Hospitals typically require a more unique approach to security than office, commercial and manufacturing facilities because they never close. Most hospitals have extended visiting hours and the "always open" emergency room that brings in people with a variety of critical situations. Additional considerations include protecting employees, patients (including newborns), patient records and controlled substances.
Exterior doors used for patient traffic usually have double sliding glass doors with each leaf at least 44 inches wide to satisfy code and make it easier for a gurney to enter or exit. Most access doors are unlocked from approximately 8 a.m. to 6 p.m. while the largest numbers of hospital personnel are at the facility.
In many hospitals, a contingency of security personnel are on duty 24 hours a day. During non-standard (6 p.m. to 8 a.m.) hours, the emergency room and sometimes the patient rooms are accessible. Later in the night when visiting hours are over, the number of publicly accessible exterior doors is reduced, usually limited to the emergency room. In the morning, exterior access doors are unlocked providing access for outpatient surgery, patient visitors and accommodate standard business operations.
Many hospital openings are fire rated. Exterior openings that are not for patient access purposes can be single or double hollow metal doors. To control entry, these doors may be equipped with a card reader, electromechanical lock, keyed trim handle or lock cylinder.
While visiting several healthcare facilities for the purpose of this article, a locksmith was asked to put an electromechanical lock on a pair of outswinging doors. The existing lock mechanisms were two rim exit devices with strikes attached to a removable mullion. There was no trim on the exterior of the door. The employees wanted an alternative entry into the facility.
The office and small occupancy load spaces can have cylindrical or mortise locks. If these rooms are equipped with double door entries, they may have an astragal and door coordinator or meeting stile gasketing. Brush gasketing can be installed onto each lock side stile where the brush mesh from 1/32" to 1/16".
Some hospitals are converting from mechanical locks to electromechanical locks throughout the facility, using employee identification badges as credentials to provide access to offices, specific units, personnel lockers and specialty locks. The ultimate goal is eliminating the need for medical personnel to carry keys.
Networked electromechanical locks can give the hospital administration/security the ability to instantly add or delete users, change schedules, monitor when access is attempted or gained and when someone is tampering with a lock. To provide an additional level of security, a number of hospitals are incorporating video surveillance at entries, public spaces and along corridors.
Antimicrobial Door Hardware
To protect patients and personnel, many hospitals have treated door hardware with antibacterial coatings designed to resist the growth of microbes. Hardware manufacturers can apply silver, zinc or copper based coatings for protection against microbes. The silver based coatings are sold under the names of MicroShield, UltraShield, BioCote and others. According to Trimco, their copper based CuVerro will not turn black, green or otherwise patina and will last the lifetime of the hardware. Coated metal hardware can include exit devices, locks, push/pull handles, railing, door/drawer pulls and anti-vandal trim.
Door Closers
Most hospital high traffic exterior doors are high powered sliding doors providing a wide opening width and glass panel visibility not available using standard swing doors. These openings have safety sensors to open, stay open and reverse direction when someone enters the sensors areas. There are sensors on the exterior side of the door as well as the interior side.
For non-powered openings, Norton developed the SafeZone, a multi-point, electromechanical door closer with a programmable motion sensor designed to detect movement within range. When the door is opened and movement is detected in either direction, the closer stops the door from closing until there is no movement within the detection area. Once movement is no longer detected, the door closes. Sensor detection and hold open time are adjustable.
Imaging Equipment Doors
A hospital's imaging equipment incorporates different kinds of radioactive materials to provide X-ray, mammography, image scans and ultrasound results. Lead lined rooms, doors and safe storage for mobile equipment are required. One hospital had a door in the Radiology Treatment department that appeared to be about one foot thick. Typically imaging room doors are lead lined while treatment room doors can be either lead-lined or solid lead or other material that is resistant to radiation. Having an imaging department can require having secure storage capability and additional security measures for the bio-hazard and radioactive waste.
Pharmacies
Some hospital pharmacies stock large amounts of controlled substances that need a safe or vault for containment. Once released from the pharmacy, patient units sometimes store prescriptions in locked cabinets of substantial construction prior to dispensing. To prevent abuse from both authorized and unauthorized personnel, procedures must be in place to ensure proper security and dispensing of medications. This can include using electromechanical locks with audit trail and two-lock systems that require two people to unlock.
Patient Records
Patient records must be secured with locks providing audit trail. The audit trail must provide history of any access or attempted access including key override. Not all electromechanical locks with audit trail include override key operation.
Maternity & Psychiatric Wards
Infant protection includes tags strapped to an ankle, controllers that are located at all exits and where practical delayed egress door hardware. When an infant with a tag is moved past a controller, the alarm sounds notifying, the unit that someone is trying to remove a baby. The tags protect infants from abduction and safeguard against mother and infant mismatches.
Hospitals that provide psychiatric services must have ways to at least slow down patients from simply walking out of the unit. With legal protection, people can no longer be locked in. To restrict patients from endangering themselves by unauthorized exiting, hospitals use delayed egress door hardware and video surveillance in corridors and at critical locations including exits. Within psychiatric units, ligature resistant hardware replaces conventional hardware in an effort to prevent suicide by strangulation. Ligature resistant hardware includes locks, handles, hinges, showerheads, valves, faucets sinks, grab bars and furniture.
Quarantine
For quarantine situations, some units must limit the outside air from entering and restrict the unauthorized from entering, possibly endangering the health of the patients or the medical personnel. Some hospitals have incorporated the use of intercom systems at the unit entries to determine who can gain access.
Interior Doors
Within a hospital there are fire rated single and double doors. The main corridor doors leading into surgeries, imaging and patient units are same swing double doors or double egress doors. Double egress doors are normally installed within corridors where there is an exit path in both directions.
These fire rated doors are required to have exit devices. They are usually equipped with concealed vertical rod exit devices to prevent damage that can be caused by gurneys, carts and mobile imaging equipment. In newer construction, these openings will have top rod only (LBR) exit devices. These Less Bottom Rod equipped exit devices eliminate obstructions that can cause tripping (i.e. bottom strike).
Important: Removing the bottom rod from a standard vertical rod exit device installed onto fire rated opening, can void the label of the door, frame and/or the exit device. Each of these components is individually listed and approved for the hardware, and must be confirmed to support the use of LBR in the application.
To take the place of the latching mechanism of the bottom rod, code requires a heat activated auxiliary fire pin mechanism. The factory installed fire pin is mounted into one door and the pin receiver is installed into the other door or jamb. When there is a fire and the heat reaches the designed temperature, the pin projects from the door edge into the pin receiver in the other door edge or jamb. Depending upon the door manufacturer, they can install one or two fire pins and receivers.
These fire rated doors and jambs are almost always equipped with power door operators, safety sensors, exit devices and activation switches on the interior side of the doors. Card readers are on the exterior. Because these doors are power operated and the hospital wants to restrict access, some doors are not equipped with any trim.
Doors can be equipped with a variety of protective features. Metal edging can protect the hinge and/or lock edge of a door. Edging is available in different lengths and can be ordered with cutouts for the hinges or the lock. For door faces, there are mop plates (under 8" height), kick plates (8" to 16" height) and armor plates (up to 48" height). For most fire rated doors, you must follow all codes in order to properly install the different sized plates.
Crash Carts
Within a unit, there will be a number of patient rooms and a nurses’ station. The nurses’ station or the area surrounding will have computer, paper files, lockable cabinets, refrigerator, crash carts, medication carts, etc.
Most crash carts are no longer equipped with padlocks or cabinet locks. They are equipped with tamper-evident plastic security seals and padlock seals that make it easier and faster to access the contents, prevent pilferage, promote user accountability and indicate when a cart is stocked and ready or needing supplies. Seals are available in various sizes and can be ordered with sequential numbering.
Pharmaceutical Storage
Some pharmaceuticals require a locked refrigerator with audit trail. For temperature controlled monitoring, CompX offers the eLock 200 and 300 Series access control locks for refrigerators and freezers. They automatically record temperature at programmed intervals, with all data history archived. The latest eLock records up to 500,000 temperature data points and provides a comprehensive audit trail of the last 15,000 access attempts. They can accommodate up to 3,000 user/supervisors codes.
Modes of access include keypad, proximity card and Magstripe card. The 300 Series network lock can use iClass HID credentials. It also offers an escalating notification system.
Patient Rooms
Hospitals separate patient care units into specialties including cardiology, intensive care, oncology, pediatrics and obstetrics to name a few. These units can be any number of rooms built within a specific fire corridor. To gain entry or egress from these units, there is a double door opening with power operator and sensors. For double swing doors, many hospitals install fire rated meeting stile gasketing - split astragals as to meet code. They can be order as silicone or nylon brush. Brush overlap can be 1/16".
Within a hospital, there are a number of non-standard use and no use of door hardware. Probably, the greatest difference is that patient room doors, which are fire rated are not equipped with door closers. There are some exceptions, however, this is the general rule for the hospitals I toured for this article.
Private (single) patient rooms reduce the possibilities for infection, make healthcare workers more efficient, afford a greater measure of privacy and provide adequate room for family members to partake in the patients' healing process.
Most patient room swing doors are equipped with push-pull handles. Some newer hospital rooms are using a three-part telescoping slider door assembly, comprised of sliding glass framed doors with no-locking levers and a hook bolt. This door design takes the place of the front wall of the room. The three leafs slide against one wall when opened, providing easy access for gurneys and testing equipment.
Patient restrooms are equipped with privacy locks. Some are cylindrical bathroom door locks equipped with an exterior T-turn. The spring loaded T-turn is normally horizontal whether the door lock is locked or unlocked. If the door is locked and hospital personnel need access, turning the T-turn clockwise unlocks the locking mechanism, permitting access. Some bathroom doors are equipped with mortise locks with an indicator and a turn knob on the exterior.
Security at hospitals seems to be moving towards electromechanical locks at an increased rate, enabling closer monitoring of the more sensitive areas within the hospital.
Manufacturers discussed in this article in alphabetic order are:
CompX Security Products, P.O. Box 200, Mauldin, SC 29662. Telephone: 864-297-6655. Web Site: www.compx.com
Norton Door Controls, an ASSA ABLOY Group company, 3000 Highway 74 East, Monroe, NC 28112. Telephone: 800-438-1951. Web Site: www.nortondoorcontrols.com.
Trimco Triangle Brass Manufacturing Company, Inc., P.O. Box 23277, 3528 Emery Street Los Angeles, CA. Telephone: 323-262-4191 . Web Site: www.trimcobbw.com
