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Eliminate curtains in patient areas - a risk management initiative

November 14, 2012
by James M. Hunt AIA
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Current thinking among some leaders in the field of behavioral health care design is now that curtains of all types should be eliminated from the patient environment to reduce risk management exposure.  This includes curtains at windows, showers and privacy curtains in multi-patient rooms.

 Even if the track is securely attached to a monolithic ceiling with no gaps, the portion of the track with the slot used to insert carriers has been removed (as recommended) and the carriers have some type of break-away fasteners for the curtain material, potential hazards still exist. 

Some of the potential hazards for any type of curtain are as follows:

     1. It was reported recently that a patient had managed to thread a ligature through the track over several of the carriers to obtain substantial hanging force.    

     2. The curtain can be gathered up into a bunch so that the holding weight of all of the break-away fasteners are added together.  Therefore, if each fastener will release at five pounds pressure and 20 fasteners are grouped together the holding force of 100 pounds can be achieved.

     3. If the curtain is removed from the break-away fasteners, the material can be used as a ligature in other ways such as tying a knot in the material and placing it over the top of a door and closing the door.

Possible solutions to these hazards for each type of curtain are the following:

    Window curtains now have some good alternative solutions to control light and views.  While curtains may be the most widely used window treatment in “typical residential environments” (if there really is such a thing) and given that they can visually “soften” a room, they also present some very serious potential hazards as listed above.  Roller blinds are now available which the manufacturer claims are safe for use in behavioral healthcare patient areas.  It is suggested that a sample be obtained for testing to determine if your facility’s Risk Management and Safety Programs are comfortable for their use in your facility.  Another option is to place this type of roller blind or a mini-blind behind a layer of shatter resistant glass or polycarbonate to keep the patients away from the blind itself.  Several types of ligature resistant operators are available for either of these products.

      Shower curtains have the same issues discussed above for window curtains.  When designing new construction projects, it is preferred to eliminate the need for a shower curtain altogether.  This can be done by providing a short wall that will help contain the water from the shower and/or placing the shower pan under the floor finish throughout the entire room.  This means that the entire bathroom is essentially designed as the shower.  This is sometimes referred to as a European style bathroom.  Of course, slip resistant flooring and other accommodations need to be included in the design of these rooms.   

      Cubicle curtains are discouraged because of the ligature issues discussed above as well.  Some facilities that are designed to treat patients with medical as well as psychiatric issues may find it necessary to provide these in multi-patient rooms.  If the facility’s Risk Management and Safety Programs support the need for these, the carriers should be non-metallic break away items and the staff should be trained on the potential hazards these represent.

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Jim Hunt

Behavioral Healthcare Design Consultant

Jim Hunt

www.bhfcllc.com

James M. Hunt, AIA, is a practicing architect and facility management professional with over 40...