Factors to consider in the safe design of intensive care units - Part 1: historical aspects and ventilation systems.

Background: Evidence linking the role of ventilation systems in transmission of infection to patients in intensive care units has increased in recent years. Aims: This research-based commentary set out to identify the historical aspect of intensive care unit design, current problems and some potential solutions with respect to ventilation systems. Methods: Databases and open source information was used to obtain data on the historical aspects and current guidance in ICU, and the authors experiences have been used to suggest potential solutions to ventilation problems in ICU. Findings: The authors found a number of problems with ventilation in ICU to which there has not been a cohesive response in terms of guidance to support users and designers. The resultant void permits new projects to proceed with suboptimal and designs which place patients and staff at risk. Discussion: The NHS is now at the start of major new investments in healthcare facilities in England and this together with the end of the antibiotic era mandates new guidance to address these major concerns.

Implementing changes to reduce infections in ICU patients. Water services and waste systems.

Background: Evidence linking the role of water services in transmission of infection to patients in ICUs has increased in recent years. Aims: This research based commentary set out to identify potential solutions for water and wastewater systems in ICU settings. Methods: Databases and open source information was used to obtain data on approaches to water and wastewater-related issues in ICU settings. This and the authors experiences have been used to describe approaches to these problems. Findings: The lack of updated guidance has required some ICUs to develop unique responses, including 'water free' patient care combined with reduction in water services. The options consider guidance, compliance, training and education as key factors to successful outcomes and protecting vulnerable patients in ICU. Discussion: The authors found a number of problems with water and wastewater systems in ICU to which there has not been a cohesive response in terms of guidance to support users and designers. The resultant void permits new projects to proceed with suboptimal and designs which place patients and staff at risk. As an interim measure a series of solutions suitable for existing units and new builds need to be considered.

Aspects and problems associated with the water services to be considered in intensive care units.

Background: Water is a product taken for granted and assumed to be a safe commodity in intensive care units (ICU). Biofilm readily becomes established in complex water services presenting a risk to vulnerable patients. Harboured within biofilms are opportunistic pathogens which can be transmitted via hand contact, splashing, aerosol and indirect contact through medical equipment. Evidence linking the role of water services in transmission of infection to patients in ICUs has increased in recent years. Aims: This research based commentary set out to identify current problems with water and wastewater systems in ICU settings. Methods: Databases and open source information was used to obtain data on current water and wastewater-related issues in ICU settings. This and the authors experiences have been used to describe current challenges. Findings: the authors found a number of problems with water systems in ICU to which there has not been a cohesive response in terms of guidance to support users and designers. The resultant void permits new projects to proceed with suboptimal and designs which place patients and staff at risk. Discussion: Hand hygiene stations are frequently misused or close enough to patients such that splashing poses a transmission risk. The wastewater system (drain) also presents a risk, from where Gram-negative antibiotic resistant organisms may be dispersed resulting in untreatable patient infections. The water and wastewater system provide a superhighway for the movement of pathogenic microorganisms and these risks need to be addressed if we are to safeguard vulnerable users in ICU.