What are the international recommendations for intensive care unit (ICU) room door usage?

From the Guidelines

Every room in an intensive care unit should have a door that opens outward into the corridor rather than inward into the patient room, with a width of at least 1.2-1.5 meters to accommodate hospital beds, equipment, and multiple staff members moving simultaneously. This design prevents doors from obstructing critical care activities during emergencies when staff need rapid access to the patient. The doors should have minimal gaps, be made of materials that can be easily cleaned and disinfected, and some units may require automatic or hands-free opening mechanisms 1. In isolation rooms, doors should remain closed except during entry and exit, and may need to maintain specific pressure differentials (positive or negative pressure depending on the isolation requirements) 1. Many modern ICUs also incorporate glass doors or windows within doors to allow visual monitoring of patients while maintaining noise control and privacy.

Some key considerations for ICU door design include:

• Wide enough to accommodate hospital beds, equipment, and multiple staff members moving simultaneously
• Made of materials that can be easily cleaned and disinfected
• Minimal gaps to prevent the spread of infection
• Automatic or hands-free opening mechanisms may be required in some units
• Glass doors or windows within doors to allow visual monitoring of patients while maintaining noise control and privacy
• Doors in isolation rooms should remain closed except during entry and exit, and may need to maintain specific pressure differentials (positive or negative pressure depending on the isolation requirements)

The most recent and highest quality study on this topic is from 2021, which emphasizes the importance of fire safety and emergency evacuation guidelines for intensive care units and operating theatres 1. However, the study from 2020 provides more specific guidance on ICU door design and infection control measures 1. Therefore, the recommendation is based on the study from 2020, which is the most relevant and recent study on this topic.

From the Research

International Recommendations for Intensive Care Unit Design

The design of intensive care units (ICUs) is crucial in preventing healthcare-associated infections and ensuring patient safety. According to various studies, the following recommendations can be made:

• Single-occupancy, acuity-scalable ICU rooms are preferred to reduce the risk of healthcare-associated infections 2
• Environmental aspects of hand hygiene, such as water risks, sink design/location, human waste management, surface selection, and cleaning, should be considered in ICU design 2
• The use of antimicrobial-treated materials, ultraviolet germicidal irradiation, and specialized rooms (airborne infection isolation and protective environments) can help reduce the risk of infections 2
• Effective design and operational use of the ICU environment of care must engage critical care personnel from initial planning and design through occupancy of the new/renovated ICU as part of the infection control risk assessment team 2

Door and Room Design Considerations

While there is no direct evidence on whether every room in an ICU should open or use a door, the studies suggest that:

• Privacy and control of space and territory are essential factors in stimulating recovery processes and promoting well-being in ICU patients 3
• The concept of "at-homeness" in ICUs is strongly related to privacy and control of space and territory, which can be achieved through single-occupancy rooms or private areas within multi-occupancy rooms 3
• The design of ICU rooms should consider the patient's perspective and philosophical underpinnings that support optimal design, including aspects such as natural light, noise reduction, and comfortable temperatures 3

Infection Control Measures

In addition to design considerations, infection control measures are crucial in preventing healthcare-associated infections in ICUs. These measures include:

• Aggressive infection control measures, such as infection prevention committees, antimicrobial stewardship programs, daily reassessments-intervention bundles, identifying and minimizing risk factors, and continuing staff education programs 4, 5
• Hand hygiene, environmental cleaning, and appropriate hospital staffing can impact ICU infection rates 5
• Implementing guidelines established by national committees and continuing staff education can help decrease infections such as catheter-related bloodstream infections, urinary tract infections, ventilator-associated pneumonia, and Clostridium difficile 5