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Duque, J.M. Quintillá, J.A. Varela, P. Garrido, Ó. Valencia, J.M. Maestre" "autores" => array:6 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Duque" ] 1 => array:2 [ "nombre" => "J.M." "apellidos" => "Quintillá" ] 2 => array:2 [ "nombre" => "J.A." "apellidos" => "Varela" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Garrido" ] 4 => array:2 [ "nombre" => "Ó." "apellidos" => "Valencia" ] 5 => array:2 [ "nombre" => "J.M." 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Barturen, D. Paz-Martín, P. Monedero, J. Cardona-Pereto, L. Fernández-Quero, J.C. Valía, R. Peyró, C. Sánchez" "autores" => array:8 [ 0 => array:2 [ "nombre" => "F." "apellidos" => "Barturen" ] 1 => array:4 [ "nombre" => "D." "apellidos" => "Paz-Martín" "email" => array:1 [ 0 => "danielpazmartin@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Monedero" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Cardona-Pereto" ] 4 => array:2 [ "nombre" => "L." "apellidos" => "Fernández-Quero" ] 5 => array:2 [ "nombre" => "J.C." "apellidos" => "Valía" ] 6 => array:2 [ "nombre" => "R." "apellidos" => "Peyró" ] 7 => array:2 [ "nombre" => "C." "apellidos" => "Sánchez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Comisión Ejecutiva de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estructura de las unidades de cuidados intensivos de anestesia: recomendaciones de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR)" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The anaesthesia intensive care unit (AICU) is a specific hospital area that is managed and organized by the anaesthesiology and critical care service. AICUs offer multidisciplinary care through a team of specialists, predominantly anaesthesiologists and critical care physicians. AICUs meet certain functional, structural and organizational requirements that guarantee high quality, effective care and ensure the safety of patients who need respiratory support, or who need basic respiratory support along with support for at least 2 organs or systems. They must also be able to treat all complex cases requiring supportive care due to multiple organ failure.<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Royal Decree 69/2015, of February 6, which regulates the Specialized Health Care Registry, defines intensive care units (ICU), among others, as units with a set number of beds in which patients are admitted by the hospital administration.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Several decades ago, Avedis Donabedian defined the quality of health care as a trilogy of structures, processes and outcomes.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">4</span></a> In hospitals, ICUs are one of the main focusses of care quality assessment strategies to determine, for example, the incidence of nosocomial infections.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The hospital environment affects the physiology, psychology and social behaviour of those who experience it.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">6</span></a> AICUs must be designed with 2 purposes in mind: creating a healing environment, and offering a pleasant environment for patients, staff, physicians, and visitors.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Articles 27–29 of Spain's Act 16/2003, on cohesion and quality of the National Health System, establishes the need for the Interterritorial Council of the National Health System to develop the safety and quality standards required by each autonomous communities in respect of opening and operating healthcare centres, services and establishments in their respective territories.<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In 2010, the Spanish Ministry of Health and Social Policy published the document “The Intensive care unit. Standards and recommendations”, which establishes the common, basic requirements for ICUs.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The design of future AICUs must take into account the burgeoning field of evidence-based design, which applies the results of scientific research to the construction of new health care spaces in order to create the best possible setting and improve clinical outcomes.<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">9,10</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The aim of this study, undertaken by the Intensive Care Section of the Spanish Society of Anaesthesiology, Critical Care and Pain Management (SCI-SEDAR), is two-fold: to establish new recommendations based on the standards published by the Ministry of Health and Social Policy and leading international guidelines for intensive care unit design,<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">11–13</span></a> and to develop a tool for improving quality and efficiency in the ICU. Our priority is to create a safe, friendly, humane environment for patients, their families, and medical personnel, and to draw up a quality control check list that can be used to renovate existing AICUs or to build new units.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">14</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0045" class="elsevierStylePara elsevierViewall">Three members of the SCI-SEDAR worked together in 2018 to define the methodology and recommendations, and to select the panel of experts.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Due to the limited evidence available for many of the recommendations put forward, and the considerable structural variability of existing AICUs, a modified Delphi approach was chosen to determine the degree of consensus. For this purpose, we used the Research ANd Development/University of California Los Angeles (RAND/UCLA) method, and rated items on a scale of 1–9.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">15</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">After each vote, the highest and lowest scores were discarded. A <span class="elsevierStyleItalic">strong consensus</span> was defined as a score or 7 or higher from all panel members. A <span class="elsevierStyleItalic">weak consensus</span> was defined as a score of less than 7 from 2 or more panel members.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Strong recommendations were considered finalized. Weak recommendations were subjected to a second round in which the comments of each panel member were evaluated and reassessed by calculating the percentage of experts who rated it 7 or more. This information is given after each weak recommendation.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">A total of 24 experts from 21 institutions were included in the panel (<a class="elsevierStyleCrossRef" href="#sec0325">Annex 1</a>). A total of 175 recommendations were established, divided into 8 sections; 129 reached a strong consensus and 46 reached a weak consensus. The recommendations included in each section, with their strength of consensus and their justification, are shown below.</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">General design of the AICU</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Location</span><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 1:</span> The AICU should be located in a clearly defined space near the surgical suite, the emergency department, and the diagnostic radiology suite. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0075" class="elsevierStylePara elsevierViewall">Justification: Strategic planning must be taken into account when choosing the location and connections, because although, ideally, all 3 services should be directly connected internally, this is not always possible; 1st surgical suite, 2nd emergency department, and 3rd, less important, the diagnostic radiology suite.</p><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 2:</span> When architectural barriers do not allow the AICU to be placed close to these areas, rapid, safe, and ample means of communication should be provided. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0085" class="elsevierStylePara elsevierViewall">Justification: The aforementioned units should be connected both horizontally, giving priority to proximity, and vertically, by means of large elevators reserved exclusively for the AICU, or to which the AICU has preferential access.</p><p id="par0090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 3:</span> The general layout of the AICU must include<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">11</span></a>:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0095" class="elsevierStylePara elsevierViewall">A patient care zone: consisting of patient rooms and adjacent areas; its primary function is direct patient care.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0100" class="elsevierStylePara elsevierViewall">A clinical support zone: consisting of functions closely related to the direct care of the patient.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0105" class="elsevierStylePara elsevierViewall">A general support zone: for administrative tasks, materials management, and staff support.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0110" class="elsevierStylePara elsevierViewall">A family support zone: an area where the needs of family members and visitors can be met.</p></li></ul></p><p id="par0115" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Strong consensus</span></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Layout</span><p id="par0120" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 4:</span> The general layout of the AIUC should separate staff and supplies pathways from more public transit areas, such as those used by visitors. <span class="elsevierStyleItalic">Weak consensus (75% consensus)</span></p><p id="par0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 5:</span> Patient circulation corridors must facilitate patient transfer, and have a minimum width of 2.5<span class="elsevierStyleHsp" style=""></span>m to allow passage of an intensive care bed, ventilation devices and haemodynamic support. <span class="elsevierStyleItalic">Strong consensus</span></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Size</span><p id="par0130" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 6:</span> The recommended surface area for the entire unit is 40–70<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> per bed. If this is not possible, general administrative and support zones could be placed outside the AICU. <span class="elsevierStyleItalic">Weak consensus (87% consensus)</span></p><p id="par0135" class="elsevierStylePara elsevierViewall">Justification: The introduction of new technology has made it necessary to increase the available surface area in terms of the space allocated to patients and to complementary facilities. Current guidelines recommend reserving up to 70<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> of ICU space per bed, including in this calculation the space needed for the 4 zones that make up the general structure of the ICU: patient care, clinical support, general support and family support.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">16</span></a> However, placing administrative and general support zones outside the AICU would reduce the surface area needed without compromising operability.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Patient care zone</span><p id="par0140" class="elsevierStylePara elsevierViewall">In the AICU, the experience of the patient, their visitors and healthcare staff revolves around the patient's room.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">17</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 7:</span> At lease 20–25<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> should be allocated per patient. <span class="elsevierStyleItalic">Weak consensus (87% consensus)</span></p><p id="par0150" class="elsevierStylePara elsevierViewall">Justification: In recent decades, patient room size has increased due to the introduction new clinical equipment and the general tendency to perform most procedures (diagnostic, therapeutic and documentation) in the patient's room. This means that the 12<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> required in the 90<span class="elsevierStyleHsp" style=""></span>s has increased to the 20–24<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> recommended by recent guidelines.</p><p id="par0155" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 8:</span> The AICU room should be as square as possible to allow easy access to any part of the bed. <span class="elsevierStyleItalic">Weak consensus (83% consensus)</span></p><p id="par0160" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 9:</span> The total number of ICU beds will depend on the type of hospital, its portfolio of services, and the population it serves. As a general guideline, it should have at least 10 beds per 100,00 inhabitants, and at least 5% of hospital beds. <span class="elsevierStyleItalic">Weak consensus (91% consensus)</span></p><p id="par0165" class="elsevierStylePara elsevierViewall">Justification: The availability of resources to care for critically ill patients varies significantly even among developed countries, with figures ranging from 3 ICU beds per 100,000 inhabitants in the United Kingdom, to more than 20 beds in Germany and the United States.<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">18</span></a> Although no specific recommendation can be established based on the available evidence, a figure between the extremes (3 and 20 beds per 100,000 inhabitants) would be reasonable. Data from the United Kingdom appear to indicate that a small number of ICU beds can be detrimental since, according to a recent analysis, the 35% increase achieved between 2000 and 2006 was accompanied by a significant decrease in hospital mortality.<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">19</span></a> In contrast, recent studies showed that in the United States almost half of terminally ill patients are admitted to the ICU; this goes against the end-of-life wishes of most of the population, and is not the initial aim of these units.<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">20</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">In any event, as hospitals become more specialized in the care of acute patients and transfer chronic patients to specific institutions, the proportion of ICU beds has been increasing with respect to the total number of hospital beds. In many hospitals, the proportion of ICU beds to hospital beds is now as high as 10%, although average figure is 5%.</p><p id="par0175" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 10:</span> The AICU should ideally contain between 8 and 12 beds. <span class="elsevierStyleItalic">Weak consensus (70% consensus)</span></p><p id="par0180" class="elsevierStylePara elsevierViewall">Justification: There is strong consensus on the number beds that each ICU should contain. Most authors recommend between 8 and 12 beds, alleging that smaller units are inefficient and larger units are excessively complex. For hospitals that require more than 8–12 ICU beds, it is best to build a second or third unit, each with 8–12 beds.</p><p id="par0185" class="elsevierStylePara elsevierViewall">An efficient unit is one that is small enough for care providers to control all the activities performed there, yet large enough to meet all care needs. Each unit must audit and evaluate its effectiveness and efficiency indicators.</p><p id="par0190" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 11:</span> Monitoring zones should be close enough to the entrance to each room to minimize staff travel. <span class="elsevierStyleItalic">Weak consensus (83% consensus)</span></p><p id="par0195" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 12:</span> The AICU room is subdivided into 3 zones:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">•</span><p id="par0200" class="elsevierStylePara elsevierViewall">Patient area.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">•</span><p id="par0205" class="elsevierStylePara elsevierViewall">Working area</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">•</span><p id="par0210" class="elsevierStylePara elsevierViewall">Area for family or visitors.</p></li></ul></p><p id="par0215" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Weak consensus (66% consensus)</span></p><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Patient area</span><p id="par0225" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 13:</span> Most patients rooms must be single-bed. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0230" class="elsevierStylePara elsevierViewall">Justification: Single-bed rooms improve the care of critical patients by giving them adequate privacy, reducing anxiety and the risk of delirium, and increasing patient satisfaction.<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">21</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">Early ICUs consisted of a single, open plan room with no separation between beds, or with flimsy curtains or screens. The aim was to maximize visibility and accessibility from the workstation, prioritizing rapid detection of emergencies and easy access of staff and equipment over other factors.</p><p id="par0240" class="elsevierStylePara elsevierViewall">By the end of the 70s, there was growing body of evidence to show that open plan ICUs led to higher rates of nosocomial infection. Based on this evidence, single-bed ICUs were designed to improve the care and privacy of critical patients. Patients were observed through glass panels fitted with Venitian blinds that could be raised or lowered as required.<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">22–24</span></a></p><p id="par0245" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 14:</span> If shared rooms are unavoidable, it is important to install elements of separation (e.g. screens or curtains) between the bed to ensure patient privacy. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0250" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 15:</span> To reduce the risk of infection, the screens must have smooth surfaces, and must be made of materials that can withstand frequent cleaning. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0255" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 16:</span> Each AICU room must be equipped with a specific ICU bed. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0260" class="elsevierStylePara elsevierViewall">Justification: The design of the ICU bed has improved over the years, with the incorporation of: (1) better mattresses that help prevent bedsores, (2) electronic controls to regulate height, headboard elevation, lateral tilting, allow anti-Trendelenburg and anti-shock positions, (3) monitors, and (4) a radiolucent base to facilitate X-rays.</p><p id="par0265" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 17:</span> Front and side glass partitions between rooms must be equipped with blinds or translucent glass strips at the level of the patient's bed to give privacy inside the room. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0270" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 18:</span> Rooms must receive natural light and have an outside view (see section “Environmental and technical characteristics of the ACIU” below). <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0275" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 19:</span> Each patient must have a calendar and a clock by their bed. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0280" class="elsevierStylePara elsevierViewall">Justification: Orientation in time is an important non-pharmacological measures for preventing delirium.</p><p id="par0285" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 20:</span> Patients should have a source of distraction, such as background music or television sets. <span class="elsevierStyleItalic">Weak consensus (58% consensus)</span></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Working area</span><p id="par0290" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 21:</span> Patient rooms should be similar in terms of design and equipment, whenever possible, to simplify staff travel between different rooms. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0295" class="elsevierStylePara elsevierViewall">Justification: Equipment and floor space should be arranged to allow fast, unobstructed access to the patient. Medical devices must be built into the room or incorporated in the bed to avoid unnecessary obstacles.</p><p id="par0300" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 22:</span> The technology available in each AICU room should be standardized. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0305" class="elsevierStylePara elsevierViewall">Justification: Standardizing medical technology will streamline purchasing and maintenance processes, and shorten staff training in the use of each piece of equipment.</p><p id="par0310" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 23:</span> The technology available in the AICU should enable information to be easily transferred between the AICU and related areas (e.g. operating room, emergency department). <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0315" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 24:</span> All patients should be clearly visible from the AICU's workstation (glass separation panels). <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0320" class="elsevierStylePara elsevierViewall">Justification: Patient rooms must be individual and allow visual control by nursing staff. The front of the patient's room, as a minimum, must have glass panels that allow staff to detect emergency situations. Video cameras can be used to control rooms that are farthest away from the workstation.</p><p id="par0325" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 25:</span> Each AICU room must be equipped with alcohol gel disinfectant dispensers. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0330" class="elsevierStylePara elsevierViewall">Justification: One of the core aims of ICU design is still the reduction of nosocomial infection. Active strategies to influence the habits of all ICU users have top priority; passive or structural measures are also important insofar as they favour active strategies. The ICU must be designed in a way that encourages good staff habits.</p><p id="par0335" class="elsevierStylePara elsevierViewall">Regarding the installation of washbasins and soap and paper towel dispensers, see recommendations 157–161.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Area for family or visitors</span><p id="par0340" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 26:</span> The AICU should permit an open visiting schedule, provided visits do not disrupt care processes or patient rest times. <span class="elsevierStyleItalic">Weak consensus (75% consensus)</span></p><p id="par0345" class="elsevierStylePara elsevierViewall">Justification: There has been growing interest in ensuring the well-being of both patients and visitors, because extended visiting times can favour patient recovery. The layout of the ICU should facilitate an “open visiting” schedule that allows the patient to be accompanied by their loved ones for as long as possible.<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">25</span></a></p><p id="par0350" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 27:</span> To facilitate access, each AICU room, and all visitor and family entry and exit routes should be clearly identified by signs. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0355" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 28:</span> The family area of AICU rooms should have comfortable armchairs, USB sockets, and connections for different devices. <span class="elsevierStyleItalic">Weak consensus (70% consensus)</span></p><p id="par0360" class="elsevierStylePara elsevierViewall">Justification: Family visits have hitherto been kept brief, and visitors often had to stand uncomfortably at the foot of the bed. Modern AICUs should provide a pleasant environment for both patients and family members.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Isolation rooms</span><p id="par0365" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 29:</span> It might be necessary to have at least 1 positive pressure room and 1 with negative pressure room, depending on the size of the ICU. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0370" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 30:</span> Negative pressure rooms are intended for patients with infection or suspected airborne pathogens (<5<span class="elsevierStyleHsp" style=""></span>μm, <span class="elsevierStyleItalic">droplet nuclei</span>) that can travel long distances before being inhaled by the host, such as tuberculosis, measles or chickenpox. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0375" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 31:</span> The aim of positive pressure isolation rooms is to provide a protective environment for patients at greater risk of infection (e.g. post-transplant neutropaenia). <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0380" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 32:</span> Negative pressure isolation room must have sealed ceilings, floors and doors. <span class="elsevierStyleItalic">Weak consensus (87% consensus)</span></p><p id="par0385" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 33:</span> Isolation rooms must have an airlock measuring at least 6<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> containing a basin, alcohol gel disinfectant dispensers, and protective material (e.g. gown, mask) for staff and visitors. <span class="elsevierStyleItalic">Strong consensus</span></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Toilets</span><p id="par0390" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 34:</span> A toilet adapted for mobile patients can be place outside the room, in a space near the common area of the ICU. However, few of these patients are expected to use a conventional toilet, and besides shared bathrooms can be a source of cross contamination, so the SCI-SEDAR considers this to be a weak recommendation. <span class="elsevierStyleItalic">Weak consensus (41% consensus)</span></p><p id="par0395" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 35:</span> Patient toilets must have a washbasin and toilet stool, and be wide enough to allow family members or staff to help the patient. <span class="elsevierStyleItalic">Weak consensus (37% consensus)</span></p><p id="par0400" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 36:</span> Most patients will use bedpans, and each AICU should have single use bedpans, together with a closed macerator or high-temperature sealed bedpan cleaner installed in the utility room. <span class="elsevierStyleItalic">Strong consensus</span></p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Clinical support zone</span><p id="par0405" class="elsevierStylePara elsevierViewall">The traditional design of critical care units has been influenced by reliance on a single paper medical record, central monitors, and a single, centrally located workstation from which all beds within the unit can be observed. This has gradually changed, as electronic information systems have replaced paper medical records, allowing patient data, prescribing information and documentation to be accessed from multiple places. As interdisciplinary care teams become more prevalent, nursing moves closer to the bedside, families become more involved in patient care, technology advances, and functions that had been centralized become decentralized.</p><p id="par0410" class="elsevierStylePara elsevierViewall">One of the main changes, if not the most important, in the modern ICU is the gradual digitizing of different medical devices and the subsequent conversion of these data to actionable information that improves the quality and efficiency of care.<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">26</span></a></p><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Central workstation</span><p id="par0415" class="elsevierStylePara elsevierViewall">The workstation or counter of the UCIA room is the central point of the unit where an important part of the monitoring, care documentation, communication and interdisciplinary and social interactions take place.<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">22</span></a> In some units, these areas have been decentralized to bring them closer to the patients, with a workstation for every 2 or 3 patient rooms. This is thought to improve observation.<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">27</span></a></p><p id="par0420" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 37:</span> The workstation must have sufficient lighting, be large enough to allow 2 nurses to work together and access the clinical information system. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0425" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 38:</span> The monitors installed in all the rooms must be visible from the station, either directly, or by means of screens. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0430" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 39:</span> The workstation must have a clear, unobstructed view of patient rooms. Video cameras can be used to control rooms that are farthest away from the workstation. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0435" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 40:</span> A nursing work station should be installed for every 6 to 8 AICU beds. <span class="elsevierStyleItalic">Weak consensus (91% consensus)</span></p><p id="par0440" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 41:</span> A wall clock should be installed in this area. <span class="elsevierStyleItalic">Weak consensus (79% consensus)</span></p><p id="par0445" class="elsevierStylePara elsevierViewall">The equipment to be included in the workstation is shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Space for crash trolley, difficult intubation trolley and portable ultrasound</span><p id="par0450" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 42:</span> The AICU must have a permanent space for storing life-saving care devices and a portable ultrasound. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0455" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 43:</span> These trolleys and devices must be located near the workstation and be rapidly accessible to nursing staff. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0460" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 44:</span> The route between the trolleys and ultrasound and any AICU room must be obstacle-free to allow the equipment to be moved rapidly and safely. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0465" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 45:</span> Both the crash trolley and difficult intubation trolley should have a maintenance protocol; they should be checked after each use, and inspected periodically to ensure they are fully equipped and in good working order. <span class="elsevierStyleItalic">Strong consensus</span></p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">AICU clean utility room or pharmacy</span><p id="par0470" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 46:</span> Depending on the layout of the UCIA, a space adjacent to the workstation should be set aside for the storage of medicines and disposable supplies. It should include a clinical refrigerator with temperature control, and a space for preparing sterile material. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0475" class="elsevierStylePara elsevierViewall">The equipment to be included in the clean utility room is shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0480" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 47:</span> Automated dispensing systems should be used for special drugs (e.g. narcotics). <span class="elsevierStyleItalic">Weak consensus (87% consensus)</span></p><p id="par0485" class="elsevierStylePara elsevierViewall">Justification: Two of the 3 experts who disagreed with this recommendation considered that all drugs should be dispensed automatically.</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Laboratory</span><p id="par0490" class="elsevierStylePara elsevierViewall">ICUs must have access to 1 or more 24-hour laboratories, so that the results of chemistry and blood tests can always be obtained immediately at any time of the day or night.</p><p id="par0495" class="elsevierStylePara elsevierViewall">The combination of centralized laboratories connected to the ICU both physically (pneumatic tube systems) and online, and of decentralized facilities where frequent, serial tests can be performed, such as arterial blood gas analysis, is a cost-saving measure that maximizes reliability and reduces turn-around time.</p><p id="par0500" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 48:</span> The possibility of installing a blood gas analysis system should be considered. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0505" class="elsevierStylePara elsevierViewall">Justification: For years, the solution has been to install laboratory equipment in the ICU itself, sometimes with a dedicated team of technicians, and nearly always housed in purpose-built facilities. However, the current trend is to centralize these services, and replace ICU laboratories with compact chemical analysis devices for frequent tests. These are commonly called gasometers, although they can also provide other analytical data of interest in the critical patient, such as glucose, haemoglobin, haematocrit, ions or lactate levels.</p><p id="par0510" class="elsevierStylePara elsevierViewall">These decentralized, compact devices do not require maintenance or calibration, and can be installed in the ICU close to the workstation, since they only require a table or shelf, a power socket, and computer connection to receive test orders and to upload test results to the electronic medical record system. Because they are so simple to use and maintain, they do not need a dedicated room, and can be installed in the patient zone. Ideally, point of care analytical equipment should be included in the laboratory network and undergo scheduled quality controls.</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Work zone</span><p id="par0515" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 49:</span> A work area for organizing and monitoring patient care, with access to computerized medical history records, should be set up near the AICU. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0520" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 50:</span> This can be a multipurpose room, and can also be used to hold meetings, in which case it must be equipped with a large table and sufficient seating. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0525" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 51:</span> This room should be separate from the staff lounge. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0530" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 52:</span> For clinical meetings, seminars and “change-of-shift” reports, a video projector should be installed in the ceiling, connected to a fixed screen and a dedicated network computer. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0535" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 53:</span> This room will be connected by intercom to the rest of the AICU. <span class="elsevierStyleItalic">Strong consensus</span></p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Food preparation rooms</span><p id="par0540" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 54:</span> Food preparation must be centralized in the hospital's kitchen, but the AICU may have a room, separate from the staff lounge, where hot drinks and food for patients is prepared. <span class="elsevierStyleItalic">Weak consensus (66% consensus)</span></p><p id="par0545" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 55:</span> This room should be equipped with a refrigerator, microwave, sink and a small larder. <span class="elsevierStyleItalic">Weak consensus (83% consensus)</span></p><p id="par0550" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 56:</span> A space with a power socket should be set aside for hot food carts, since blast chilling, which is becoming more widespread as a complement to cooked food, requires electrical power. <span class="elsevierStyleItalic">Weak consensus (83% consensus)</span></p></span></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">General support zone</span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Design of the staff area</span><p id="par0555" class="elsevierStylePara elsevierViewall">The AICU must include facilities where staff can carry out tasks not directly related to patient monitoring and care. These tasks include preparing documentation, taking part in clinical meetings, drawing up protocols and guidelines, obtaining activity indicators and activity quality indicators, etc.</p></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Work zone</span><p id="par0560" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 57:</span> Depending on the organizational system implemented and the bed capacity of the unit, a room for administrative work might be required. This room should be separate from the patient zones. <span class="elsevierStyleItalic">Weak consensus (87% consensus)</span></p></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Meeting room/session room/library</span><p id="par0565" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 58:</span> The AICU must have a multi-purpose room (meetings, clinical sessions, library) located in the immediate vicinity of the unit in order to allow staff to rapidly attend to patients or their family members. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0570" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 59:</span> This room will be used for clinical sessions, as a library, and for training and teaching, and will be equipped according to its purpose. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0575" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 60:</span> The room will be connected by intercom with the rest of the AICU. <span class="elsevierStyleItalic">Strong consensus</span></p></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Doctor's office</span><p id="par0580" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 61:</span> The AICU should have workspaces for doctors to study and conduct research. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0585" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 62:</span> The head of the AICU must have an office for individual use. <span class="elsevierStyleItalic">Weak consensus (79% consensus)</span></p></span><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0190">On-call rooms</span><p id="par0590" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 63:</span> The AICU must have adequate on-call rooms where duty doctors can rest. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0595" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 64:</span> Each duty doctor must have their own on-call room. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0600" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 65:</span> All on-call rooms must have an intercom system connected to the workstation, a toilet, shower and locker. <span class="elsevierStyleItalic">Strong consensus</span></p></span><span id="sec0135" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0195">On-call lounge</span><p id="par0605" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 66:</span> The on-call lounge should be located in a quiet area near the workstation, but outside the area where patients and family members circulate. <span class="elsevierStyleItalic">Weak consensus (79% consensus)</span></p><p id="par0610" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 67:</span> Ideally, the on-call lounge should have natural light. <span class="elsevierStyleItalic">Weak consensus (83% consensus)</span></p><p id="par0615" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 68:</span> It must be connected by intercom to the workstation. <span class="elsevierStyleItalic">Weak consensus (83% consensus)</span></p></span><span id="sec0140" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0200">Nurse's lounge with pantry</span><p id="par0620" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 69:</span> The nurse's lounge must be located near the workstation. It must have comfortable furnishings that will allow staff to relax during their break. The room must be equipped with a sink, fridge and microwave. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0625" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 70:</span> To increase staff satisfaction, this room should have natural lighting. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0630" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 71:</span> The room will be connected by intercom to the rest of the AICU. <span class="elsevierStyleItalic">Weak consensus (83% consensus)</span></p></span><span id="sec0145" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0205">Staff changing rooms and toilets</span><p id="par0635" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 72:</span> A staff toilet with a washbasin, toilet and shower must be placed near the workstation and pantry. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0640" class="elsevierStylePara elsevierViewall">Justification: AICU staff are at high risk of contamination by biological and chemical fluids. Some authors suggest installing additional emergency eye wash stations.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">11</span></a></p><p id="par0645" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 73:</span> Separate shower rooms must be built for male and female staff. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0650" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 74:</span> Separate toilets must be built for male and female staff. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0655" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 75:</span> Separate changing rooms must be built for male and female staff. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0660" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 76:</span> In the absence of centralized changing rooms, the minimum recommended surface area in the AICU is 25<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> for every 8 beds. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0665" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 77:</span> The changing room must include secure lockers for each member of staff to deposit clothes and valuables. <span class="elsevierStyleItalic">Strong consensus</span></p></span><span id="sec0150" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0210">Head nurse's office</span><p id="par0670" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 78:</span> The head nurse should have a private, pleasantly furnished office with natural lighting and meeting capacity for 6 people. <span class="elsevierStyleItalic">Strong consensus</span></p></span></span><span id="sec0155" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0215">Layout of the cleaning zone</span><span id="sec0160" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0220">Soiled utility room and waste disposal</span><p id="par0675" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 79:</span> The AICU must have a specific room for waste disposal, with different containers for each category of soiled materials. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0680" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 80:</span> There must be a sluice room for the disposal of waste (clinical sink, garbage disposal, etc.) and contaminated material. <span class="elsevierStyleItalic">Strong consensus</span></p></span><span id="sec0165" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0225">Linen room</span><p id="par0685" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 81:</span> The AICU consumes a great deal of bed linen. A linen supply system should be set up to reduce the amount of linen stored in the unit. <span class="elsevierStyleItalic">Strong consensus</span></p></span><span id="sec0170" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0230">Laundry collection</span><p id="par0690" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 82:</span> A room should be set aside for storing soiled linen before it is taken to the laundry. <span class="elsevierStyleItalic">Strong consensus</span></p></span><span id="sec0175" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0235">AICU logistics, supplies and medical devices</span><p id="par0695" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 83:</span> The AICU must include a technical and logistics area, adapted to the number of UCIA beds. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0700" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 84:</span> The minimum recommended surface area for the logistics area of the AICU is 5<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> per bed. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0705" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 85:</span> These spaces should be located near the general circulation paths of the AICU to facilitate the reception and dispatch of the material. <span class="elsevierStyleItalic">Strong consensus</span></p></span><span id="sec0180" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0240">Equipment room/workshop</span><p id="par0710" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 86:</span> Portable equipment, medical devices and trolleys should be stored in large rooms with shelves and enough room for heavy equipment. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0715" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 87:</span> It should be located in an area of the unit that minimizes travel to patient rooms. <span class="elsevierStyleItalic">Weak consensus (87% consensus)</span></p><p id="par0720" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 88:</span> This room must have a plenty of power sockets to allow battery operated devices to be recharged. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0725" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 89:</span> It would be advisable to install oxygen and compressed air intakes for the maintenance of ventilation equipment. <span class="elsevierStyleItalic">Strong consensus</span></p></span><span id="sec0185" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0245">Material storeroom</span><p id="par0730" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 90:</span> The AICU must have a storage room for frequently used clean and sterile material. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0735" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 91:</span> Sufficient space must be set aside for material used in continuous renal replacement therapy (fluids, filters and tubing). <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0740" class="elsevierStylePara elsevierViewall">Justification: The size of the material storeroom will depend on how the AICU is organized and how material is supplied. The availability of electronic activity registers and medication dispensing systems that track per-procedure consumption will reduce storage demands. This in turn reduces space, improves expiration date management and, ultimately, saves costs. An alternative medication replenishment system is the “two bin Kanban” method, in which individual stocks are replenished when 50% has been consumed. The re-stocking order is sent by scanning a bar code on the bin. In any event, the current trend is to significantly reduce material storage space by improving stock management and replenishment systems.</p></span><span id="sec0190" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0250">Electrical equipment</span><p id="par0745" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 92:</span> Electrical equipment, such as a centralized uninterrupted power supply (UPS) or batteries, should be place where they are easily accessible for maintenance, but do not disrupt the normal operation of the unit. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0750" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 93:</span> Air conditioning equipment must be located outside the AICU to optimize acoustic control of the unit and facilitate maintenance work. <span class="elsevierStyleItalic">Strong consensus</span></p></span></span><span id="sec0195" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0255">Family support zone</span><span id="sec0200" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0260">Layout of the family and visitor zone</span><p id="par0755" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 94:</span> AICU visiting hours should be open, and families must be able to access the patient's room at all times. <span class="elsevierStyleItalic">Weak consensus (79% consensus)</span></p><p id="par0760" class="elsevierStylePara elsevierViewall">Justification: The role of family members in the ICU has changed substantially. Originally thought of as a potential source of infection, visiting hours were restricted and families had to use external pathways to avoid direct contact with the patient. Now, however, they are potential actors in the care process, and are known to directly and positively influence the evolution of the patient. Based on this notion, modern ICUs have flexible visiting hours, and families are encouraged to spend more time with the patient, and are invited to participate in tasks such as body or dental hygiene, They are also encouraged to bring personal items with them, such as photographs or music.<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">28</span></a></p><p id="par0765" class="elsevierStylePara elsevierViewall">This conceptual change must be taken into account when designing spaces and pathways, and elements for the use of family members must be placed in the patient's room in order to make their stay more comfortable and enable them to interact with the patient.</p><p id="par0770" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 95:</span> Good signage will make it easier for family members to find the AICU. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0775" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 96:</span> Families should be able to access the ICU from public pathways in the main hospital. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0780" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 97:</span> Ideally, patient, staff, material and supplies, and visitor pathways should be segregated. <span class="elsevierStyleItalic">Weak consensus (75% consensus)</span></p></span><span id="sec0205" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0265">Reception</span><p id="par0785" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 98:</span> Visitors should be met in the waiting room or at the entrance to the AICU by a receptionist who liaises with ICU staff. <span class="elsevierStyleItalic">Weak consensus (66% consensus)</span></p><p id="par0790" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 99:</span> The entrance to the AICU must be directly visible from the workstation, or by means of monitors. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0795" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 100:</span> Both the work area and administrative area must be placed near the AICU reception. <span class="elsevierStyleItalic">Weak consensus (75% consensus)</span></p></span><span id="sec0210" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0270">Family and visitor lounge</span><p id="par0800" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 101:</span> The family room and visitor lounge must be placed near the AICU reception. Snack dispensers and toilets, including at least 1 disabled toilet, must be placed nearby. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0805" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 102:</span> This space should receive natural light and have comfortable furniture. <span class="elsevierStyleItalic">Weak consensus (87% consensus)</span></p><p id="par0810" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 103:</span> It should have 1.5 chairs for each room in the IACU.<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">29</span></a><span class="elsevierStyleItalic">Weak consensus (79% consensus)</span></p><p id="par0815" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 104:</span> Ideally, seating arrangements should allow families to sit together with relative privacy, separated by partitions. <span class="elsevierStyleItalic">Weak consensus (70% consensus)</span></p><p id="par0820" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 105:</span> This area should ideally have Wi-Fi connection and mobile phone chargers. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0825" class="elsevierStylePara elsevierViewall">Justification: Visitors benefit from a pleasant environment with warm colours, natural decoration and entertainment systems (e.g. television, Internet). The aim is to offer family members privacy and support, particularly when they are expected to stay for long periods and participate in patient care.</p></span><span id="sec0215" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0275">Information office</span><p id="par0830" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 106:</span> The family information office should be placed near the entrance to the AICU. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0835" class="elsevierStylePara elsevierViewall">Justification: The information office is used for holding interviews with family members to report on the status of the patient, to advise and educate the family on patient care, and to communicate the need for invasive procedures and the risks involved, and obtain the corresponding informed consent if the patient is not able to cooperate.</p><p id="par0840" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 107:</span> The room must provide families with adequate privacy to talk to staff about the patient's health status. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0845" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 108:</span> It should be comfortable and pleasantly furnished to create a non-hospital environment, and must be connected to the computer network in order to consult relevant data and show family members the results of analytical or imaging tests. <span class="elsevierStyleItalic">Weak consensus (91% consensus)</span></p></span><span id="sec0220" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0280">Visitors’ changing room</span><p id="par0850" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 109:</span> A changing room for family and visitors must be placed at the entrance to the AICU. <span class="elsevierStyleItalic">Weak consensus (91% consensus)</span></p><p id="par0855" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 110:</span> The room must be equipped with alcohol gel dispensers for hand sanitation and washbasins, and protective clothing must be available (caps, gowns, masks, etc.) if required. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0860" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 111:</span> The changing room must include a number of secure lockers where family members can deposit clothes and valuables. <span class="elsevierStyleItalic">Weak consensus (75% consensus)</span></p><p id="par0865" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 112:</span> Given the importance of hand washing to prevent infection, there should be posters on the wall asking visitors to use the hand sanitizers and showing how to do so. <span class="elsevierStyleItalic">Strong consensus</span></p></span></span><span id="sec0225" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0285">Environmental and technical characteristics of the AICU</span><p id="par0870" class="elsevierStylePara elsevierViewall">Every effort must be made to ensure that the ICU environment reduces stress in both patients and staff. Growing importance has been given in recent years to creating a beneficial environment for both patients and AICU staff.</p><span id="sec0230" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0290">Lighting</span><p id="par0875" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 113:</span> Patient rooms must have windows and natural lighting. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0880" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 114:</span> The windows must have blinds or similar that can be used to provide shade or darken the room during daylight hours. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0885" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 115:</span> Rooms should ideally have an outside view. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0890" class="elsevierStylePara elsevierViewall">Justification: Natural light and an outside view help maintain circadian rhythms and prevent delirium.<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">11,30,31</span></a></p><p id="par0895" class="elsevierStylePara elsevierViewall">In the 70s, visitors were not allowed to enter the patient's room or the patient zone in order to reduce the risk of nosocomial infection. This led to the construction of units with perimeter corridors that ran along the outer façade, so that the visitor would be separated from the patient but still be able to maintain visual contact. This layout wasted valuable space and significantly limited the entry of natural light into the room. Natural light is considered essential in the recovery of circadian rhythms, and the absence of such light could eventually prolong the patient's stay and increase the likelihood of nosocomial infection.</p><p id="par0900" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 116:</span> Room lighting should include:<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">•</span><p id="par0905" class="elsevierStylePara elsevierViewall">General lighting, directed away from the patient's head. It must be strong enough for detailed examination of the patient, but soft enough to be pleasant for the patient, their family and staff members (maximum 300<span class="elsevierStyleHsp" style=""></span>lux).</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">•</span><p id="par0910" class="elsevierStylePara elsevierViewall">A reading light at the head of the bed that can be controlled by the patient. Maximum intensity of 300<span class="elsevierStyleHsp" style=""></span>lux.</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">•</span><p id="par0915" class="elsevierStylePara elsevierViewall">Stronger lighting (between 1000 and 1500<span class="elsevierStyleHsp" style=""></span>lux) for care procedures, which should be located on the patient's bed and should not generate shadows.</p></li></ul></p><p id="par0920" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0925" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 117:</span> Care must be taken with lighting accessories, the photometric properties of the light sources, and the direction and colour of the lighting, as well as the relationships between lighting, room surfaces and finishes. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0930" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 118:</span> The screens of both monitoring and care systems must be adapted to ambient light. <span class="elsevierStyleItalic">Weak consensus (91% consensus)</span></p></span><span id="sec0235" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0295">Acoustic control</span><p id="par0935" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 119:</span> The ICU, and particularly patient rooms, must ensure a quiet, peaceful environment. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0940" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 120:</span> Acoustic control in the AICU must comply with the International Noise Council's maximum noise recommendations for hospitalised patients<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">32</span></a>:<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">•</span><p id="par0945" class="elsevierStylePara elsevierViewall">Noise during the morning should be less than 45 decibels (dBA).</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">•</span><p id="par0950" class="elsevierStylePara elsevierViewall">Noise during the afternoon and evening should be less than 40 decibels (dBA).</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">•</span><p id="par0955" class="elsevierStylePara elsevierViewall">Noise at night should be less than 20 decibels (dBA).</p></li></ul></p><p id="par0960" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0965" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 121:</span> Sound level limits should be set for different times of the day, and the volume of alarms and acoustic signals must be adapted to these limits. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0970" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 122:</span> The use of background music or low-volume ambient music is recommended. <span class="elsevierStyleItalic">Weak consensus (66% consensus)</span></p><p id="par0975" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 123:</span> Acoustic alarms, sometimes accompanied by a light signal at the entrance of each room, should clearly identify each patient's room. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0980" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 124:</span> Patient/nurse alarm systems must be volume-controlled, but must always allow staff to monitor the patient's status.<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">33</span></a><span class="elsevierStyleItalic">Strong consensus</span></p><p id="par0985" class="elsevierStylePara elsevierViewall">Justification: Several authors have pointed out that noise in the ICU is often above recommended levels,<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">6,34</span></a> and have suggested that reducing this form of environmental pollution should be a priority in these units.</p><p id="par0990" class="elsevierStylePara elsevierViewall">Critical patients may be more sensitive to noise than staff, and high noise levels can interrupt sleep and increase pain perception.<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">35</span></a> The sound of moving equipment and chairs, alarms, the noise emitted by monitors or other elements and phones are perceived by patients as loud, and they can also be disturbed by conversations maintained at what staff perceive to be an acceptable noise level.<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">36</span></a></p><p id="par0995" class="elsevierStylePara elsevierViewall">Noise can be physically dampened by the use of sound absorbing materials on walls and ceiling, soundproof windows, and mufflers in the heating, ventilation and air conditioning system.<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">37</span></a> Materials that minimize noise should be used not only in patient rooms, but throughout the unit. It is particularly important to raise awareness among staff, and encourage them to reduce noise levels as much as possible. Periodic monitoring of noise levels in the ICU may help reinforce these measures.</p></span><span id="sec0240" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0300">Air conditioning</span><p id="par1000" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 125:</span> Room temperature must be maintained between 21 and 26<span class="elsevierStyleHsp" style=""></span>°C. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 126:</span> It must be possible to regulate the temperature according to the needs of the patient. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1010" class="elsevierStylePara elsevierViewall">Justification: Body temperature regulation mechanisms may be impaired in critically ill patients, or they may be very sensitive to changes in ambient temperature.</p><p id="par1015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 127:</span> The AICU must comply with the UNE-100713: 2005 standard that requires relative humidity in patient zones to be between 45% and 55%. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 128:</span> Ventilation system must allow room air to be changed at least 8–10 times per hour, and ambient air at least 2 times per hour. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1025" class="elsevierStylePara elsevierViewall">Justification: According to prevailing regulations (European Standard EN 13779: 2007), outdoor air must meet a series of requirements in order be used for indoor ventilation. However, the standard recognizes that there are no universally accepted definitions of outdoor air quality, and those that exist were not initially intended for the design of ventilation systems.</p><p id="par1030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 129:</span> Air flow should never be directed towards the patient's bed. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 130:</span> To reduce the risk of contamination, the treatment unit must be equipped with prefilters, HEPA EU13<span class="elsevierStyleItalic">(High-efficiency particulate absorption filters)</span> ultra-high efficiency air filters or absolute filters, and systems to eliminate the most frequent contaminants (CO<span class="elsevierStyleInf">2</span>, NOx, SO<span class="elsevierStyleInf">2</span>). <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 131:</span> The sound produced by air management systems must not exceed 35 dBA. <span class="elsevierStyleItalic">Strong consensus</span></p></span></span><span id="sec0245" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0305">General characteristics of material finishes</span><p id="par1045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 132:</span> The quality of furnishings and superficial finishes must meet the strength and durability requirements of UNE 11022, UNE 56868, UNE 11019, BS 2483 and UNE 11011, NTP 38 (reaction to fire).<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">14</span></a><span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 133:</span> 133: Furnishings and furniture in the AICU should be as comfortable as possible. <span class="elsevierStyleItalic">Strong consensus</span></p><span id="sec0250" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0310">Flooring</span><p id="par1055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 134:</span> Flooring must be able to withstand the weight of heavy equipment but offer some cushioning to reduce staff fatigue. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 135:</span> Flooring should have an attractive, non-hospital design. <span class="elsevierStyleItalic">Weak consensus (70% consensus)</span></p><p id="par1065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 136:</span> It must absorb loud sounds and absorb noise from adjacent spaces. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 137:</span> To reduce the risk of contamination, flooring must:<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">•</span><p id="par1075" class="elsevierStylePara elsevierViewall">Withstand demanding, high-frequency cleaning schedules.</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">•</span><p id="par1080" class="elsevierStylePara elsevierViewall">Have a smooth surface, with minimal perforations and cracks.</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">•</span><p id="par1085" class="elsevierStylePara elsevierViewall">Extend up the wall for a few centimetres.</p></li></ul></p><p id="par1090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1095" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 138:</span> To facilitate patient mobility and reduce the risk of falls, vinyl floors with welded seams that provide smooth continuous coverage are recommended. <span class="elsevierStyleItalic">Strong consensus</span></p></span><span id="sec0255" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0315">Walls</span><p id="par1100" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 139:</span> To reduce the risk of infection, wall should have smooth finishes with welded seams, and withstand aggressive cleaning. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1105" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 140:</span> They must withstand impacts from trolleys and heavy portable equipment. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1110" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 141:</span> The finish, preferably in warm colours, should not look hospitable-like; this, together with the use of natural motifs for decoration, is beneficial for patients, visitors and staff. <span class="elsevierStyleItalic">Weak consensus (79% consensus)</span></p></span><span id="sec0260" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0320">Doors</span><p id="par1115" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 142:</span> Doors should open and close automatically, to avoid hand contact. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1120" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 143:</span> They must be at least 1.4<span class="elsevierStyleHsp" style=""></span>m wide. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1125" class="elsevierStylePara elsevierViewall">Justification: The doors must be wide enough to allow the passage of ICU beds, with monitors, infusion systems and ventilation devices.</p><p id="par1130" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 144:</span> They must include areas of glass to allow staff to observe the patient while respecting their privacy and that of their family. <span class="elsevierStyleItalic">Strong consensus</span></p></span><span id="sec0265" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0325">Windows</span><p id="par1135" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 145:</span> Windows must comply with the requirements of the Spanish Basic Document for Safety of Use and Accessibility (SUA, in Spanish) with respect to the risk of falls, and the risk of impact or entrapment (SUA 1 and 2).<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">38</span></a><span class="elsevierStyleItalic">Strong consensus</span></p></span><span id="sec0270" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0330">Ceilings</span><p id="par1140" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 146:</span> Good noise-absorbing materials should be used. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1145" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 147:</span> The design must be attractive, painted in warm colours or with natural motifs. <span class="elsevierStyleItalic">Weak consensus (75% consensus)</span></p></span></span><span id="sec0275" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0335">Basic characteristics of AICU distribution systems</span><p id="par1150" class="elsevierStylePara elsevierViewall">The placement of power, medical gas, vacuum, and data sockets, together with monitor holders and other medical devices has a great impact on both the patient and staff.<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">39</span></a> There are currently 3 configuration systems: flat headwall, suspended column and boom.</p><p id="par1155" class="elsevierStylePara elsevierViewall">Flat headwall: This is the traditional, least expensive, most widely used system that allows sockets to be easily arranged according to patient needs. However, it has 2 drawbacks: the headwall cannot be made of glass, and during emergency situations, staff member responsible for keeping the airway clear have to step over a tangle of lines, tubes, and cords.</p><p id="par1160" class="elsevierStylePara elsevierViewall">Suspended column: The column is attached to the floor or the ceiling, and has an array of gas, vacuum, power and data sockets, together with other elements, such as drawers, shelves, monitor and screen holders, an auxiliary light, communication systems, IV holders, etc. The most advanced models include moveable elements on a column attached to the ceiling, and sockets and other elements can be configured as required.</p><p id="par1165" class="elsevierStylePara elsevierViewall">Booms: The most sophisticated booms consist of a series of articulated arms suspended from the ceiling that give maximum flexibility in positioning each element, adapting the room to the needs of each patient.<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">39</span></a> Columns were initially of 2 types: dry columns (for monitoring and electronic equipment), and wet columns (intended for IV holders and perfusion pumps). However, the increasingly frequent addition of a point of care computer (essentially, an additional workstation), and the need for power, data, gas and vacuum sockets on both sides of the patient have made this division obsolete.</p><p id="par1170" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 148:</span> Whatever the configuration of sockets and connections, easy access to the patient and medical devices takes priority over other considerations. <span class="elsevierStyleItalic">Strong consensus</span></p><span id="sec0280" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0340">Electrical power</span><p id="par1175" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 149:</span> Each bed must have twelve 16<span class="elsevierStyleHsp" style=""></span>A power sockets, lateral ll<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>tt, distributed in 3 independent circuits with 4 power sockets each, and powered, according to Spanish electrical regulation MIE BT 025, by a 3-phase isolation transformer with a minimum output of 3.5<span class="elsevierStyleHsp" style=""></span>kVA or 5<span class="elsevierStyleHsp" style=""></span>kVA if it supplies 2 beds, in which case 6 independent circuits must be available.<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">40</span></a><span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1180" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 150:</span> The IT network, in accordance with MIE BT 008, will be permanently monitored by means of a line isolation metre equipped with optical and acoustic alarms, adjustable to between 2 and 5<span class="elsevierStyleHsp" style=""></span>mA of leakage current (50 and 250<span class="elsevierStyleHsp" style=""></span>kohm).<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">40</span></a><span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1185" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 151:</span> The main electrical panel of the AICU must be connected to the emergency electrical systems: generator and UPS. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1190" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 152:</span> Emergency electrical systems must be located in specific rooms so that maintenance tasks do not interfere with the operation of the AICU. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1195" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 153:</span> At least 6 electrical sockets in each room will be connected to a UPS-protected network. The remaining the sockets should be connected to a network linked to the hospital's emergency circuit, which is activated within seconds of a power cut. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1200" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 154:</span> The sockets connected to the UPS should preferably be reserved for electronic equipment (monitors, computers and communication switches) that could lose their settings after a power cut, making them difficult to restart once back-up power system starts. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1205" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 155:</span> The AICU must comply with the provisions of Royal Decree 842/2002, of August 2, which establishes the requirements of the Electrotechnical regulation for low voltage. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1210" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 156:</span> Each bed must have at least 2 electrical bonding conductors (that earth the metal parts of the equipment). <span class="elsevierStyleItalic">Strong consensus</span></p></span><span id="sec0285" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0345">Water</span><p id="par1215" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 157:</span> The water supplied to the AICU should have clearly differentiated uses:<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">•</span><p id="par1220" class="elsevierStylePara elsevierViewall">Wash basins</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">•</span><p id="par1225" class="elsevierStylePara elsevierViewall">Drinking water/oral nutrition/oral medication.</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">•</span><p id="par1230" class="elsevierStylePara elsevierViewall">Cleaning of material that will be subjected to high level disinfection or sterilization.</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">•</span><p id="par1235" class="elsevierStylePara elsevierViewall">Patient hygiene</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">•</span><p id="par1240" class="elsevierStylePara elsevierViewall">Dialysis</p></li></ul></p><p id="par1245" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1250" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 158:</span> To reduce the risk of bacteria accumulating in and on taps due to frequent use, the lowest number of taps needed for each task should be installed. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1255" class="elsevierStylePara elsevierViewall">Justification: Increased use of alcohol gel solutions has reduced the need for basins for hand washing, which can increase the presence of <span class="elsevierStyleItalic">Escherichia coli</span>, coliforms and even non-fermenting gram-negative bacilli in drinking water.</p><p id="par1260" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 159:</span> If the AICU is located near the haemodialysis unit or other kidney intensive care units, a tap supplying highly purified or ultra-pure water could be installed in a patient room (maximum conductivity 1.1<span class="elsevierStyleHsp" style=""></span>μS<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">−1</span>, measured at 20<span class="elsevierStyleHsp" style=""></span>°C; maximum total organic carbon 0.5<span class="elsevierStyleHsp" style=""></span>mg/l; maximum nitrates 0.2<span class="elsevierStyleHsp" style=""></span>ppm; less than 10<span class="elsevierStyleHsp" style=""></span>CFU/100<span class="elsevierStyleHsp" style=""></span>ml bacterial contamination, and less than 0.03<span class="elsevierStyleHsp" style=""></span>EU/ml endotoxins). <span class="elsevierStyleItalic">Weak consensus (79% consensus)</span></p><p id="par1265" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 160:</span> In the absence of centralized water treatment units, individual portable ultrapure water treatment systems could be used for haemodialysis. At least 1 room should be equipped with water and drainage (apart from hand washing basins). <span class="elsevierStyleItalic">Weak consensus (91% consensus)</span></p><p id="par1270" class="elsevierStylePara elsevierViewall">Justification: At present, the use of autonomous systems that only require 1 water outlet from the general supply and 1 drain must be considered as an alternative, because they are more adaptable, and easier and less expensive to install and maintain.</p><p id="par1275" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 161:</span> Washbasins for cleaning visibly soiled hands with water and soap should be installed near each room, in addition to the aforementioned alcohol gel dispensers.<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">41</span></a><span class="elsevierStyleItalic">Strong consensus</span></p></span><span id="sec0290" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0350">Medical gas</span><p id="par1280" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 162:</span> Oxygen and compressed air must be supplied by the hospital's central system. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1285" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 163:</span> Each room should have 3 oxygen sockets, 4 vacuum sockets and 2 medical compressed air sockets. The quality of medical gases must comply with the provisions of both UNE Standard 110-013-91 and the Spanish Pharmacopoeia.<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">40</span></a><span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1290" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 164:</span> Medical gases must have at least 1 pressure regulator and control panel per unit. These must be clearly visible, and the gas pipeline must be distributed into subsections supplying 2–3 beds.<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">40</span></a><span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1295" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 165:</span> Valves will be installed in such a way that repairs can be carried out even when the system is being used.<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">40</span></a><span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1300" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 166:</span> Medical gas inlets will have shut-down systems and pressure alarms. <span class="elsevierStyleItalic">Strong consensus</span></p></span><span id="sec0295" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0355">Vacuum</span><p id="par1305" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 167:</span> Each room should have at least 4 vacuum outlets. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1310" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 168:</span> The vacuum system will have a low pressure alarm. <span class="elsevierStyleItalic">Strong consensus</span></p></span><span id="sec0300" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0360">Communication system</span><p id="par1315" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 169:</span> The AICU must have a rapid, simple communication system between each staff zone, and between these zones and the rest of the hospital. The system must be as discreet as possible, to avoid disturbing both patients and other staff members. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1320" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 170:</span> Patient rooms must be connected by intercom with the central workstation. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1325" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 171:</span> The system must include a specific code for life-threatening situations. <span class="elsevierStyleItalic">Strong consensus</span></p></span><span id="sec0305" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0365">Transport systems</span><p id="par1330" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 172:</span> The pneumatic tube system should be located near the central workstation. <span class="elsevierStyleItalic">Weak consensus (91% consensus)</span></p><p id="par1335" class="elsevierStylePara elsevierViewall">Justification: This is a quick, simple system of sending samples from the ICU to the central laboratory using a pneumatic tube. The system needs no special training to operate, hardly requires maintenance, and the results of the tests can be received over the hospital's intranet.</p><p id="par1340" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 173:</span> Lifts must be available to transfer patients in large beds with various medical devices, at times accompanied by several medical professionals. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1345" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 174:</span> Lifts should ideally have power sockets. <span class="elsevierStyleItalic">Weak consensus (62% consensus)</span></p><p id="par1350" class="elsevierStylePara elsevierViewall">Justification: Two of the 8 experts who disagreed with this recommendation argued that all equipment used during patient transport must be equipped with electric batteries.</p><p id="par1355" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendation 175:</span> Each lift should measure at least 2.70<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1.80<span class="elsevierStyleHsp" style=""></span>m, door width 1.80<span class="elsevierStyleHsp" style=""></span>m, and height 2.10<span class="elsevierStyleHsp" style=""></span>m. <span class="elsevierStyleItalic">Strong consensus</span></p><p id="par1360" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#sec0325">Annex 2</a> contains all these recommendations in the form of a checklist that can be used for AICU quality control.</p></span></span></span><span id="sec0310" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0370">Funding</span><p id="par1365" class="elsevierStylePara elsevierViewall">No funding was received.</p></span><span id="sec0315" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0375">Conflicts of interest</span><p id="par1370" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1276687" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1180780" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1276688" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiales y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1180779" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:9 [ 0 => array:3 [ "identificador" => "sec0020" "titulo" => "General design of the AICU" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Location" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Layout" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Size" ] ] ] 1 => array:3 [ "identificador" => "sec0040" "titulo" => "Patient care zone" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Patient area" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Working area" ] 2 => array:2 [ "identificador" => "sec0055" "titulo" => "Area for family or visitors" ] 3 => array:2 [ "identificador" => "sec0060" "titulo" => "Isolation rooms" ] 4 => array:2 [ "identificador" => "sec0065" "titulo" => "Toilets" ] ] ] 2 => array:3 [ "identificador" => "sec0070" "titulo" => "Clinical support zone" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0075" "titulo" => "Central workstation" ] 1 => array:2 [ "identificador" => "sec0080" "titulo" => "Space for crash trolley, difficult intubation trolley and portable ultrasound" ] 2 => array:2 [ "identificador" => "sec0085" "titulo" => "AICU clean utility room or pharmacy" ] 3 => array:2 [ "identificador" => "sec0090" "titulo" => "Laboratory" ] 4 => array:2 [ "identificador" => "sec0095" "titulo" => "Work zone" ] 5 => array:2 [ "identificador" => "sec0100" "titulo" => "Food preparation rooms" ] ] ] 3 => array:3 [ "identificador" => "sec0105" "titulo" => "General support zone" "secciones" => array:9 [ 0 => array:2 [ "identificador" => "sec0110" "titulo" => "Design of the staff area" ] 1 => array:2 [ "identificador" => "sec0115" "titulo" => "Work zone" ] 2 => array:2 [ "identificador" => "sec0120" "titulo" => "Meeting room/session room/library" ] 3 => array:2 [ "identificador" => "sec0125" "titulo" => "Doctor's office" ] 4 => array:2 [ "identificador" => "sec0130" "titulo" => "On-call rooms" ] 5 => array:2 [ "identificador" => "sec0135" "titulo" => "On-call lounge" ] 6 => array:2 [ "identificador" => "sec0140" "titulo" => "Nurse's lounge with pantry" ] 7 => array:2 [ "identificador" => "sec0145" "titulo" => "Staff changing rooms and toilets" ] 8 => array:2 [ "identificador" => "sec0150" "titulo" => "Head nurse's office" ] ] ] 4 => array:3 [ "identificador" => "sec0155" "titulo" => "Layout of the cleaning zone" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0160" "titulo" => "Soiled utility room and waste disposal" ] 1 => array:2 [ "identificador" => "sec0165" "titulo" => "Linen room" ] 2 => array:2 [ "identificador" => "sec0170" "titulo" => "Laundry collection" ] 3 => array:2 [ "identificador" => "sec0175" "titulo" => "AICU logistics, supplies and medical devices" ] 4 => array:2 [ "identificador" => "sec0180" "titulo" => "Equipment room/workshop" ] 5 => array:2 [ "identificador" => "sec0185" "titulo" => "Material storeroom" ] 6 => array:2 [ "identificador" => "sec0190" "titulo" => "Electrical equipment" ] ] ] 5 => array:3 [ "identificador" => "sec0195" "titulo" => "Family support zone" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0200" "titulo" => "Layout of the family and visitor zone" ] 1 => array:2 [ "identificador" => "sec0205" "titulo" => "Reception" ] 2 => array:2 [ "identificador" => "sec0210" "titulo" => "Family and visitor lounge" ] 3 => array:2 [ "identificador" => "sec0215" "titulo" => "Information office" ] 4 => array:2 [ "identificador" => "sec0220" "titulo" => "Visitors’ changing room" ] ] ] 6 => array:3 [ "identificador" => "sec0225" "titulo" => "Environmental and technical characteristics of the AICU" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0230" "titulo" => "Lighting" ] 1 => array:2 [ "identificador" => "sec0235" "titulo" => "Acoustic control" ] 2 => array:2 [ "identificador" => "sec0240" "titulo" => "Air conditioning" ] ] ] 7 => array:3 [ "identificador" => "sec0245" "titulo" => "General characteristics of material finishes" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0250" "titulo" => "Flooring" ] 1 => array:2 [ "identificador" => "sec0255" "titulo" => "Walls" ] 2 => array:2 [ "identificador" => "sec0260" "titulo" => "Doors" ] 3 => array:2 [ "identificador" => "sec0265" "titulo" => "Windows" ] 4 => array:2 [ "identificador" => "sec0270" "titulo" => "Ceilings" ] ] ] 8 => array:3 [ "identificador" => "sec0275" "titulo" => "Basic characteristics of AICU distribution systems" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0280" "titulo" => "Electrical power" ] 1 => array:2 [ "identificador" => "sec0285" "titulo" => "Water" ] 2 => array:2 [ "identificador" => "sec0290" "titulo" => "Medical gas" ] 3 => array:2 [ "identificador" => "sec0295" "titulo" => "Vacuum" ] 4 => array:2 [ "identificador" => "sec0300" "titulo" => "Communication system" ] 5 => array:2 [ "identificador" => "sec0305" "titulo" => "Transport systems" ] ] ] ] ] 7 => array:2 [ "identificador" => "sec0310" "titulo" => "Funding" ] 8 => array:2 [ "identificador" => "sec0315" "titulo" => "Conflicts of interest" ] 9 => array:2 [ "identificador" => "xack438452" "titulo" => "Acknowledgements" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-03-13" "fechaAceptado" => "2019-06-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1180780" "palabras" => array:4 [ 0 => "Structural requirements" 1 => "Anaesthesia intensive care unit" 2 => "Quality of care" 3 => "Consensus paper" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1180779" "palabras" => array:4 [ 0 => "Recomendaciones estructurales" 1 => "Unidad de cuidados intensivos de anestesia" 2 => "Calidad asistencial" 3 => "Consenso" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">In this article, the Intensive Care Section of the Spanish Society of Anesthesiology (SCI-SEDAR) establishes new recommendations based on the standards published by the Ministry of Health, Consumer Affairs and Social Welfare and aligned with the principle international guidelines, and develops a tool to improve quality and efficiency.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Over a 12-month period (2018), 3 members of the SCI-SEDAR defined the methodology, developed the recommendations and selected the panel of experts.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Due to the limited evidence available for many of the recommendations and the significant structural differences between existing anaesthesia intensive care units, we chose a modified Delphi approach to determine the degree of consensus.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The panel consisted of 24 experts from 21 institutions. The group put forward 175 recommendations on 8 sections, including 129 with strong consensus and 46 with weak consensus.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The SCI-SEDAR has established a series of structural recommendations that should be used when renovating or creating new anaesthesia intensive care units.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Los objetivos de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SCI-SEDAR) con el presente trabajo son: establecer nuevas recomendaciones adaptando los estándares publicados por el Ministerio de Sanidad y Política Social, y alineadas con las principales guías internacionales, y desarrollar una herramienta de mejora de la calidad y la eficiencia.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y método</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A lo largo de 2018, 3 miembros de la SCI-SEDAR definieron la metodología, desarrollaron las recomendaciones y seleccionaron al panel de expertos.</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Debido a la limitada evidencia de buena parte de las recomendaciones y a la importante variabilidad estructural de las unidades de cuidados intensivos de anestesia actuales, se optó por un abordaje Delphi modificado para determinar el grado de consenso.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Un total de 24 expertos de 21 instituciones constituyeron el grupo de expertos del presente trabajo. Se establecieron 175 recomendaciones sobre 8 apartados, incluyendo 129 con consenso fuerte y 46 con consenso débil.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La SCI-SEDAR estableció las recomendaciones estructurales de las unidades de cuidados intensivos de anestesia que deberán guiar la renovación o la creación de nuevas unidades.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiales y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Barturen F, Paz-Martín D, Monedero P, Cardona-Pereto J, Fernández-Quero L, Valía JC, et al. Estructura de las unidades de cuidados intensivos de anestesia: recomendaciones de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR). Rev Esp Anestesiol Reanim. 2019;66:506–520.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par1385" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0325" ] ] ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ample space with several workstation with computer sockets, and a long, wide table for various office supplies. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Central monitoring systems \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Computers with access to the clinical information system and multifunction printer \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Books on equipment, pharmacological guides and protocols \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Telephone, intercom and emergency call \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Environmental control panel (temperature, pressure and humidity) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Wash basin with disposable paper towels \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clock and adequate lighting \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2183655.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Central workstation.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; 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entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Disposables for medication preparation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Disposables for wound dressing and other procedures, and for replenishing trolleys and material stored in patient rooms. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical sink with elbow or foot control and drying system with disposable element \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Data outlet, for future installation of computer-controlled dispensing systems \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; 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