The Importance of Selecting the Right Hospital Doors

Here’s some advice about key design considerations when specifying doors in hospitals and other hygiene critical facilities.

Since microorganisms can be transmitted by contact, choosing the right doors can make a huge difference to infection control. Hospital doors can be a major source of contamination as they are the piece of equipment which is touched the most by patients and staff. Hospital doors are also vital for controlling clean air and traffic flow. This is why it’s crucial that the correct door is chosen as it can significantly affect the risk of infection.

Making the right door choice

When specifying hospital doors, considering the following points will not only help infection control, but it will also ensure building regulations are met and the doors operate efficiently, with a long, trouble-free lifespan.

• Hygiene performance
• Inorganic door construction
• X-ray and laser protection
• Hermetic sealing for clean air control
• Fire and smoke regulations
• Automations and accessibility
• Strength, durability and maintenance requirements
• Sound insulation
• Life cycle costs.

Choose Hygienic Door Materials

One of the most important aspects of a successful infection control policy, is choosing the correct materials for both the construction of the room and the components within it.

The Health Building Note 00-09: ‘Infection control in the built environment’ offers valuable guidance for architects and specifiers. ‘Doors should be cleanable, that is, smooth, non-porous and fluid resistant’. This is particularly crucial in areas where infection control is paramount.

Hospital doors should be carefully selected to ensure they are constructed using an inorganic hygienic material such as GRP (Glass Reinforced Polyester). Doors should also be easy to clean and resistant to moisture and disinfection procedures. A smooth construction should be defined as seamless with no texture, voids, reveals or laminated components which can harbor bacteria.

Specifying hygienic GRP doors for infection control

Hygienic GRP hospital doors are manufactured from a high technology moulded composite which has been independently tested. Laboratory tests conducted by IMSL (Industrial Microbiological Services) prove that hygienic GRP doors help prevent bacterial and fungal growth. Dortek Hygienic GRP doors have been independently tested by IMSL for resisting infections such as MRSA, Aspergillus Niger, Staphylococcus Aureus & E Coli.

Critical to the doors hygienic performance is its one-piece moulded GRP construction with no seams, joints or voids where bacteria, dust or dirt can build up undetected. The inorganic construction and water repellency of Dortek doors provides no sustenance for harmful microorganisms. Hygienic GRP hospital doors have no lips, joins or edges (even around vision panels). They have an easy to clean surface which is unaffected by moisture or common cleaning chemicals and disinfectants. Colour is also built into the gel coat of the door to provide continuous long-lasting protection, which is not reduced by impact damage.

Hermetic sealing for clean air control

Hermetically sealing doors should always be considered for reducing cross contamination through air flow in high risk areas such as operating rooms and patient isolation areas.

Hygienic GRP hospital doors can be supplied with hermetic sealing options for controlling air. Hermetic hygienic doors have a unique patented track system so it seals perfectly against the floor and frame. The efficiency of the seal has been officially tested and results show it to be over 99% effective thus helping to reduce the spread of airborne infections, cross contamination and air handling costs.

Third party tested fire ratings and lead protection

In certain areas of a hospital, evacuation in the event of a fire is almost impossible. Intensive care units and operating theatres are obvious examples. Fire doors are often the first line of defence in a fire and their correct specification can be the difference between life and death for building occupants.

Hygienic GRP doors have a vermiculite-core and can provide up to 4 hours fire protection. Vermiculite is a mined mineral rock, which is classed as non-combustible. Hygienic GRP fire doors have been third party tested and have a patented concealed intumescent strip built into the door. This maintains a smooth seamless profile ensuring that there are no seams or ledges where dirt and germs can gather.  It is also ideal for high traffic areas as it never comes lose or needs to be replaced. Hygienic GRP doors can also be supplied with x-ray ratings and sound insulation for the added protection of patients and staff.

Touchless automations to reduce cross contamination

Hygienic GRP Doors can be automated to provide hands-free entry and further reduce the risk of infection. The doors use an intelligent automation which is key for user safety. The automations react to the smallest obstruction and photo sensors stop the door from closing onto passing traffic. Doors can also be provided with access control systems, locking and interface with BMS (Building Management Systems) for extra security.

Durability and life cycle costs

With sustainability at the forefront of the healthcare sector, doors which require frequent servicing or redecoration should always be avoided. Hygienic GRP doors are up to 42% lighter than wood or laminate doors. This removes any need for expensive maintenance work or replacement due to excessive wear on hinges and closers. GRP is an exceptionally strong and heavy-duty material which gives it the lowest whole life cycle costs in comparison to other alternatives.

Complete project management from specialists with over 50 years’ experience

Dortek has over 50 years’ experience working in the healthcare sector and has completed over 2000 projects for the NHS, international healthcare authorities and the private sector.

Dortek’s in-house project managers work with architects to provide fully integrated, hygienic door systems which help to improve both infection control rates and operational costs. Dortek hygienic GRP doors are extremely versatile and can meet a wide variety of performance characteristics to suit all healthcare applications. This includes requirements for hygiene, fire ratings, smoke, air sealing control, touch-free automations, x-ray and laser protection, acoustics, water resistance, infection control and durability.

For these reasons Dortek hygienic GRP doors are specified by hospitals, architects, healthcare planners and infection control departments across the world.

Just some of the hospital’s already benefiting from using Dortek’s hygienic GRP hospital doors.

• The London Clinic, Harley Street, UK
• Great Ormond Street Hospital, UK
• School of Hygiene and Tropical Medicine, UK
• Royal London Hospital, UK
• Guys and St Thomas Hospital, UK
• New York-Presbyterian Hospital, US
• Yale University Hospital, US
• National Children’s Hospital, US
• Baptist Health South Florida, US
• St. Luke’s Hospital, US
• Sengkang General Hospital, Singapore
• Ng Teng Fong Hospital, Singapore
• Singapore General Hospital, Singapore
• KK Women and Children’s Hospital, Singapore
• National Heart Centre (NHC), Singapore
• National University Hospital, Singapore
• National Centre for Infectious Diseases, Singapore
• Alice Spring Hospital, Australia
• Vincent’s Private Hospital, Australia
• Royal Adelaide Hospital, Australia
• Mercy Hospital, New Zealand

Abstract

The physical design and infrastructure of a hospital or institution is an essential component of its infection control measure. Thus is must be a prerequisite to take these into consideration from the initial conception and planning stages of the building. The balance between designing a hospital to be an open, accessible and public place and the control to reduce the spread of infections diseases is a necessity. At Singapore General Hospital, many lessons were learnt during the SARS outbreak pertaining to this. During and subsequent to the SARS outbreak, many changes evolved in the hospital to enable us to handle and face any emerging infectious situation with calm, confidence and the knowledge that staff and patients will be in good stead.

This paper will share some of our experiences as well as challenges

Keywords:

Emerging infection, infection control measures

INTRODUCTION

When the statutes of the hospital of St John Bridgewater were developed in 1219, Bishop Joscelin of Bath commented -, “No lepers, lunatics or persons having the following sickness or other contagious diseases are to be admitted to the house, and if any such be admitted by mistake, they are to be expelled as soon as possible”.[1] Hospitals and healthcare institutions have certainly come a long way from the days of Bishop Joscelin. We are not as drastic in our sentiments today and we do not expel patients with infectious diseases. In fact, we admit them to suitably planned facilities and rooms and ensure that they do not cause unnecessary hazards to staff and other hospital users.

The physical design of a hospital is an essential component of its infection control measures to minimize the risk of transmission of any infectious disease. When historical and traditional hospitals were built, there were minimal concerns of new emerging infectious diseases. Today, with a more progressive outlook, it is the fundamental requirement to adopt a holistic view of the design and management of hospitals. Designing hospitals to be open, public spaces can make it difficult to control the spread of infectious diseases. The ease of travel and transportation today helps people cross borders easily. They can harbor, carry or catch infectious agents readily. During the Severe Acute Respiratory Syndrome (SARS) outbreak it became clear that the multiple public entrances in hospitals make it difficult, and often costly, to control entry and thus infiltration of infectious diseases.[2,3]

Only a few hospitals have an adequate supply of isolation and negative pressure rooms in wards, emergency departments (EDs) and Intensive Care Units (ICUs). While hospitals may not have complete control over host factors and agents, they are still responsible for the environment that surrounds the patients. By controlling and ensuring adequate sanitization of the environment of the host, hospital authorities can reduce the incidence of hospital acquired infections.

A decision on hospital buildings must be based on multiple factors besides cost, like fire protection, strength of construction material, hygiene, building health, environmental protection, sound isolation, energy saving, durability and utilization rate, among others. Even after initial completion of the hospital building, systematic data collection and feedback for addition, modification and upgrading of the infrastructure must be ongoing.[4] Built-in flexibility in design is becoming more crucial, mainly because technology is quickly obsolete and patient population is constantly changing. For example, single rooms may be more useful to have as they can be converted to isolation rooms more readily during an outbreak. Healthcare buildings are a complex environment with a need for specialized areas like high wear and tear areas, circulation areas, wards, specialized theatres and hazardous material chain of disposition. Choice of material and finish is also important and needs to be mainstreamed into the planning stages.[2,4]

With the challenges of new and emerging infectious diseases as well as higher public expectations and awareness of healthcare related issues, much consideration has to be given to these in the planning phase of building hospitals. For existing institutions and hospital buildings, renovation and upgrading plans must incorporate the necessary changes. Among the various methods for infection control two important environment factors are isolation and ventilation. Infected patients or those highly susceptible to infection need to be isolated in private rooms with proper ventilation systems in order to stop spread and reduce the possibility of developing a new infection. Bronson Methodist Hospital in Michigan demonstrated that private rooms, location of sinks and air flow design have resulted in a 10-11% decline in overall nosocomial infections rate.[5]

HOSPITAL DESIGN AND HAND HYGIENE

The experience of controlling SARS provided many lessons on how to prepare for a major outbreak. Improving general infection control measures and procedures as well as preparedness has the potential to enhance routine healthcare on a daily basis as well as increase our chance of a successful handling of the next pandemic.

One key component of limiting the spread of healthcare related infectious diseases is adequate infection control practice. A cornerstone of this is ensuring good hand hygiene. Hand washing has been recommended as the single most important practice to control hospital acquired infection. In isolation rooms, of observation and general wards, there are personalized hand washing facilities within each room to reduce cross-contamination. These isolation rooms help to prevent direct and even indirect contact transmission and droplet transmission. Access to examination gloves, alcohol-based hand-rub and trash containers or receptacle is also important. Many have the perception that unavailability or inadequate hand washing facilities and sinks contribute towards poor compliance. Few studies have prospectively evaluated the association between hand hygiene compliance and building plan and design. Lankford et al. found that hand hygiene compliance in a new healthcare facility (with more sinks provided) decreased significantly.[12] They concluded that peer and team behaviour have greater impact on good habits rather than just building design and ergonomics. This was echoed by a few other studies as well.[13,14]

INVASIVE PROCEDURES

In performing procedures where there exists a considerable and high risk of transmission, appropriate garment and devices have to be used. These would include, N 95 masks, goggles and face shields, hair and shoe covers, impervious gowns and aprons as well as positive pressure air-powered respirator (PAPR). The latter is a hood worn over the head and face to shield the healthcare personnel from air droplets and any secretions from infected patients when performing procedures such as suctioning and endotracheal intubation.

OTHER PRACTICES

In handling an outbreak such as SARS there must be good coordination at all levels. This would mean the communications must be excellent as well. Relevant messages, information and instructions must be disseminated effectively through an agreed upon channel or system. Notification of infectious disease cases must also be timely and this calls for staff to be highly vigilant.

At Singapore General Hospital, with the use of computerized records, it is easier to trace and track patients and information. This is important for contact tracing and syndromic surveillance. In the re-engineering of the departments, after SARS, inputs from clinicians and nurses were obtained. Infectious diseases specialists also played an important role from the inception, where they educated the engineers and architects as well as the contractors about potential infection control risks. Frequent site visits are a must. Caution must also be maintained when interpreting results from infection control literature, because the findings and recommendations are often based on retrospective investigations of infection outbreaks in particular settings and thus are tailored to those settings. They may or may not be applicable to other settings.[15,16]

CONCLUSION

In being able to handle outbreaks well, there must be collaboration and a consolidated strategy which is understood and practiced by all. At the hospitals there must be continuity between Emergency Departments, observation wards and general wards, ICUs, isolation wards, operating theatres, laboratories and outpatient clinics. However, this must go beyond just healthcare institutions and hospitals. At the national level, it must include primary care and general practice clinics, communicable diseases centers, government services, schools, the mass media and press, immigrations department, transportation department, pharmaceutical industry, the police and many more. Frequent exercises to practice and test out our preparedness are also very crucial because then only can we learn the setbacks and correct them.

The Ministry of Health, Singapore Medical Association, College of Family Practitioners and various other healthcare organizations have created a detailed plan called the Primary Care Pandemic Framework, to help primary care clinics work with the 18 government polyclinics to provide appropriate care for influenza and non-influenza patients during a pandemic. The Framework advises on how to prepare and organize a primary care clinic for a pandemic; including modifications to clinic workflow and processes to avoid cross infection, use of personal protection equipment, hospital referral and environmental design and cleaning.[17] Both infrastructure and design have a significant effect on our work in the healthcare sectors. This issue has often been taken for granted but now is the time to make it work for us and our patients.

Footnotes

Source of Support: Nil.

Conflict of Interest: None declared.

Hospital doors, especially those leading to and from high-risk areas like operating theaters, ICUs, and isolation wards, are frequently opened and touched.

This makes them potential hotspots for contamination. The right door, designed with hygiene in mind, can act as a barrier, preventing the spread of harmful pathogens from one area to another.

The Psychological Impact of Doors in Patient Care

Beyond the tangible benefits of infection control and energy conservation, doors play a subtle yet crucial role in the psychological well-being of patients. The right door can offer patients a sense of privacy, security, and comfort. For instance, a hermetically sealed door not only keeps out contaminants but also buffers noise, ensuring that patients can rest without disturbances.

Similarly, doors with vision panels allow medical staff to monitor patients without constantly intruding, giving patients a sense of autonomy and dignity. In essence, the doors in a healthcare facility contribute to creating an environment where patients feel cared for, respected, and safe.