Intensive Care Unit for COVID-19 patients

These are the requirements which are needed to be fulfiled while setting up an intensive care unit for COVID-19 patients:

• The intensive care unit should be segregated from other patient care areas to minimise the spread of the infection. The ICUs should have a separate entry and exit from the rest of the hospital departments. It should not be close to recovery wards, post-surgical, dialysis department, neonatal ICU or labour room.
• If the ICU is not on the ground floor, there should be dedicated lifts and guarded stairs for the COVID-19 ICU.
• Patients should be kept in a separate single cubicle ICU. If single cubicles are not available, beds can be placed in an ICU with spatial separation of at least 1 meter (3 feet) from one another. One ICU bed requires a total space of 12m x 25m. The total ICU area should ideally be 3 times the total space of beds.
• The ICU should have two oxygen outlets, one air outlet, two suction outlets and twelve main electricity outlets to run all the gadgets.
• There should be provision for invasive/non-invasive physiological monitoring.
• There should be a point of care investigations with the help of efficient laboratory support. Point of care testing is also known as near-patient testing, where lab investigations are done at the time of the consultation with instant availability of results which helps in making immediate and informed decisions about patient care. 
• The patient should have a 24/7 expert nursing care. 
• The air in the COVID-19 ICU should be sterile with a low velocity of airflow. The relative humidity of the air should be between 30 to 60%.
• A proper ventilation system should be prsent in a COVID-19 ICU. An ICU with a single bed should have at least 6 air changes and out of which 2 air changes should be of fresh air per hour. 
• The COVID-19 ICUs should have separate Air Handling Units (AHU), which help in the re-conditioning and circulation of air. 
• The air conditioners should have HEPA filters which increase the efficiency of sterilization in the ICU to 99%.
• Due to the production of aerosols during intubation, extubation and coughing, there is a high viral load in the ICU. There should be multiple exhaust fans in the ICU to create negative pressure which helps remove the aerosols. Make sure that the exhaust fans should not throw the air filled with aerosols to the kitchen area or parking areas.
• If the ICUs do not have air-conditioners negative pressure would be created using natural ventilation. For that, the ICU should have large windows on opposite walls of the isolation ward allowing a natural unidirectional flow and air changes.

There are certain items listed below that should be present in an intensive care unit (ICU) for both the patients as well as the doctors:

• Oxygen points or air points
• Trolleys and beds
• Multiparameter monitors (for checking the vital signs)
• EKG machines (for checking the electrical activity of the heart) along with cardiac monitoring disposables such as the leads and sensors
• Infusion pumps (for delivering fluids)
• Ventilators with circuits, heat and moisture exchanger (HME filters) and viral filters
• Portable X-ray machines and ultrasounds
• Defibrillators 
• Intubation kits which involve video laryngoscope, tubes, Magill forceps and special kits for difficult airway intubation
• Renal replacement therapy devices as a lot of patients with severe symptoms of COVID-19 are known to develop renal failure.
• Clothes and diapers for the patients
• Intravenous cannula syringes
• Catheters for central venous pressure (CVP) line and arterial line 
• Urine catheters and bags
• Nasogastric tubes (NG tube), endotracheal tubes (ET tube) and tracheostomy tubes (T tube)
• Fixing adhesives like tapes for keeping the tubes in place
• Closed suction catheters and chest drains (to remove the mucous)
• Crystalloids, colloids and nutritional solutions to maintain the body’s fluid balance 
• Burette sets to deliver intravenous fluids
• Necessary drugs and previous medication of the patient 
• Personal Protective Equipment (PPE) kit which involves shoe covers, hood or head caps for the head, single-use long-sleeved fluid-resistant gown or drape, N-95 or FFP2 respirator (mask), face shield or eye-protective goggles and surgical gloves 
• Tablets and mini laptops to make the virtual rounds on non-emergent patients
• Ventilators both invasive and non-invasive
• Refurbished machines and splitters (two patients can be ventilated at the same time on a splitter)