What should be the ideal design and layout of an Intensive Care Unit (ICU)?

Optimal ICU Design and Layout

Single-patient rooms of at least 25 m² are strongly recommended as the foundation of modern ICU design to minimize cross-contamination, reduce patient stress, and improve long-term outcomes, with the total ICU area being approximately 2.5-3 times the patient care area. 1

Planning Team Requirements

The planning phase must involve a multidisciplinary team that includes:

• ICU director and medical staff representative 1
• Head nurse 1
• Architect and engineer 1
• Hospital management representative 1
• Safety officer and infection control specialist 1
• Representatives from referring medical/surgical departments 1
• Patient association representative (strongly considered) 1

This comprehensive team composition is crucial for successful planning and implementation. 1

Geographic Location and Access

Strategic Positioning

The ICU should be a geographically distinct entity with controlled access, ideally on the ground floor with horizontal connections to operating theaters and the emergency department. 1 If ground floor location is impractical, evacuation lifts with dual electrical supply must be provided. 1

Critical Adjacencies Requiring Rapid Access

The layout must allow immediate access to:

• Emergency department 1
• Operating theaters and postoperative areas 1
• Medical imaging department 1
• Functional testing facilities (catheterization, endoscopy) 1

Essential Service Connections

Fast connections on a 24-hour basis must be established with:

• Blood transfusion service 1
• Pharmacy and pharmacology services 1
• Technical support services 1
• Laboratory and microbiology service 1
• Physiotherapy service 1

A centrally located, keyed, oversized elevator with ICU priority ensures connection with referring and diagnostic departments. 1

Traffic Flow and Separation

Public and visitor traffic must be completely separated from professional and supply traffic. 1 Through-traffic of patients and provisioning not intended for the ICU should be avoided. 1 Transport of patients to and from the ICU should ideally be separated from public corridors and visitor waiting areas. 1

Patient Room Specifications

Room Size and Configuration

• Minimum 25 m² for single rooms 1
• Minimum 20 m² per bed for common rooms (though single rooms are strongly preferred) 1
• Rectangular ground plan with at least 2.5-meter traffic area beyond the bed 1
• Doorways wide enough to accommodate beds with orthopedic traction, ECMO equipment, and cot sides 1
• Door widths must allow bariatric beds to pass through without adjustment 1

Rationale for Single Rooms

Single rooms are strongly recommended because they minimize cross-contamination, reduce patient stress from unrelated illness/noise/activities, and improve patients' long-term outcomes. 1 The design should prevent conscious patients from being distressed by acute problems (arrhythmia, alarms, cardioversion, resuscitation) of other patients. 1

Isolation Room Requirements

• 1-2 isolation rooms per 10 beds for general ICUs 1
• 5-6 isolation rooms per 10 beds for specialized units (burn units, transplantation, infection units) 1
• Negative pressure capability for airborne infection isolation 1
• Anteroom of at least 3 m² for hand washing, gowning, and isolation material storage 1
• Visible isolation instructions at entrance 1
• Separate circuit for contaminated material evacuation 1

Visual Observation and Natural Light

Patients must be visualized at all times through large window openings or glass doors, preferably by their own nurse rather than only from a central station. 1 Patients should be oriented so they can see the nurse but cannot see other patients. 1

All patient rooms must have a daylight source, with the bed positioned to allow direct view out of external windows. 1 External windows can only be opened with safety locks. 1

Fire Safety and Emergency Design Features

Critical Safety Elements

ICUs should be designed with small fire-rated bays (ideally no more than six patients) or side rooms, multiple exit points (ideally three separate exits with two allowing horizontal evacuation), and interconnecting routes with operating theaters to facilitate evacuation. 1

Additional safety features include:

• Smoke control systems and consideration for misting fire suppression systems 1
• Well-marked fire manual call points, fire extinguishers, and oxygen shut-off valves 1
• Area valve service units (AVSUs) positioned to isolate individual zones without shutting off oxygen to the entire ICU 1
• Low-level emergency lighting to assist with evacuations 1
• Alternative escape route and adjoining safe space to relocate patients, equipped with oxygen, compressed air, and electricity 1

Ventilation Requirements

ICUs must have ventilation systems ensuring >10 air changes per hour to prevent oxygen enrichment of ambient air, particularly important with high-flow nasal oxygen, CPAP, and non-invasive ventilation. 1

Central ICU Areas and Support Spaces

Essential Support Rooms

A clean utility room (15 m²) must be completely separate from the dirty utility room (25 m²) to prevent cross-contamination. 2 The clean utility room stores sterile materials and clean linen, while the dirty utility room handles soiled linen, waste, and dismantling used equipment. 2

Additional required spaces include:

• Laboratory space (15 m²) for point-of-care testing (blood gases, hemoglobin, glucose, lactate, electrolytes) 1
• Special procedures/therapy/admission room (at least 35 m²) with all bedside facilities, high-intensity lighting, and scrub-up sink 1
• Workshop (28 m²) for minor repairs and equipment testing 1
• Seminar/conference room (40 m²) for teaching and interdisciplinary discussion 1

Staff Areas

• Staff lounge (40 m² for eight ICU beds) with beverage bars, emergency code alarm, intercom, and telephone 1
• Staff changing rooms with lockable lockers, showers, and toilets 1
• Receptionist's office (10 m² for units >12 beds) strategically located for visitor identification 1
• Interview room (15 m²) for family conferences 1
• Kitchen (25 m²) for patient food preparation and staff snacks 1

Visitor Accommodations

• Reception area (10 m² per eight beds, providing 1.5-2 chairs/bed) 1
• Relatives' rooms (2 m² per eight beds with bed and shower) 1

Infrastructure and Environmental Specifications

Floor, Wall, and Ceiling Requirements

Seamless floor covering should be chemically resistant to antiseptics and sound-absorbing, maintaining <40 dB during daytime and <30 dB during nighttime. 1 Special care must be taken to avoid level differences, and flooring must allow heavy-wheeled equipment to move without difficulty. 1

Wall decoration and ceiling materials should be easy to clean, nonabsorbent, with low sound transmission and neutral colors. 1

Capacity Planning

The total ICU area should be roughly 2.5-3 times the total area devoted to patient care. 1 ICU beds should constitute approximately 5-10% of total hospital beds, with university/tertiary care hospitals targeting the higher end (up to 10%) and general hospitals maintaining around 5%. 3

Standards for architecture and staffing should be calculated for 100% capacity, but only 75% occupancy should be expected when calculated on an hourly basis. 3

Common Pitfalls to Avoid

Failing to account for surge capacity can lead to insufficient ICU capacity during mass casualty events or pandemics, when ICU capacity may need to expand 100-200% beyond conventional beds. 3 Central oxygen systems, emergency power capacity, and ventilator availability often become limiting factors before physical space. 3

Ceiling voids with removable ceiling tiles and electrical cabling should only be included if no other alternatives are possible, as they pose fire risks. 1

Construction specifications must anticipate heavy equipment use (mobile isotope cameras, mobile X-ray equipment, air beds) to prevent structural inadequacy. 1

Patient Room Core Design Principles

The patient room is the core of the ICU experience for patients, staff, and visitors, and should focus on functionality, ease of use, healing, safety, infection control, communications, and connectivity. 4, 5 Each patient room should be designed for single patient use and be similarly configured and equipped. 4, 5