organization of a neonatal intensive care unit

7/23/2019 Organization of a Neonatal Intensive Care Unit

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ORGANIZATION OF A

NEONATAL INTENSIVECARE UNIT


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INTRODUCTION

Neonatal intensive care is also

considered synonymous with providing

advanced life support (ALS) to critically sick

babies with multisystem organ dysfunction.

Those who weigh < 1500gms or


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GOALS

To improve the clinical care of the

critically ill neonate.

To reduce the neonatal morbidity &

mortality.

To provide continuing in- service training

of medical & nursing personnel in the

care of newborn.


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LEVELS 0F

NEONATAL CARE


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Level I neonatal care (Basic)

Well newborn nurseryLEVEL II neonatal care( speciality) special care nursery

LEVEL II A LEVEL IIBLEVEL III NICU(SUB SPECIALITY)

LEVEL III A NICU LEVEL III B NICU LEVEL III C NICU


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TYPES OF ENVIRONMENT Physical : Design

Social : Staff & Parents


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PHYSICAL FACILITIES


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PHYSICAL FACIITIES

LOCATION

Should be located as close as possible to

the labor room & obstetrics OT.

Elevator should be available in close

proximity Transport of sick out born

babies.


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SPACE

NICU design should allow 500 600

gross sq.ft per bed.

For patient care, 100 sq.ft is required

for each baby.


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SETTING

Unit facility preferably in square space.

Adequate taps Elbow & foot operated.

Built-in wooden cabinets for stocking

purpose.

Isolation room for infected babies.


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VENTILATION

Effective ventilation - To reduce

nosocomial infections.

When centralized air conditioning is

used minimum of 12 changes of air

room per hour.

Provision of exhaust fan in reverse

direction.


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LIGHTING

Well shadow-free illuminated(100 foot

candles) at babys level.

Painted white or slightly off white- early

detection of jaundice & cyanosis.


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ENVIRONMENTAL TEMPERATURE &HUMIDITY

Temperature must be maintained around 28+/- 2 degree C To minimize thermal stress.

Humidity must be above 50%

WATER

o Uninterrupted clean water supply ,& each

patient care area must have a washbasin

with foot, elbow, or sensor operated water

taps.


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ACOUSTIC

CHARECTERISTICS

In critical care area 64-66 db.

IN growing nursery50-60 db.


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ELECTRICAL OUTLETS

Each patient station should 12-16 have central

voltage-stabilized electrical outlets sufficient to

handle all equipments.

2 oxygen outlets, 1 compressed air outlet & 2suction outlets.

Voltage supply Stabilized with Voltage Servo-

Stabilizer.


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COMMUNICATING SYSTEM

Nursery complex should be providedwith an intercom system &

Direct line external telephone is

mandatory Parents have an easy

access.


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PERSONNEL


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According to bed occupancy

Medical

Nursing

Paramedical staff are allotted in

neonatal unit.


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Medical

A Director Full time neonatologistwith special qualification & training in

neonatal medicine should head the

unit.


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One Neonatal Physician - for every 6 to 10

patients in the continuing care,

intermediate care and intensive care areas.

OneResident Doctor should be present in

the unit round the clock.


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For special care and intermediate care

neonatal units number of senior doctor

will be same.

One Resident Doctor in each shift for 8 to

10 beds with one reliever.


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Nurses

A nurse : patient ratio of 1:1 in all shifts

for babies on multisystem support

including ventilatory therapy.

A ratio of 1 : 2 for sick babies not

requiring ventilatory support.

For special care neonatal unit (SCNU) andintermediate care, 1:3 is ideal but 1:5 per

shift is manageable.


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In addition, 30 % provision should be made

for day off, leaves and other emergencies.

Desirable to have atleast 2/3 rd of the staff

nurses fully trained and permanent in the

unit at any given time.


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EQUIPMENTS


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NEEDED EQUIPMENTS

o Resuscitation Equipment

o Oxygen & Suction Facilities

o Catheters, Syringes & Needles

o Drugs Needed

o Feeding Equipments

o Weighing Machines

o Bassinets


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o Incubators

o Thermometers

o Oxygen Hood

o Radiant Heat Warmer

o Phototherapy Unit

o Oxygen Analyzer

o Heat Rate Monitor

o Respiratory Rate & Apnea Monitor

o Blood Pressure Monitor


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o Infusion Pump

o Transcutaneous Bilirubin Meter

o Transcutaneous Blood Gas Monitor

o Vein Viewer

o Pulse Oximetry

o Ventilators

o Intracranial Pressure Monitor

o Extracorporeal Membrane Oxygenator

(ECMO)


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documentation


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INFECTION

CONTROL &SURVEILLANCE


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Follow up program

organization of a neonatal intensive care unit

Documents