Intensive Care Unit (ITU) & High Dependency Unit (HDU)

Introduction

The Intensive Care Unit (ITU) has 5 beds where patients from young babies to the elderly receive treatment for serious illnesses, injuries or following major operations.

The 4 bedded High Dependency Unit (HDU) treats patients who may be recovering from surgery or serious illness. It is for patients who no longer need intensive care or those who need more specilaist medical and nursing care than provided in the general wards.

What to Expect When you are Admitted to our Ward

Very little is required. Personal toiletries such as flannel, soap, toothpaste, shaving things, etc. are welcome. If you would like to help with some of your relative's care, please ask the nurse caring for them.

Any photographs, get well cards and small personal mementos are welcome although unfortunately no flowers are allowed.

Please be aware that the Trust is now a smoke free NHS. Smoking is not permitted in any building or within the grounds of any of our sites. Information and support is available to any patients who wish to stop smoking. Nicotine Replacement Therapy is available to help reduce your cravings during your stay.

Our Staff

The nursing and medical team cover both units with one nurse allocated to each ITU patient and one nurse responsible for two HDU patients.

The nurses work 12 hour shifts, changing over at 8.00am to 8.00pm.

Consultant Ward Rounds / When will I see a Doctor?

An Intensive Care Consultant is responsible for patients medical care 24 hours a day. A resident doctor is always available on the unit. We aim to keep you fully informed of your relative's progress. Please ask if you need any further information.

Social Worker

If you require any advice or help with home or financial difficulties the hospital social worker may be able to assist you. The nursing staff will refer you.

Religious Needs

The hospital Chaplain is available 24 hours a day. We can contact representatives of other faiths if you require them to visit.

Donor Liaison Team

As part of our bereavement care, we aim to give all families the choice of possible organ and / or tissue donation. Information is available on the unit or you can speak to our specialist nurse.

Mealtimes and Catering

Visitors

The mornings are generally the busiest time of the day due to the consultant doctors' ward round, physiotherapy, x-rays and other tests / procedures. If you wish to visitbefore 11:00am, you may be asked to wait whilst these are carried out.

There is a patient rest time between 1.00pm - 3.00pm when we do not disturb the patients unless absolutely necessary. In special circumstances, relatives may be able to visit during this time, but please arrange this with your nurse.

When visiting both units, please ring the bell outside the door and wait for someone to let you know if you can come in. There may be procedures in progress such as x-rays.

There is a visitors' room in which you can wait.

How to Contact the Ward

You can ring our direct telephone lines for information at any time, day or night. If you are likely to have a lot of relatives and friends who may wish to ring, we suggest that one or two people are appointed to ring on behalf of you all, to prevent too many calls which might take the nurses away from the patients.

Telephone numbers: -

Or Telephone Switchboard on 08454 22 2222 and ask for either Intensive Care or High Dependency Unit.

Going Home

When you have been ill and nursed in ITU / HDU, it may take a while for you to return to feeling your normal self. It is difficult to know exactly how long this will take, but it will depend on: -

• Your general state of health before you were ill
• The length of time that you have been ill
• Whether you have lost weight since you admission to hospital
• The length of time you were nursed in ITU / HDU

Leaving ITU / HDU and going to a general ward is an important and positive step on the way to recovery and towards going home. It is however normal, for both you and your family, to feel apprehensive about this move as you will have become familiar with all the staff and routines. The thought of meeting new people can be worrying at any time, but it may seem harder when you have been very ill, and the new people are those looking after you.

Once you are on a ward you will be visited by a Follow-up Nurse from the Unit. Please feel free to ask any questions.

Cleanliness and Infections in Hospital

Some people are admitted to hospital with infections that require them to be cared for away from other patients to prevent the spread of that particular infection. Please follow the instructions given to you by staff.

Please pay particular attention to hand washing and general cleanliness at all times, especially when leaving the room.

If you have been in contact with chickenpox, measles or mumps within 3 weeks of your admittance to hospital, please inform a member of staff.

We ask that visitors suffering from minor infections such as a cold avoid visiting if possible, for their sake as well as the patients. We do not recommend babies being brought in to visit, again for their own protection.

Hand washing. The most common means by which infection is transmitted is by hand, therefore handwashing is a very basic, yet vital infection control measure. Alcohol hand gel is kept at the entrance of the ward and at each bedside for all the visitors to use before and after visiting. For hygienic hand disinfection apply 3ml (3 shots) to physically clean hands for 30 seconds ensuring all areas are covered, until dry.

What is clostridium difficile? Also called c diff

It is a bacteria that normally lives in the intestine. Up to 5% of the population are thought to carry this without any problems. It is usually kept in check by other bacteria in the intestines, which are normally present in our gut.

What problems does clostridium difficile cause?

Some strains of c.diff produce toxins, these toxins (poisons) cause diarrhoea. It can only do this when the balance of the normal gut bacteria has been disturbed. This can happen when antibiotics are given for infections. This enables the c-diff bacteria to multiply and produce more toxins that damage the cells in the intestines causing diarrhoea.

How is it Diagnosed?

A sample of diarrhoea is sent to the microbiology lab within the hospital. The laboratory looks for c-diff the toxins produced by some strains of the bacteria

How can it be treated?

If it is possible the antibiotics that have contributed to the disease will be stopped. Sometimes other antibiotics will be given, which are effective against the c-diff bacteria

What should happen if someone has diarrheoa?

Whenever possible you will be moved into a side room, before the microbiology result of the diarrhoea specimen is known This is to help prevent the spread of this bacteria. Not all patients can be placed in side rooms. it will depend on the condition of the patient and the availability.

Personal hygiene must be very strict. Everyone must wash their hands with soap and water after going to the toilet and before eating. If diagnosed as c-diff you may be transferred to the Cohort Ward (6A). this is a 16 bedded infection control ward dedicated to the management of patients who have or are suspected to have c-diff.

What is MRSA?

The organism Staphylococcus aureus is found on many individuals skin and seems to cause no major problems. However if it gets inside the body, for instance under the skin or into the lungs, it can cause important infections such as boils or pneumonia. Individuals who carry this organism are usually totally healthy, have no problems whatever and are considered simply to be carriers of the organism.

The term MRSA or methicillin resistant Staphylococcus aureus is used to describe those examples of this organism that are resistant to commonly used antibiotics. Methicillin was an antibiotic used many years ago to treat patients with Staphylococcus aureus infections. It is now no longer used except as a means of identifying this particular type of antibiotic resistance.

Individuals can become carriers of MRSA in the same way that they can become a carrier of ordinary Staphylococcus aureus which is by physical contact with the organism. If the organism is on the skin then it can be passed around by physical contact. If the organism is in the nose or is associated with the lungs rather than the skin then it may be passed around by droplet spread from the mouth and nose. We can find out if and where Staphylococcus aureus is located on a patient by taking various samples, sending them to the laboratory and growing the organism. Tests done on any Staphylococcus aureus grown from such specimens can then decide how sensitive the organism is to antibiotics and if it is a methicillin resistant (MRSA) organism. These tests usually take 2-3 days.

Why bother with MRSA?

MRSA organisms are often associated with patients in hospitals but can also be found on patients not in a hospital. Usually it is not necessary to do anything about MRSA organisms. However if MRSA organisms are passed on to someone who is already ill, then a more serious infection may occur in that individual. When patients with MRSA are discovered in a hospital, the hospital will try to prevent it from passing around to other patients. This is known as infection control.

How do we prevent the spread of MRSA?

Measures to prevent the spread of organisms from one person to another are called isolation or infection control. The type of infection control or isolation required for any patient depends on the organism, where the organism is found on an individual and the patient.

The most important type of isolation required for MRSA is what is called Contact Isolation. This type of isolation requires everyone in contact with the patient to be very careful about hand washing after touching either the patient or anything in contact with the patient. If the organism is in the nose or lungs it may also be necessary to have the patient in a room to prevent spread to others by droplet spread. Because dust and surfaces can become contaminated with the organism, cleaning of surfaces are also important.

What do visitors need to do?

Provided relatives and friends of patients with MRSA are healthy there is no restriction on visiting and it carries no risk. Visitors are not required to wear special clothing BUT we would ask you to help us prevent this organism spreading around our hospital by keeping the patients' door closed at all times and always washing your hands whenever you leave the room.

What about MRSA at home?

In patients who are otherwise well the organisms often disappear once the patient leaves the hospital. Sometimes they do not however, and this may mean that when a patient has to go back into hospital the isolation precautions need to be used again. Provided everyone at home is healthy special precautions are not required at home.

What can be done about MRSA?

In certain situations it may be a good idea to try to get rid of the organism from a patient and this can be done with various creams and shampoos or on occasions combinations of antibiotics taken by mouth or by injection depending on the health of the patient.

Additional Information

If English is not your first language, and you may require the services of an interpreter, please let the ward know before your admission, if at all possible.

If you are hearing impaired and need to sign, we may also be able to provide someone to help with this.

A Hairdresser, Dietician, Chiropodist, Dentist and Pharmacist are all available on site and the staff will inform you of these in more detail should you wish.

Physiotherapy, Occupational Therapy and Social Services can be accessed via referral from Ward staff. Chaplaincy staff visit the Ward, or you may arrange for your own spiritual advisor to visit.

Any Questions?

Whilst your relative is being cared for on ITU / HDU, it is important that we look after you too. If there is anything you need, please don not hesitate to ask.