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, and sliding doors are preferred over swinging doors to save space, allow for easier movement of medical equipment and beds, and to be operated more efficiently during emergencies. The doors should be wide enough (typically 1.2-1.5 meters) to accommodate hospital beds, equipment, and multiple staff members moving simultaneously 1. For infection control purposes, automatic sliding doors with motion sensors are ideal as they minimize touch points and reduce cross-contamination 1.

Key Considerations for ICU Doors

• The doors should have visibility panels at appropriate heights to allow staff to observe patients without entering the room, while still maintaining patient privacy 1.
• In isolation rooms, doors should maintain proper pressure differentials (positive or negative pressure depending on the isolation requirements) and should close automatically to maintain these pressure gradients 1.
• Door materials should be smooth, non-porous, and easily cleanable to meet infection control standards 1.
• Additionally, doors should be equipped with emergency override mechanisms that allow them to be opened manually in case of power failures or other emergencies 1.

Fire Safety and Emergency Evacuation

• ICUs should be designed with multiple exit points, and small fire-rated bays (ideally for no more than six patients) or side rooms to assist with smoke control and help prevent the spread of fire 1.
• Sufficient ventilation should be ensured to prevent oxygen enrichment of the ambient atmosphere when high-flow nasal oxygen, facemask continuous positive airway pressure, and non-invasive ventilation are used 1.
• Consideration should be given to ground floor location for ICUs, and easy interconnecting routes between ICU and operating theatres to make evacuation easier 1.

Design and Refurbishment of ICUs

• When designing or refurbishing a new ICU, factors such as well-marked fire manual call points, fire extinguishers, and oxygen shut-off valves should be prioritized 1.
• The location of area valve service units that allows individual areas or zones of the ICU affected by a fire to be isolated without necessarily shutting off the oxygen supply to the whole ICU should be considered 1.
• Multiple exit routes, ideally each department should have three separate exits, with two of the three exits allowing for horizontal evacuation, should be included in the design 1.

From the Research

International Recommendations for Intensive Care Unit Design

The design of intensive care units (ICUs) is crucial for patient safety and quality of care. When it comes to the question of whether every room in an ICU should open or use a door, there are several international recommendations to consider:

• The use of single-occupancy, acuity-scalable ICU rooms is recommended to reduce the risk of healthcare-associated 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.
• A multidisciplinary approach, including infection prevention committees, antimicrobial stewardship programs, and continuing staff education programs, is essential to limit the incidence of ICU-acquired infections 3, 4.

Considerations for ICU Room Design

When designing ICU rooms, several factors should be taken into account:

• Privacy, welfare, and comfort of patients and families should be improved by redesigning the ICU and its organization 5.
• Environmental aspects of hand hygiene, such as water risks, sink design/location, human waste management, surface selection, and cleaning, should be considered 2.
• The use of antimicrobial-treated or similar materials, ultraviolet germicidal irradiation, and specialized rooms (airborne infection isolation and protective environments) may be beneficial in reducing the risk of healthcare-associated infections 2.

Importance of Infection Control in ICUs

Infection control is a critical aspect of ICU care, and aggressive measures must be implemented and enforced to limit the incidence of ICU-acquired infections:

• ICU-acquired infections have significant economic, clinical, and social expenses to patients and hospitals 3, 4.
• A multifaceted approach, including infection prevention committees, antimicrobial stewardship programs, daily reassessments-intervention bundles, and continuing staff education programs, is essential to control ICU infections 3, 4.