ICU Design: BasicsThe requirement of ICU beds has increased from the traditional 1-4 beds per 100 hospital beds to 10-0 per cent of the total hospital bedsThe old concept of identifying ICU as just a separate area with high-tech gadgets no longer holds true. One should take cognizance of the recent developments and the various recommendations y odies like the !ociety of Critical Care "edicine #!CC"$% Indian !ocietyof Critical Care "edicine #I!CC"$ and the pulished literature on the suject. &n important dimension is the concerns of the patients and their families% who often complain aout overwhelming feelings of insecurity% disorientation% an'iety% fear and anger. The sheer volume of technology% the unfamiliar% sterile surroundings% lack of privacy% constantly revolving medical teams% incessant noise and glaring light% and the lack of natural forms% materials% and sensory e'periences all add to this traumatic e'perience. &s a result% the patients feel trapped in an environment they dislike and cannot control% and their families feel helpless. Comfort: Top !riorit"The focus% therefore% is on ICU designs that provide comfort topatients% reduce hospital ac(uired infections and cost of ICU stay.On one hand the severity of the interventions re(uires the utmostin technology% methodology and sterility% while on the other hand%the patients and their families who are e'periencing some of themost traumatic moments of their lives need a natural feel andlook environment that is comforting and de-stressing. There is also increasing awareness aout (uality in healthcare and institutions are keen to comply with the standards laid down y agencies like the )oint Commission on &ccreditation of *ealthcare organisations #)C&*O$% )oint Commission International #)CI$% +ational ,ire -revention &ssociation #+,-&$% +ational &ccreditation .oard for *ealthcare Organisations #+&.*$% for upgrading their facilities to promote safety as well as usiness. These organisations have developed minimum standards for healthcare institutions independently and although these standards y these non-!tate agencies are technically considered non-inding% many governmental and private reimursement organisations re(uire compliance with them to (ualify for reimursement. &s a result% more and more hospitals in India are opting voluntarily for accreditation y these agencies.!rime #actorsThe various factors that need to e considered while designing an ICU are sources of patients% admission and discharge criteria% e'pected rate of occupancy% economic investment% financial viaility% personnel re(uired as well as the technological resources. One has to also consider the level of ICU care re(uired. /evel I provide monitoring% oservation andshort term ventilation. /evel II provides oservation% monitoring and long term ventilation with resident doctors. /evel III provides all aspects of intensive care including invasive hemodynamic monitoring and dialysis. 0& direct elevator is an e'cellent ideato transfer sick patients to and fro from the ICU% reducing transport time and avoiding the visitors0 - Dr $a%esh !andeChairman1epartment of Criticalcare and 2mergency"edicine./3 "emorial *ospital+ew 1elhiThe TeamThe designing team should consist of an ICU specialist% nursing administrators and supervisors% hospital administrators% architect% engineers% environmental engineers% interior designers with considerale input from patients and their families. ICU floor plan should e ased on patient admission pattern% staff and visitor traffic pattern. It should e centrally located close to the operation theatres% *1Us% Imaging and the 2mergency 1epartments. !ome hospitals have amalgated the 24 triage with the ICU% so-called shock las% increasing the preparedness and eliminating the duplication of resources and manpower. .ut to achievethese oth facilities should e located on the same floor. &n Ideal ICUThere should not e any thorough traffic to other departments from the ICU. It is a good idea to separate the supply and professional traffic from pulic5 visitor traffic. & direct elevator is an e'cellent idea to transfer sick patients to and fro from the ICU% reducing transport time and avoiding the visitors. The patient transport corridors should e separate than those used y the visiting pulic. -atient privacy should e preserved and transportation should e rapid and unostructed. The elevators should e oversized keyed elevators% separate from pulic access. The support facilities should include nursing stations%storage% clerical space% administrative and educational re(uirements% and other services uni(ue to the institution. Call for a ChangeThe re(uirement of ICU eds has increased from the traditional 6-7 eds per 688 hospital eds to 68-98 per cent of the total hospital eds% ut this depends on the type as well as onthe role of an ICU. ICUs with less than four eds are not seen as cost-effective and from a functional point of view :-69 eds per unit is est% if a large ICU is planned. ICU should have positive and negative pressure isolation rooms within the unit. 2ach ICU should e a geographically distinct area with controlled access. 4egarding the suspecialty ICUs% it;s for the Institution to decide whether to organise its ICU into multiple units% e.g.% medical and surgical ICUs etc. under separate management or to make a general multidisciplinary ICU managed y the Intensive care specialists.'inimum $equirements2ach patient ed area in an adult ICU re(uires a minimum floor space of 98 m9 #96< ft9$% with single rooms eing larger #= 9? for multidisciplinary ICUs% though it also depends on the role and type of the ICU. Utilities per ed space as recommended are> @ o'ygen% 9 air% @ suction% 6? power outlets% and an ade(uate appropriate edside light. &ll eds should have uninterrupted supply and attery ackup to run life saving e(uipment. Centrally supplied o'ygen and compressed air must e provided at atient room design and bed number2 The patient room is the most fundamental wor-ing module of a critical care unit. The current sample of intensive care environments dates bac- almost two decades. )t that time, the trend of private patient rooms appeared to be rapidly becoming the norm. This is further supported by the fact that no double occupancy rooms were noted in any of the adult units surveyed.This study finds unit si.e of adult $C%s varying between '2 and 40 patient beds, with the averagenumber being 24 and the number of beds occurring most fre3uently being 20. This is higher than the ; to'2 bed target recommended by the SCC /uidelines for $ntensive Care %nit 0esign