observation technology in
computers, screens and technical equipment. There are also more staff who utilise this facility therefore the
INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT
Health Facility Guides: 05 June 2012
Intensive care units [DISCUSSION DRAFT 1]
17
worktop space should be increased. The size of the space must allow for the devices and the equipment as
well as the administrative functions for the unit.

Space for blood gas analysing machine, three resuscitation trolleys, two drug cupboards, medication
fridge next to workstation

TEG machines to analyse blood – These equipment (also see bullet 8 for blood gas analyzer) is
normally placed in front of the nurses’ station to ensure quick staff access.

Other devices that also need to be placed here is the emergency trolley and defibrillator fitted
with a power outlet. A stainless steel wash hand basin is normally part of the setup

very efficient and more reliable than lab. Sits on a counter top
LOCATION AND RELATIONSHIPS
At least one nurses’ station within each patient 8 bed unit, central to bed units to allow for full observation of
all patients at all times. The nurses’ station must be within the bed unit with direct access to the patients.
Ideally, staff at the base(s) should be able to see all multi-bed spaces under their control and the entry point to
clinical areas. Control of the visitors' entry system will be transferred from the reception desk to the
communication base(s) at night.
ACTIVITIES
 Clinical management and control of the unit
 Making and receiving phone calls
 Writing clinical and administrative reports
 Access and print data from computer
 Recording patient information in patient file and filing printed reports
 Manage nurse call system
 Monitor service alarms (e.g. fire alarm system)
 Updating patient bed allocation board
 Manage key cupboard
 Doctor / staff will be accommodated in a clinical administration room
SERVICES
 Alarms to signify the failure of medical gas and power outlets within the bed spaces
 Fire and smoke alarm systems
 Central stations or consoles for multi-parameter patient monitoring equipment.
 4 x telephone points for internal and external calls will be required.
 Task lighting should be provided for use at night to prevent disturbing patients
 Data points : 1 point for 2 to 3 beds within the Unit (6-bed unit 2,for an 8 bed unit 4 will be
required for the staff to manage patient data, lab reports, digital x-rays, pharmaceuticals,
 For HC patients where data is not managed at the bed side. Data points at the nurses’ station
should be provided.,
 Hands free wash hand basin,
 Nurse call system,
 Power outlets for 3 computer points, 3 central monitors, fax, printer and blood gas machine.
 Power outlet for digital X-ray monitor
 Digital radiography units with viewing panel
 Emergency and UPS power
 Power outlets may be colour coded but the outlets must not differ from each other (e.g. half
round earth, triangular earth, etc.) There is no time to change the equipment plugs when
power source change
INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT
Health Facility Guides: 05 June 2012
Intensive care units [DISCUSSION DRAFT 1]
18
Malawi Drawing Magda
DESIGN CONSIDERATIONS
 Large counter facing patients with a view of the entrance,
 Maximum view of patient rooms and other areas
 Work area for doctors and nurses to fill in forms and make notes
 Work area for the ward clerk, as discussed
 Direct vision of all beds from nurses’ station or corridor
 Wall mounted wipe board and pin board
 Engraved, wall mounted aluminium ward diagram indicating fire exits
 Workstation for computers, printer, fax machine, photocopier and telephone
 Work surface and space for filing, shelves to accommodate files and stationery with drawers and
cupboards
 Each base should be partially enclosed to control noise transfer.
 Shelving, file cabinets and other storage for medical record, forms etc. must be located so that they
are readily accessible
 Wall clock (clearly visible from all beds – increase number as required)

Space for emergency equipment: resuscitation trolley, extra oxygen cylinders, etc.
 Need a picture

Computerized patient charting is becoming increasingly popular in ICUs. 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.

Data points must be positioned on the pendants to facilitate patient management by permitting
nurses and physicians to remain at the bedside during the charting process. To minimize errors,
monitored data can be recorded automatically The requirements should be included in IT plan
from start and ensure it is requested with the pendants

Access to medical gas shut-off valves must be in visual control and within easy reach of the nursing
staff
Record of nurse calls reaction.
Examination lights that are dimmable


CLINICAL SUPPORT SPACES
STANDARD ROOMS: Refer to the standard dictionary of rooms. Doc.No…?.

Cleaners room

Clean utility

Dirty utility

IT room

Interview room

Ward kitchenette

Sluice room
INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT
Health Facility Guides: 05 June 2012
Intensive care units [DISCUSSION DRAFT 1]
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
Stores:
o
Linen
o
Equipment (Require a larger space as well as additional power outlets)
o
Medicine
o
Consumables
o
Surgical and sterile
o
Kit room
NON-STANDARD ROOMS:
Laboratory:
DESCRIPTION
An ICU should have a small 24hour laboratory service to provide first line minimum chemistry and
haematology testing, including arterial blood gas analysis. In Tertiary & Central it is common that
microscopes and centrifuges are used
All equipment in Regional hospitals can be placed inside the ICU
LOCATION AND RELATIONSHIPS
The laboratory needs to be located away from the patient and visitors areas, close to the staff facilities and
directly off the main ward corridor.
SERVICES
 1 x telephone,
 Data points,
 Hands free wash hand basin,
 Power outlets for 1 computer points, 1x blood gas machine, 2 x additional plug points
 Stainless steel side with draining board
 Large worktop area with cupboards below and above,
 Good lighting
Clinical equipment decontamination room or bed/trolley wash (optional)
DESCRIPTION
Area is utilized to wash down beds and trolleys.
This may include the cleaning of clinical equipment which should be cleaned following use prior to transfer to
the clinical equipment store(s) or, if the equipment requires maintenance, to the equipment servicing room. A
clinical equipment decontamination room should be provided for this purpose. This room should be adjacent
to the clinical equipment store(s).
SERVICES
 High pressure hose
 Floor drainage
 Stainless steel sink
CONSIDERATIONS
 Easily accessible (beds)
 Space to dry beds/trolleys
 Space for mattress
INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT
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Intensive care units [DISCUSSION DRAFT 1]
20


Worktop
shelves
ADDITIONAL REQUIREMENTS:
Ice Making Machine Bay
An industrial ice-making machine should be provided to facilitate hypothermic interventions at teriary and
central hospitals. It should be located in a designated bay.
Clinical Equipment Store(S)
The size of the room will be influenced by levels of care and the bed in the unit as defined by the LOC,
The size will be influenced by levels of care and the unit size (beds) as only certain devices will be allowed
for Regional, Tertiary and Central. Also see comment below A dedicated area should be provided for the
storage and charging of transfer equipment (transport trolley, monitors, syringes, ventilators, suction pumps).
Approximately 32 power outlets should be provided for charging equipment.
Dedicated ventilation may be required to remove gases and heat from chargers. An area for hanging
endoscopes and trans-oesophageal echocardiography probes is also required. The clinical equipment store(s)
should be within easy access of the bed areas.
Imaging Equipment Bay
An open bay should be provided close to the clinical equipment store(s) for the storage of imaging equipment
with hanging space for protective lead aprons. Lead aprons should be stored vertically to maintain their
protective capability. An electrical socket-outlet should be provided for charging equipment.
Suitable wall brackets attached to a load-bearing wall, or mobile stands, are required for this purpose. The bay
should also accommodate a mobile X-ray machine, a minimum of one ultrasound machine, and a trans
oesophageal echocardiography machine. A larger bay is required if mobile image intensifiers are used.
Regulations pertaining to the use of ionising radiation must be complied with.
Resuscitation Trolley Bays and Warming units
It is essential that adequate provision is made for placing resuscitation trolleys within the critical care unit. The
precise equipment positioned on these trolleys should be determined locally.
Space should be provided for liquid warming units: one within the Unit and another in the Clean Utility
Blood Refrigerator Bay (Optional)
A blood refrigerator will only be required if a blood store is not available nearby. If provided, the fridge should
be located in a designated bay and should be networked to the central system to permit traceability of blood.
Clinical Equipment Service Room (Optional)
Facilities are required for equipment servicing as defined in equipment manufacturers’ user manuals,
supplemented by any formally agreed local instructions. A dedicated room should be provided in the critical
care unit for this purpose if an existing biomedical engineering workshop is not located nearby.
When provided as part of the critical care unit, this room should be adjacent to the clinical equipment
decontamination room.
INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT
Health Facility Guides: 05 June 2012
Intensive care units [DISCUSSION DRAFT 1]
21
STAFF SPACES
STANDARD ROOMS: refer to standard dictionary of rooms Doc No….?

Doctors office (Optional)

Unit managers office

Staff room

Staff toilet

Staff change room

Doctors sleep over facilities
ADDITIONAL ADMINISTRATIVE ACCOMMODATION REQUIREMENTS:
Admin areas:
The following staff may require access to a workstation, but these may be provided in an open-plan office
environment:
 clinical staff (doctors, nurses, allied health professions);
 outreach staff;
 audit clerk;
 technician;
 secretarial staff;
 research staff.
Workstations for clinical staff should provide quick and easy access to the patient bed areas in case of an
emergency.
Seminar room:
A seminar room that could double up as a meeting/training room should be provided within the vicinity of the
critical care unit. The room should be equipped with data projector and screen. Provide a WHB and sink. An
intercom system should be installed between the seminar room and the clinical areas to recall staff in an
emergency. The room may double up as a skills laboratory, for example for training in resuscitation, using
manikins, defibrillators, and simulated body parts for venepuncture or suture practice. A learning devices store
is required off the
Staff change/ locker room:
Space is required within the changing areas for the storage and disposal of scrub suits and footwear.
INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT
Health Facility Guides: 05 June 2012
Intensive care units [DISCUSSION DRAFT 1]
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PART C – Accommodation schedules COULD WE DISCUSS ?
PATIENT AREA
ROOM
6 Bed Unit
Interview/Counseling
Isolation Units
En suite
Patient Toilet
STAFF AREAS
Office: Doctor’s Office
Office : Nursing Manager
Staff room
Staff change
Staff toilet
Staff/student training (optional)
Nurse’s Station
Doctors sleep over facility
PUBLIC AREAS
Entrance
Reception
Public waiting area
Disabled/Public Toilet
SUPPORT AREAS
Blood Fridge area
Bay – Mobile Equipment
Bay – Resuscitation Trolley
Bay - Ice machine
Bed and trolley wash
Cleaners Room
Clean Utility
Dirty Utility- Waste Disposal
IT switch room
Laboratory
Sluice
Store room - medicine
Store room – Clean linen
Store - Equipment
Store – Consumables
Store – Patient Kit
Store – Surgical Packs
Ward Kitchen
Standard
Component
Non Standard
Component
x
x
x
varies
1
varies
Area Each
m²
150
9
16
x
x
varies
varies
5
4
x
x
x
x
x
x
x
1
1
1
1
varies
1
1 or 2
varies
9
9
varies
varies
3
25
varies
12
x
x
x
x
1
1
1
1
5
6
varies
4
x
x
x
1
1
varies
1
varies
1
1
1
1
1
1
1
1
1
1
1
1
1
4
6
4
1
9
4
12
6
8
6
9
4
9
20
9
6
10
7
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
Quantity
INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT
Health Facility Guides: 1 February 2012
Adult inpatient accommodation [DISCUSSION DRAFT 2]
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PART D – Room data
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Adult inpatient accommodation [DISCUSSION DRAFT 2]
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LIST OF ABBREVIATIONS
ENT
Ear nose and throat
HIG
Hospital Infrastructure Grant
HRG
Hospital Revitalisation Grant
IUSS
Infrastructure Unit Systems Support
NDoH
National Department of Health
OoM
Order of Magnitude
PMIS
Project Management Information System
PMSU
Project Management Support Unit
RC
Recommendation Committee
ICU
Intensive Care Unit
INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT
Health Facility Guides: 1 February 2012
Adult inpatient accommodation [DISCUSSION DRAFT 2]
25