1. Hazards due to Shortage of Staff:
ICUs are perpetually short of staff vis-a-vis the patient load. Many of the patients require intensive observation or intensive therapy. That is why ICU has authorized nurses at the scale of one/bed/shift and residents at the scale of, 17/bed/shift. If the staff posted in ICU is not adequate as per the occupancy, the care definitely will fall short of the desired standards, adding to the complications and compromising the chances of survival.
Infections are, perhaps the most serious and common hazard that the ICU patients are exposed to. ICU patients are seriously sick with weak body defenses and are highly prone to infections. They must be protected by attending to the following aspects. i. Hazards due to poor hygiene and sanitation ii.
Failure of the staff to follow universal precautions iii. Contamination of ventilators/humidifiers iv. Long standing (>72 hours) cannula, antibiotic resistance causing aggravated hazard of infections v. Lack of proper isolation (with separate ventilation) arrangement for infectious cases such as meningococcal meningitis, SARS, Avian Flu, Pulmonary Tuberculosis (open cases). One patient admitted in ICU with a highly contagious disease can infect all the others and jeopardize, whatever chances of survival they have vi.
Lack of a documented admission/discharge policy for intensive care units vii. Lack of standardized protocols for prevention of infections viii.Inadequate hand washing/disinfection facilities ix.
Unregulated entry of visitors can be a major source of infections from outside and must be effectively, regulated, by restricting the visitors to visiting hours only, one at a time and after putting on disposable shoe covers, masks.
3. Medication/Sampling Errors:
Chances of medication and sampling errors can be more in intensive care, if understaffed. Patients being critically sick/comatose, errors in identification and mistakes in medication or sampling may occur, if the overworked staff has to keep shuttling from one patient to another.
4. Bed sores:
Comatose, paralyzed, bed ridden patients are prone to develop bed sores/ decubitus ulcers if the nursing care is not adequate. Nursing in-charge ICU must prevent the menace of bed sores by identifying all the patients who are prone to develop bed sores and without any delay starting all necessary measures to prevent their occurrence.
5. Equipment Failure:
Hospitals that do not seriously follow a program of planned preventive maintenance of equipment may face the serious problem of sudden equipment failure. Malfunctioning ventilators, humidifiers, defibrillators, echocardiography, ultrasonongraphy or gas and vacuum delivery can seriously affect the chances of survival because of erratic functioning or sudden failure. Instances are known when nurses kept complacently believing that ventilator is functioning and patient is getting the oxygen at the desired rate, while the patient had already quietly died of anoxia. Similarly a malfunctioning syringe pump or a blocked IV cannula can deny the life saving drug or fluid to the patient. It is of paramount importance that the hospital should have a well staffed and equipped maintenance service including a biomedical engineering section to check (and repair) every piece of equipment, so as to ensure their operational reliability at all times.
6. Power Failure:
Power failure means sudden failure of all the equipment, air conditioning and lighting which can suddenly disrupt the life support and patient care activities. For that the hospitals must have mains supply from two different phases, a standby generator supply and in addition, UPS for every vital equipment.
7. Accidental Fires:
ICU is an area with concentration of a lot of electrical equipment.
If the adequate numbers of sockets of suitable quality are not provided for every bed, there may be overloading of sockets and added chances of fire. Similarly, temporary connections through lose hanging wires are an obvious hazard. Knowing that all the patients are bed ridden and unable to move, management should pay special attention to fire safety aspects. Fire-fighting equipment of right type should be available and all staff of all shifts should know how to use it.
8. Safety of Patients’ Property:
Many patients brought to ICU in emergency situations still have their valuables such as watch, cell phone, wallet or jewelry on them. If the patient is accompanied by an attendant, then the valuables can be handed over to him/ her after making a list and obtaining a receipt. However, if the patient is not accompanied by anyone, then the items should be collected in the presence of security officer/ supervisor, the ICU resident and the ICU sister and a list of all the items including the exact cash in the wallet should be prepared and signed by all in triplicate.
The valuables including the clothes should be handed over to the security officer for safe keeping along with a copy of the list. Jewelry items, however, should be sealed in a polythene bag before handing over to the security officer. The items can be handed over to the next of kin (after proper identification) and a receipt obtained with full details of contact address and relationship. Safe custody of patient’s property is a very important aspect because often, after discharge/death of the patient, there are disputes about the property alleged to be missing. Therefore, it is always advisable that all valuables are taken off and accounted for in the presence of at least two people, one of which should be the security officer or the resident doctor.
Privacy of Patients:
Most of the patients in ICU are too sick and incapacitated or comatose, unable to protect even their modesty and privacy. The staff must be fully alive to this aspect and ensure that the patients, especially females, are properly covered and not exposed, unnecessarily. For servicing female beds only female housekeepers should be detailed. Similarly, whenever a female patient is being examined/attended to by a male staff, a nurse or a female house keeper should be present.