From the Guidelines
Controlled access to Intensive Care Units (ICUs) for non-unit healthcare providers and administrative personnel should implement a tiered authorization system with electronic badge access, visitor logs, and time-limited permissions, as recommended by intensive care societies around the world 1. The ICU should be a geographically distinct entity in the hospital with controlled access, avoiding through-traffic of patients and provisioning not intended for the ICU, as stated in the recommendations on basic requirements for intensive care units 1. Key aspects of controlled access include:
- Restricting ICU access to essential personnel only, with non-unit healthcare providers requiring specific clinical justification for entry and administrative staff limited to necessary operational functions
- Implementing electronic access control systems that track entry/exit, mandatory identification badges displayed at all times, and regular auditing of access logs
- Establishing fast and easy connections with necessary services, such as blood transfusion, pharmacy, technical support, laboratory, and physiotherapy services, while maintaining controlled access 1
- Ensuring lines of communication are available on a round-the-clock basis, while limiting traffic in ICUs to create a more controlled healing environment for vulnerable patients The rationale for restricted access stems from evidence showing reduced healthcare-associated infections, decreased interruptions to critical care delivery, enhanced patient privacy, and improved security of medications and equipment, ultimately prioritizing morbidity, mortality, and quality of life outcomes.
From the Research
Controlled Access in Intensive Care Units
To implement controlled access in Intensive Care Units (ICUs) for healthcare providers who do not belong to the unit and administrative personnel, several guidelines and recommendations from intensive care societies around the world can be considered.
- Restrictive Access: Limit access to authorized personnel only, to minimize the risk of hospital-acquired infections (HAIs) 2, 3.
- Screening and Education: Screen all visitors and personnel for infectious diseases and provide education on infection control measures, such as hand hygiene and personal protective equipment (PPE) use 4, 5.
- Surveillance Program: Implement a surveillance program to monitor HAIs and track compliance with infection control measures 4, 6.
- Antibiotic Stewardship: Implement an antibiotic stewardship program to reduce the risk of antibiotic-resistant infections 2, 4.
- Personal Protective Equipment: Ensure that all personnel wear appropriate PPE, such as masks, gloves, and gowns, when interacting with patients or entering patient rooms 5.
- Hand Hygiene: Enforce strict hand hygiene policies, including the use of alcohol-based hand sanitizers and soap and water 3, 4.
- Environmental Cleaning: Ensure that the ICU environment is cleaned and disinfected regularly, including all surfaces, equipment, and patient rooms 3, 6.
Implementation and Enforcement
To ensure the effective implementation and enforcement of these measures, ICUs can:
- Develop Policies and Procedures: Develop and implement policies and procedures for controlled access, screening, education, surveillance, and infection control 2, 3.
- Train Personnel: Provide regular training and education to all personnel on infection control measures and policies 4, 5.
- Monitor Compliance: Monitor compliance with infection control measures and policies, and take corrective action when necessary 4, 6.
- Continuously Evaluate and Improve: Continuously evaluate and improve infection control measures and policies to ensure that they are effective and up-to-date 2, 3.