The floor plan of an ICU allocates areas for patients, staff, visitors, storage, and services. In addition to patient bed areas (see below), two to three times more space is required to support the operations of an ICU. The advantages of an open-ward design compared with multiple single rooms are debatable. Single rooms offer isolation facilities and more privacy but demand more nursing staff; a patient will be left unattended if the nurse leaves the room for whatever reason. There is no evidence that either design has a lower nosocomial infection rate than the other ( Huebner.etal 1989). In practical terms, the debate is largely irrelevant. An open-ward ICU still requires some single rooms (at least 20 per cent of its total beds) for patients who need isolation or extra privacy. An ICU made up entirely of single-room beds will require a high nursing staff level to care for critically ill patients and will be less cost-effective. Thus the ICU design should incorporate open-ward bays (of two to eight beds) as well as single rooms in a ratio appropriate to the defined role and function of the unit. Open-ward bays may be clustered.
Traffic flow patterns should be considered in the floor plan. Traffic patterns should facilitate patient transport and restocking of bedside supplies, alleviate nurse fatigue from moving between the bed and store rooms, and enable rapid staff access in emergencies. Corners and doors must not impede trolley movements. Through traffic to other departments should not be permitted. Access into the ICU should be controlled by siting the reception area at the entry. A separate access for the ICU staff and a service corridor for moving goods and equipment may be desirable if space permits. Of course, the floor plan must conform to local safety regulations such as those pertaining to fire (e.g. fire doors and emergency exits).
The ICU should be located close to the accident and emergency department, operating rooms, acute wards, and radiological and imaging services. If a single-discipline ICU is planned, it is best located adjacent or close to other ICUs to enable sharing of facilities such as a common laboratory.
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