Anti-ligature knob and thumbturn lock
Keypad lock on hospital closet where soiled linens are stored
Authorized personnel can push to open for hands-free passage through door
Hospital lobby doors see heavy traffic
Baby formula stored in this room
Authorized personnel only, Phoenix Children's Hospital
Double doors open to allow gurneys through
Designing, installing and maintaining the openings in a healthcare facility is no simple task, but there is one way to make it easier. Standardizing on solutions from a single provider will ensure that you have more control over your openings. You will become more efficient in your installation and maintenance activities; key systems will be easier to manage, and you’ll notice smoother performance of your electronic access control and electrified door hardware. The results will be less maintenance and far more reliable performance.
Hospital doors used day in and day out withstand constant use and potential problems may not always be obvious. These may be products that aren’t functioning correctly and devices that just need a little maintenance to keep things running smoothly.
Here are a few issues that should be identified and addressed immediately.
- Latches that don’t engage, preventing doors from properly closing and locking (and don’t meet safety ratings)
- Malfunctioning closers that cause the door to slam shut or not close completely, as well as closers that don’t have covers or are leaking oil
- Corroded or worn hinges that don’t allow doors to open or close smoothly, including hinges pulling from the door frame causing binding
- Poor quality exit devices that can catch on clothing and carts, including damaged or missing end caps and missing or bent bottom rods
- Faulty power transfers that can prevent the use of credentials for entry
- Loose door hardware that can eventually break or inhibit easy use of the door
- Wall magnets that are loose, shoved into the drywall or malfunctioning so that electronics don’t work and doors end up being propped open.
Quiet Hardware: In areas used for patient care and staff concentration, the overall reduction of auditory disturbances is very important. Specially designed quiet latches and sound reducing exit devices can help. By incorporating exit devices with dampers that decelerate the mechanical push pads on the push and return stroke and motor-driven electronic latches, most noise associated with traditional exit devices is eliminated. Using a concealed vertical cable system eliminates the rattles of rods in the door and the clanking of rods on the floor.
Hinges: Healthcare facility doors get extremely heavy use. Doors that sag in their frames may be the result of faulty hinges. Continuous hinges provide support for the entire length of the door or pivot hinges that support the door at the top and bottom.
Antimicrobial Coatings: Infection control is another hot topic. Hospitals can leverage ActivClean™ door hardware made with CuVerro® antimicrobial copper surfaces. ActivClean proactively protects hospital patients and staff from infectious bacteria1 with a copper alloy surface that is proven to continuously kill bacteria, killing more than 99.9 percent of bacteria within two hours2.
A number of specialty door hardware solutions are available to create a safer and more efficient environment. Push/pull hospital latches help patients and staff members operate doors when their hands are full and they are ADA compliant. Specially designed anti-ligature devices help create a safer space for behavioral health patients. With unique sloped and recessed surfaces, these locks and hinges cannot be used as a ligature point for someone intending to do harm to themselves.
Also be aware that Joint Commission inspections now include a Life Safety specialist as part of the team. Life Safety codes require that certain doors have appropriate smoke seals and fire protection rating. Getting into compliance can be as easy as installing a steel door that seals tightly when closed. The seals also reduce noise, which is an important part of creating a quiet and safe environment for patients.
In addition to general issues that need attention in a healthcare facility, specialty openings have unique needs.
Cross-Corridor Openings: Doctors and other hospital personnel need quick, easy movement throughout the facility. Doors that don’t open as needed can sustain repeated damage from carts and other equipment banging into them. A smart solution is to automate the hospital’s cross-corridor openings.
To automate them with enough time for easy flow of traffic, locate a push or touchless actuator farther than from the door opening. By creating a longer distance between the actuator and the door, it lets the user trigger the actuator sooner with the result that a door is open by the time the user gets to it, minimizing damage from pushing. To make this transition, there are wireless actuator options that talk directly to the auto-operators and make installation simpler.
Labor and Delivery, Neonatal Intensive Care (NICU) and Nursery Departments: Security is one of the biggest priorities in these areas. While keeping mother and baby safe is of the utmost importance, maintaining a warm and nurturing environment is also imperative. These areas also include private patient rooms and care areas, public areas like waiting and vending areas and staff offices within the department. Facility managers and independent locksmiths need to consider:
- Coordination with infant abduction systems,
- Controlled access and monitoring of visitors coming and going within department,
- Reduction of unwanted noise,
- Openings that allow room for carts, gurneys and other equipment to pass easily
- Compliance with fire codes, and
- Reduction of dangerous bacteria.
Emergency Department: The fast pace and constant flow of people in and out of emergency rooms makes tracking visitors difficult. The constant wear and tear on doors and hardware means special care is needed to keep openings functioning properly. Increasing levels of violence also requires facilities to plan for the unexpected.
Hospitals need to be prepared for the following possibilities:
- Lockdown situations to contain violence,
- High use and abuse that causes damage to doors and hardware, and
- Behavioral health patients that require care areas designed to remove physical risk.
Patient Records Storage: Whether protecting physical patient records or computers that access them, patient records must be easily accessible and are often used by many people on any given day. However, HIPAA regulations require strict protection of confidential patient information. That means effective security systems are critical. Challenges include:
- Compatibility between locks, credential systems and/or hardware
- Adequate key and access control
- Adoption of wireless devices such as electronic locks to meet the needs of existing buildings that don’t permit easy installation of hard-wired access control systems
- Reduction of liabilities associated with a records breach and HIPAA regulations.
Although regular staff offices within a hospital may only be used by a few people, they also often contain highly sensitive information ranging from patient charts to inter-office communications. Suggest adding electronic access control to these openings in order to control access and track who has entered that specific door.
If the hospital can’t accommodate the installation of a networked access control system for records rooms or offices, consider a standalone electronic lock such as the Schlage CO-Series. This easy-to-use lock requires a PIN and/or other credential for entry and can track up to 2,000 events at each lock. The administrator can then know who used the lock and when.
Stairway Doors: Stairways in hospitals don’t typically see much traffic, aside from staff using them to get quickly from place to place. Stairwell doors play an important safety role by allowing quick, easy egress in an emergency. However, they can also compromise security by allowing access to unauthorized persons within the hospital.
Look for the following issues:
- Older doors may not be able to prevent unauthorized entrance
- Doors may not close and latch correctly
- Doors may not be up to current code
- Gaps between doors and frame don’t provide proper fire and smoke seal
- Doors propped open - compromising security and environmental air pressures.
One sure sign of an improperly functioning door is one that’s propped open with a broom handle or wood wedge. If there is one door that won’t close although it appears that all hardware is working correctly, check that all the other doors in the area are properly closed. Often fixing a door is as easy as making sure all the others are closing properly.
Patient Rooms: Patient room doors need to provide easy access for gurneys, equipment, wheelchairs and medical staff while still providing patients and family the privacy and safety they need. Because patient rooms turn over frequently, cleanliness is also critical to patient and staff wellbeing. Consider the following factors:
- Push-pull latches in place of standard levers to make doors easier to open when the user’s hands are not free
- Openings wide enough for equipment to pass to avoid damage to frame, hardware and door
- Door hardware made from antimicrobial copper solutions such as ActivClean from Ingersoll Rand to reduce the spread of infectious bacteria
- Kick plates that cover the appropriate amount of the door to avoid damage from cleaning equipment.
Doors that aren’t quite wide enough to let carts or equipment pass easily can be made wider by changing to swing-clear hinges. These hinges let the door swing past the frame to maximize the size of the door opening.
Patient Restrooms: Patient restrooms must provide privacy but also the right safety features to prevent injury to the patient and provide quick, easy staff access in an emergency. Consider these issues:
- Doors should swing outward to allow staff access in the event of a patient fall
- Push/pull latches with a privacy function
- Locks with a release on opposite side provides for emergency access
- Use of overhead stops on doors that may swing into walls and cause damage
- Doorways wide enough for wheelchairs to pass easily.
Hospital Pharmacy and In-Department Pharmaceutical Storage: When it comes to the pharmacy, theft is the number one security concern. Pharmaceutical supplies are accessible to staff members across shifts and possibly from other departments. These areas may also be in view of patients and/or accessible to visitors. Access control and tracking is critical to preventing drug theft and maintaining patient confidentiality.
Pharmacy requirements include:
- Maintaining key control and/or accurate access management
- Use of the correct device for the opening – whether it’s access to a room, or a cabinet
- A quality lock will not have lever sag, which may prevent correct latching, compromising security.
A great way to control pharmacy access is with biometric readers. Biometric readers, networked or standalone ensure only those who are authorized gain access to these sensitive areas.
Receiving Dock: The shipping and receiving dock in a hospital is one of the most vulnerable areas when it comes to security and access control. Staff and delivery personnel come and go through this area 24 hours a day, creating a need for effective and reliable access management.
Linens/Hazmat: Linen storage rooms do not typically see high traffic but they do take abuse from carts being pushed in and out, banging into the door and frame. Allowing only the people who should to have access to these areas is very important as linen chutes and other hazmat receptacles pose a risk for transfer of infectious materials. Be aware that:
- Doors are not propped open to allow unauthorized or accidental access,
- Damage to doors from carts and equipment can compromise latching, closing and locking
- Using access control measures such as electronic locks can eliminate unauthorized access.
Ann Geissler Timme is Ingersoll Rand Security Technologies’ Healthcare Marketing Manager.