From the Guidelines
International guidelines recommend controlled access to Intensive Care Units (ICUs) through a geographically distinct entity in the hospital with controlled access, avoiding through-traffic of patients and provisioning not intended for the ICU. This approach is supported by the study published in Intensive Care Medicine in 2011 1, which emphasizes the importance of a structured layout to allow rapid access from key departments such as the emergency department, operating theaters, and medical imaging department.
The recommended layout should include:
- Designated entry points with controlled access
- Separation of public and visitor traffic from professional and supply traffic
- Horizontal connections with key departments
- Centrally located keyed oversized elevator for patient transport
- Fast and easy connections with support services such as blood transfusion, pharmacy, and laboratory services
The unit should have a total area of roughly 2.5–3 times the total area devoted to patient care, allowing for efficient clinical workflow and a therapeutic environment. The study published in 2011 1 provides the most recent and highest quality evidence on this topic, and its recommendations should be prioritized in clinical practice.
In terms of visitor management, while there is no direct evidence from the provided studies, a structured visitation policy that balances patient care, infection control, and family needs is essential. This may include set visiting hours, limiting visitors, and requiring hand hygiene, but the primary focus should be on maintaining a controlled access environment to prevent healthcare-associated infections and protect patient privacy.
Overall, the key principle is to maintain a controlled access environment that balances patient care, infection control, and family needs, while ensuring efficient clinical workflow and a therapeutic environment.
From the Research
Controlled Access to Intensive Care Unit
- The international guidelines and associations recommend a controlled access to the Intensive Care Unit (ICU) to prevent infection transmission to patients 2, 3, 4, 5.
- A study published in 2011 found that open visitation in the ICU setting positively impacts patient outcomes, but many ICUs continue to strictly limit visitation hours due to concerns about infection prevention and control 2.
- However, another study published in 2014 found that a multifaceted approach, including infection prevention committees, antimicrobial stewardship programs, and continuing staff education programs, is essential to limit the incidence of ICU-acquired infections 3.
- A review of the literature published in 2014 found that there is a wide variability in open visiting policies in ICUs internationally, with the highest percentage of open ICUs reported in Sweden (70%) and the lowest rate in Italy (1%) 4.
- The review also found that patients, visitors, and staff seem to be inclined to support open ICU programs, although physicians are more inclined to the enhancement of visiting hours than nurses 4.
- A study published in 2022 developed consensus statements on infection control for SARS-CoV-2 in an ICU using a Delphi process, including guidance on visiting policy, personal protective equipment, and disinfection 5.
- Another study published in 2020 found that healthcare workers reported widespread shortages, frequent reuse of, and adverse effects related to personal protective equipment (PPE) when caring for COVID-19 patients in the ICU 6.
Recommendations for Controlled Access
- The guidelines recommend a controlled access to the ICU, with visiting hours policies and number of allowed relatives variable, from limits of short precise segments to 24 hours and usually 2 visitors 4.
- The guidelines also recommend that visitors should wash their hands to prevent the risk of infection transmission to patients 4.
- The use of personal protective equipment (PPE) is also recommended for healthcare workers when caring for patients in the ICU 5, 6.