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A Surefire Cure for Hospital Doorway Security

Few facility-types encompass as many applications all under one roof, or require as much attention to detail, as a typical hospital building. Maternity wards, patient rooms, psychiatric wards, business offices, surgical suites, storage rooms—each application within a hospital, necessitates distinct door security solutions that, although designed for different challenges, must integrate together to form a comprehensive, yet easily manageable security system. A thorough understanding of each application’s opening demands—security, life-safety, and convenience—is the first step toward securing doorways in a health care setting.

External Examination
As with any building, the first layer of access control begins with the outside entrances. Most hospitals have a main public entrance open during normal visiting hours, separate parking lot entrances for staff and employees, receiving areas for deliveries and an emergency room entrance open around the clock. Each opening serves a different purpose and will likely have completely different door and hardware requirements.

Convenience is the top priority for the main public entrance. The doorway must accommodate a steady flow of traffic and allow easy clearance for wheel chairs, a task best met with a slightly modified storefront entrance. The opening should have automatic sliding doors that provide ample space for wheel chairs. Since security is usually not of primary importance for the main entrance, the doorway might simply be equipped with a deadbolt tied into a networked access control system.

Emergency room entrances also need to be designed for convenience. Emergency medical personnel wheeling patients into the facility need quick and unencumbered access. This is accomplished with sliding doors or pairs of doors equipped with sensors that automatically open upon approach. Again, considering that ERs are open all the time, locking security is not a top issue.

Continuing around the building perimeter, security is the top consideration for employee entrances. These doorways often lead to offices or other restricted access areas and therefore must limit passage to credentialed personnel. Software-driven locking hardware is the ideal access control solution and is available in a number of variations.

A hardwired lockset integrated into a facility-wide security system permits central control of all connected locks. Commands such as changes in access privileges or a facility lockdown, can be issued to each lock in the network. Doors, frames, hinges and locking hardware pre-wired with plug-in connectors can cut down on the time and labor required to hardwire the opening, and allow for easy upgrade in the future. New wireless networking capabilities are also available that eliminate the need to hardwire each door.

If cost is an issue, stand-alone locks offer a dependable, yet lower priced security alternative. Stand-alone locks are also ideal for solitary doors isolated from the main body of wired openings, or in retrofit applications. All the options just mentioned—hardwired, wireless networked, stand-alone—can be combined together into an integrated system.

Receiving and loading dock areas require strong security, but with less demand for access control. Doorways in these areas are not access points for employees and are typically used to receive shipments and deliveries from outside suppliers. Strength and durability are the hallmark characteristics for these openings, attributes that are easily achieved with hollow metal doors and mortise locks.

The final perimeter doors to consider, stairwell egress and emergency exit, need a mix of security and life-safety; delayed egress exit devices provide both. When the exit device push bar is depressed it sounds an alarm and delays opening of the door for 15 seconds. This allows the staff ample warning if a patient or visitor attempts to leave through an unauthorized egress point. Life-safety is maintained by tying the exit device into the fire alarm system. The delayed egress feature is automatically deactivated if the fire alarm is activated.

Overall, the building exterior encompasses a mostly routine mix of mechanical and electromechanical hardware not unlike typical commercial or office facilities. It is the interior where the challenge really begins.

Internal Exam
Another common opening element found throughout health care facilities are corridor doors. Life-safety is the top function of these doorways. Code requires pairs of double egress doors for every 150’ stretch of corridor. Non-exit doors are typically held in the open position with either closer-holders or wall magnets, both equipped with release devices that are tied into the buildings fire alarm system. In the event of a fire, the doors automatically close to act as a fire or smoke barrier while allowing free egress from either side. Since these are fire-rated openings, positive latching is required through the application of exit devices, usually concealed vertical rod type. This type of exit device eliminates exposed bottom rods on the face of the doors, which can become a target for cart traffic.

Patient Needs
Most patient rooms throughout the facility will be equipped in the same manner: push/pull latches on wide doors hung with swing- clear hinges and bathroom doors fitted with hospital privacy locks. The combination provides great convenience and life-safety benefits, but where is the security? This all-important function is established at the ward entrances, each of which will likely have their own desired level of access control. Power operated doors and electronic locking devices are commonly used to tailor security to fit the needs of each area.

Ward Controls
Maternity wards probably receive the most visitors of any hospital area. Because the newborns spend time in the nursery away from the supervision of their parents, the primary security task is preventing abduction. Therefore, the goal is not keeping people out, but keeping people in. Concealed door closers or automatic operators activated by push button wall controls provide free access into the ward during normal visiting hours. Egress however, demands greater control and should be supervised from a nursing station with a commanding view of the doorway. The positioning should force all visitors, patients and facility personnel to pass nurses who control the door operators with a switch behind the desk. As an added protection, the doors should be equipped with magnetic detection devices and security tags should be attached to infants immediately after birth. The tags trigger an alarm that warns staff and security if the infant is carried through the maternity ward doors. This is also another area to consider delayed egress exit devices.

Conversely, critical care wards seek to limit the number of visitors. This can be accomplished with a doorway similar to the maternity ward but with the controls geared toward access rather than egress. A push button intercom system placed just outside the ward entrance allows visitors to communicate with the nurses’ station. An employee then checks to see if a patient is able to receive visitors. If so, a switch is used to open the door and allow access.

Crisis intervention units pose an entirely different challenge. Unlike other areas of a hospital, individual patient rooms in this section require hardware with special security and life-safety features. Patients in this unit, commonly referred to as a psych ward, are being kept against their will either because they are a danger to themselves or others. The doorway should be designed to take tremendous abuse and eliminate the possibility of a patient harming themselves. A strong mortise lock and either heavy duty hinges or pivots with “hospital tips” are needed to keep the door secure. The lock should have a special detention function that requires a key to open the door from either side. In addition, the doorway should be void of protrusions that might be used to inflict personal harm or broken off and used as a weapon. Sloping knobs developed specifically for this application and hinges or pivots with tapered “hospital tips” eliminate potential snag points that are considered a safety risk. Concealed door closers enclosed within the door or floor are also in order.

Pharmacy, Radiology and Operating Room Areas
Pharmaceutical storage rooms or closets are yet another security priority within hospitals. Strict access control must be maintained to secure narcotics, syringes and other medical supplies. A card reader or keypad lock connected to a centralized system, or a stand-alone lock with an audit trail feature provides the greatest level of accountability, especially when teamed with a video camera inside the space. If items are missing, the lock can be interrogated to determine when the door was opened and—based on the access code or card holder—who entered the room or closet.

Surgical suites should be secured to ensure a sterile environment prior to entering the operating room. The suite is usually divided into two sections: a scrub room and the actual operating room. The exterior of the scrub room should only allow authorized entry and be equipped with software driven hardware that requires appropriate access credentials. The entrance to the OR should facilitate hands- free passage, which can be accomplished with a low energy automatic door operator activated either by a motion sensor or wall button, or a push/pull latch that can be opened with a nudge of the body. Swing clear hinges are needed to allow sufficient clearance of gurneys and equipment through the doorway. In these sterile environments, concealed (overhead or floor) closers are an asset.

The Final Stitch
Each hospital or health care facility will likely have a number of special applications that add to the challenge. The objective is to link all the different applications together to form an integrated and manageable system of openings.

Configuring doorway security in a health care setting is a great challenge. A practical solution is to first define the security, life-safety and convenience needs of each application and then choose doors and hardware that will best fulfill the desired objective.

Robert Tibbling is a director of business development with ASSA ABLOY’s Door Security Solutions.

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