Merck Manual

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Special Care Units


Oren Traub

, MD, PhD, Pacific Medical Centers

Last full review/revision Mar 2018| Content last modified Mar 2018
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People who need specific types of care may be put in special care units.

Types of units

Intensive care units (ICUs) are for people who are seriously ill. These people include those who have had a sudden, general malfunction (failure) of an organ, such as the liver, lungs (requiring assistance with breathing), or kidneys (requiring dialysis). People who are in shock, who have a severe infection, or who have had major surgery are likely to be placed in an ICU. Large hospitals may have a special pediatric intensive care unit (PICU) for children.

Coronary care units are for people who are having or have had a heart attack or who have abnormal heart rhythms (arrhythmia), heart failure, or another severe heart problem.

Intensive care and coronary care units are similar in that both have equipment to support and constantly monitor vital functions. This equipment includes the following:

  • A cardiac monitor is a machine that monitors heart rate and rhythm (electrocardiography, or ECG), blood pressure, and breathing rate. The monitor is connected to people by various lines or wires.

  • A flexible catheter inserted into a vein (a central intravenous line) in the neck, upper chest, or upper thigh is used to give people drugs, fluids, and sometimes nutrients.

  • Ventilators to help people with breathing and defibrillators to restore heart rhythm to normal are available.

Because people in these units require more care than usual, more staff members are available to provide care. Visiting hours and rules for visitors are more restrictive in these units.

Cardiac telemetry units are for people who require cardiac monitoring but are not ill enough to require intensive monitoring in intensive care or coronary care units. The cardiac monitors used in these units usually transmit information wirelessly to make it easier for people to walk around and use the bathroom.

Step-down units (intermediate care units) are a type of intensive care unit for people who are too sick to go to a regular hospital bed but are more stable than people in the ICU. Not all hospitals have these units.


Isolation is used to prevent a person from infecting others. Isolation may be

  • Complete (when a disorder can be transmitted through the air), requiring hospital staff members who enter the person's room to wear a respirator, face shield, gown, and gloves

  • Incomplete (when a disorder is transmitted only by contact with the skin, blood, or stool), only requiring staff members to wear a gown and gloves

Reverse isolation is used to prevent a person from being infected by others. Reverse isolation is needed when a person’s immune system is not functioning well—for example, after bone marrow transplantation or after receiving chemotherapy.

Either type of isolation may involve the following:

  • The person is placed in a single room.

  • Anyone who goes into the room must wear the protective equipment described above.

  • The air in the room may be filtered.

  • Visitors are usually limited to the immediate family.

  • Small children and people with a weakened immune system should not visit someone with a contagious infection.

  • People with a contagious infection (even if only a common cold) should not visit people in the hospital, especially someone in reverse isolation.

NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
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