INTRODUCTION

 Newborn or neonatal intensive care unit,an

 Adequate space
 Availability of running water
 Centralized oxygen and suction facilities
 Maintenance of thermo- neutral environment
 Availability of plenty of linen and disposables
 Facilities for availability to treat common
neonatalproblems
PHYSICAL LAYOUT
MAIN COMPONENTS TO BE CONSIDER WHILE
ORGANIZING A NICU:

 PHYSICAL FACILITIES
 • PERSONNEL
 • EQUIPMENTS
 • LABORATORY FACILITIES
 • PROCEDURE MANUAL
 • TRANSPORT OF SICK INFANTS
 • COOPERATION BETWEEN THE OBSTETRICIAN
AND NEONATOLOGIST
 1.PHYSICAL FACILITIES:
 Location
 Space
 Floor plan
 Lighting
 Environmental temperature and humidity
 Handling and social contacts
 Communication system
 Acoustic characteristics
 Ventilation
 Electrical outlets
 LOCATION
 NICU should be located as close as to labour
room and obstetric operation theater unit to
promote safe and easy transfer of neonates from
one area to other. Provisions for adequate
sunlight for illumination and fair degree of
ventilation for fresh air should be created.
 SPACE
 NICU serve as a referral unit for the infants born outside
the hospital. The size of the NICU is related to the
expected population intended to be served. Each infant
should be provided with a minimum area of 100 sq. ft. or
10 m2. Space for promotion of breast feeding 500-600
Gross square feet per bed should be made.Space includes
patient care area, storage area, space for doctors, nurses,
other staff, procedure room, pantry,toilet and bathroom,
milk storage room, laboratory area, space for families and
cleaning area where used articles or fomites can be
washed and sterilized or disinfected. 6 Feet gap should be
provided between two incubators for adequate circulation
and keeping the essential lifesaving equipment.
 FLOOR PLAN
 NICU should be an open encumbered space. The
walls should be made of washable glazed tiles and
windows should have two layers of glass panes to
ensure protection from heat and sound insulation.
Wash basins with elbow or floor operated taps
facility having constant round-the clock water
supply should be provided. The doors should be
provided with automatic door closers. The NICU
should have a clean area and infected area
(isolation room), separately located where infants
can be segregated. The clean area should be for
infants with non-infectious diseases.
 VENTILATION
 Effective air ventilation of NICU is necessary to
reduce nosocomial infection. Also provide
centralized air conditioning in the NICU.
 LIGHTING
 The whole unit must be well illuminatedand
painted white or slightly off white to permit
prompt detection of jaundice and cyanosis. The
lighting is well achieved by cool white fluorescent
tubes to provide uniform shadow-free,
illumination of 100-foot candles at the baby’s
level. Spot illumination for various procedures can
be provided by portable angle poise lamp having
two, 15-Watt fluorescent bulbs. In places where
electric failure is frequent, the ward must be
attached to a generator.
 ENVIRONMANTAL TEMPERATURE AND HUMIDITY
 The temperature inside the unit should be
maintained at 28 ± 20C, in order to minimize
effects of thermal stress on babies. The humidity
must be above 50%, which is satisfactory for
routine needs of newborn babies. Portable
radiant heater, infra-red lamp and hot air
blowers can also be used.
 ACOUSTIC CHARACTERISTICS
 The ventilation system, incubators, aircompressors,
suction pumps and manyother devicesused in the
nursery producenoise.Sound intensity in the unit
should not exceed75 decibels.Telephone rings and
equipment alarmsshould be replaced by blinking
lights. Excessive noise may lead to hearing lose
psychological and behavioral disturbances like sleep
disturbances, startles and crying episodes. It is
desirable to have effective sound proofing of
ceilings, walls and floor when a new unit is
designed. It is desirable to have gentile music in
units
 COMMUNICATION SYSTEM
 The unit should also have an intercom
systemanda direct outside telephone line for
creating effective communication with the other
units in the hospital and the parents of the
babies respectively.
 ELECTRICAL OUTLETS
 There should be adequate number of lights and
power plug points attached to the common
ground. Each patient station should have 12 to
16 centralvoltage – stabilized electrical outlets
sufficient tohandle all pieces of equipment. The
use of adaptors and extension boards should be
avoided. There should be round-the-clock power
back upincluding provision of UPS system. The
voltage supply to the unit should be stabilize
with the help of voltage stabilizers.
 BABY CARE AREA
 Areas and rooms for inborn or intramural babies
 Examination area
 Mother’s area for breast feeding and expression
of breast milk
 Nurses station and charting area.
 HAND-WASHING AND GOWNING ROOM:
 Should be located at the entrance.
 Self-closing doors.
 STAFF
 A direct who is a full-time neonatologist
 One neonatal physician is required for every 6-
10 patients
 One resident doctor should be present in the unit
round-the-clock.
 Anesthetist - pediatric surgeon and pediatric
pathologist are essential persons in
establishment of a good quality NICU
 2.PERSONNEL:
 NURSES
 A nurse: patient ratio of 1:1 maintained
throughout day and night is absolutely essential
for babies on multi system support including
ventilation therapy.
 For special care neonatal unit and intermediate
care, nurse to patient ratio of 1:3 is ideal but 1:5
per shift is manageable.
 Head nurse is the overall in-charge
 In addition to basic nursing training for level-II
care, tertiary care requires, staff nurse need to
be trained in handling equipment, use of
ventilators and initiation of life-support like use
of bag and mask resuscitation, endotracheal
intubations, arterial sampling and so-on.
 The staff must have a minimum of 3 years work
experience in special care neonatal unit in
addition to having 3 months handon-training in
an intensive care neonatal unit.
 OTHER STAFF
 Respiratory therapist
 • Laboratory technician
 • Public health nurse or social worker
 • Biomedical engineer
 • Pathologists
 3.EQUIPMENT’S
 The maintenance of existing equipment in proper
working condition is more important than
acquiring new and sophisticated gadgets. The
equipment used in units are:
 Resuscitation equipment
 Bag and mask resuscitator
 Oxygen and suction facilities
 Catheters, syringes and needles
 Feeding equipment
 Weighing machine
 Thermometer
 Oxygen hood
 Phototherapy unit
 Infusion pump
 Radiant Warmer:
 DISPOSABLE ARTICLES REQUIRED FOR THE NICU
 IV Catheters
 IV sets
 Micro burette sets
 Bacterial filters
 Feeding tubes
 Endotracheal tubes
 Suction catheters
 Three-way stopcocks
 Extension tubing
 Umbilical arterial and venous catheters
 Syringes, needles
 4. LABORATORY FACILITIES
 Satisfactory facilities for routine radiological
examination should be available in the unit. A
side laboratory for routine analysis of blood,
urine, gastric aspirate should be available in the
unit.
 5. PROCEDURE MANUAL
 It is essential to have a procedure manual to establish
continuity and uniformity of services. It should offer ready
guidance to new nurses so that no discrepancy occurs. The
manual should outline detailed instructions regarding:
 Care of babies
 Indications for admission and discharge
 Housekeeping rituals to prevent infections
 Instructions regarding temperature maintenance of unit,
nurse’s observation, recording of vital signs and working of
equipment.
 Policy regarding mother and baby contact.
 Policy regarding management of emergencies in unit.
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