STATUS IN WALES

1 For queries on the STATUS of this document contact or telephone 029 2031 5512 STATUS Note amended March 2013 HEALTH BUILDING NOTE 57 Facilities for critical care STATUS IN WALES APPLIES This document replaced HBN 27 - Intensive therapy unit 1992 Facilities for critical careHBN 57 Facilities for critical care HBN 57 DESIGN & BRIEFINGF acilities for critical careHBN 57 London: The Stationery OfficePublished by TSO (The Stationery Office) and available , Telephone, Fax & E-mailTSOPO Box 29, Norwich NR3 1 GNTe lephone orders/General enquiries 0870 600 5522 Fax orders 0870 600 5533E-mail Shops123 Kingsway, London WC2B 6PQ020 7242 6393 Fax 020 7242 639468 69 Bull Street, Birmingham B4 6AD0121 236 9696 Fax 0121 236 96999 21 Princess Street, Manchester M60 8AS0161 834 7201 Fax 0161 833 063416 Arthur Street, Belfast BT1 4GD028 9023 8451 Fax 028 9023 540118 19 High Street, Cardiff CF10 1PT029 2039 5548 Fax 029 2038 434771 Lothian Road.

2 Edinburgh EH3 9AZ0870 606 5566 Fax 0870 606 5588 TSO Accredited Agents(see Yellow Pages)and through good booksellers Crown copyright 2003 Published with the permission of NHS Estates, an Executive Agency of the Department of Health, on behalf of the Controller of Her Majesty s for reproduction should be made in writing to:The Copyright Unit,Her Majesty s Stationery Office,St Clements House,2 16 Colegate,Norwich NR3 0-11-322588-1 First published 2003 Printed in the United Kingdom for The Stationery OfficeCover photograph: courtesy of Leeds General Infirmary andWexham Park HospitaliiiIt has been 10 years since the last guidance on the built environment for critical care areas was this time intensive care medicine has become arecognised specialty and its delivery is undergoing acomplete overhaul following the publication of Comprehensive Critical Care by the Department ofHealth (2000).

3 The Intensive Care Society had a majorinput into that document, and also into Health BuildingNote (HBN) 57 Facilities for critical care . The Society,on behalf of those working in critical care areas,welcomes the foresight of NHS Estates in seeking aswide an input as possible into the design of the areaswhere they work. It is a credit to the process that HBN57 now addresses such matters as the need for naturallight, adequate staff changing facilities, appropriateareas for the patient s family and a host of , users will now be able to more easilyinfluence design teams who have in the past notappeared to listen to such concerns.

4 A considerableamount of research and work has gone into thepreparation of this guidance. Design teams now have an up-to-date resource to use during the process ofcreating a new facility or altering an existing one. Failureto follow this guidance may quite rightly be questioned. Because the practice of intensive care medicinecontinues to change rapidly, it is likely that HBN 57 will require regular review. NHS Estates has made anexcellent decision in enabling this process by placingupdates on its website. Peter NightingalePresident, Intensive Care SocietyForewordivCritically ill patients are highly vulnerable, and most arecompletely dependent on the care provided by expertstaff.

5 The experience of being admitted to a critical carearea (CCA), whether planned or as an emergency, islikely to be a highly physically and psychologicallystressful experience for patients, their families andfriends and sometimes of the recommendations made in ComprehensiveCritical Care (Department of Health (DoH), 2000) is areview of the built environment in CCAs. Since thepublication of that document, the NHS ModernisationAgency has initiated a development programme toreconfigure critical care services. The programmeacknowledges that it is the level of care required by the patient that is important, not where the patient islocated in the hospital; patients who fulfil the criteria forcritical illness may be found in locations other thandesignated intensive care units (ICUs) and high-dependency units (HDUs).

6 This critical care withoutwalls approach to the identification and management ofthe critically ill is reflected in this to ensuring excellence is providing state-of-the-arttechnology and facilities that are fit for the purpose. Thisshould include the clinical areas in which patients arecared for and the support facilities that underpin guidance supersedes HBN 27 Intensive therapyunit (NHS Estates, 1992). It will be of interest to: planning and design teams; executive directors and senior managers of NHStrusts, including estates directors and their staff; clinicians from every profession working in, or inpartnership with, CCAs; infection control teams; all support staff employed within CCAs; representatives of patients and their families; manufacturers of information technology (IT), clinicaland support equipment and furnishings.

7 And the medical engineering are substantial differences between this guidanceand its predecessor HBN 27. They are listed inAppendix 2 and are based on evidence from a series of visits to CCAs made by the Working Group, theresponses obtained from a postal survey of existingICUs and HDUs, the views of the Reference Group, thestrategy outlined in the NHS Plan and the experiencesof critically ill patients, their families and friends. This guidance includes all general CCAs that admit adult(or adolescent) patients whose dependency levels areclassified as level 2 or level 3 (see Appendix 2).

8 It willrequire review with reference to the provision of intensiveor high-dependency care for patients under the age of16 years admitted to a general CCA either for definitivetreatment or for stabilisation prior to transfer to anotherlocation. Guidance on hospital accommodation forchildren will be published later this year in conjunctionwith the Hospital Services module of the Children sNational Service guidance outlines the emerging principles inplanning facilities for critically ill people: userrequirements, location and departmental factors and the views of users.

9 The main issues related to improvingpatient areas are discussed including increasing the area of bed-spaces, increasing the number of singlebedrooms, reducing Hospital Acquired Infection, thepatient s right to privacy and dignity, strategies for noisereduction, and maximising natural patient/staff ratio in critical care is very high. Morespace is required in staff facilities, including rest rooms,catering facilities, changing rooms, en-suite overnightaccommodation for on-call staff, and education andtraining facilities. Improvements in support facilities forfamily and friends are also guidance covers general design considerations andprovides detailed information on the specific functionaland design requirements and engineering requirementsfor CCAs.

10 It provides cost information, which includesschedules of in the appendices are recommended roomlayouts, along with a comprehensive list of FOR CRITICAL CAREE xecutive summaryvHelen Bourner, Senior Advisor, NHS EstatesAndrew Cohen, Consultant in Intensive Care, St JamesHospital, Leeds; ICSG inny Edwards, National Programme Director, CriticalCare Programme, NHS Modernisation AgencyIan Fraser, Senior Engineer, NHS EstatesCarole Fry, Nursing Officer, Communicable Diseases,Department of Health (DoH)Ruth Haigh, Ergonomics ConsultantSteve Isaac, Principal, AHA Architects, co-authorDr Elizabeth Jones, Principal Clinical Advisor, NHS EstatesBrian Latham, Principal Engineer, NHS EstatesIan Macartney, Consultant in Critical Care Medicine,North Manchester General HospitalDave Morgan, Quantity Surveyor, InventuresGiles Morgan, Consultant in Anaesthesia and IntensiveCare, Royal Cornwall Hospitals Trust, Truro, Cornwall.