Health Building Note 00-10 Part E: Curtains and tracking - Health Facilities Scotland
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1
2
3 Health Building Note 00-10
4 Part E: Curtains and
5 tracking
6
7 Version 1.0
8 February 2020
9
10
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HBN 00-10 Part E Curtains and Tracking February 2020Controlled circulation not for publication
Version Date Author Changes
history/revisions
Version 1.0 14 February 2020 Jenny Gill Created skeleton draft from the structure of the 2018 Scoping
document. Draft developed in line with working group requirements
and review by policy lead (Michael Rope).
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12 Introduction to NHS Technical
13 Standards
14 Prelim to be inserted here when finalised.
15
16 Health Building Notes (HBNs)
17
18 Health Building Notes give best practice guidance on the design and planning of new healthcare
19 buildings and on the adaptation or extension of existing facilities. The Health Building Notes have
20 been organised into a suite of core subjects. Care-group-based Health Building Notes provide
21 information about a specific care group or pathway but cross-refer to Health Building Notes on
22 generic (clinical) activities or support systems as appropriate. Core subjects are subdivided into
23 specific topics and classified by a two-digit suffix (-01, -02 etc), and may be further subdivided into
24 Supplements A, B etc. They provide information to support the briefing and design processes for
25 individual projects in the NHS building programme.
26 Where there is an opportunity to build a new department/ facility or refurbish an existing one, it
27 provides the opportunity to design a modern department that inspires and intuitively supports safe,
28 effective and efficient patient care, with the flexibility to meet future developments in healthcare,
29 technology and patient needs.
30
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31 Contents
32 Introduction to NHS Technical Standards ............................................................................................... 3
33 Health Building Notes (HBNs) ............................................................................................................. 3
34 Glossary ................................................................................................................................................... 7
35 Terminology ............................................................................................................................................ 7
36 Executive Summary................................................................................................................................. 8
37 Policy and regulatory overview....................................................................................................... 8
38 Patient safety alerts ........................................................................................................................ 8
39 Acknowledgements................................................................................................................................. 9
40 1.0 Introduction to Health Building Note 00-10 Part E ......................................................................... 10
41 Background ....................................................................................................................................... 10
42 2.0 Scope and status of this document................................................................................................. 11
43 3.0 Mental health environments .......................................................................................................... 12
44 4.0 Ensuring that building components are fit for purpose.................................................................. 13
45 5.0 Cubicle curtain track ....................................................................................................................... 14
46 Constituent parts .............................................................................................................................. 14
47 Materials ........................................................................................................................................... 14
48 Strength ............................................................................................................................................ 14
49 Height ................................................................................................................................................ 15
50 Layouts .............................................................................................................................................. 15
51 Track suspension ........................................................................................................................... 17
52 Cubicle Curtains ................................................................................................................................ 18
53 Selecting cubicle curtains .............................................................................................................. 18
54 Cubicle curtain parking ................................................................................................................. 19
55 Hanging cubicle curtains ............................................................................................................... 19
56 Cubicle curtain changing ............................................................................................................... 20
57 Window curtain track ....................................................................................................................... 20
58 Constituent parts .......................................................................................................................... 20
59 Track suspension ........................................................................................................................... 21
60 Materials ....................................................................................................................................... 21
61 Strength......................................................................................................................................... 21
62 Height ............................................................................................................................................ 22
63 Window Curtains............................................................................................................................... 22
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64 Selecting window curtains ............................................................................................................ 22
65 Window curtain parking................................................................................................................ 22
66 Hanging window curtains.............................................................................................................. 22
67 Window curtain changing ............................................................................................................. 23
68 Shower curtain track ......................................................................................................................... 23
69 Constituent parts .......................................................................................................................... 23
70 Materials ....................................................................................................................................... 23
71 Strength......................................................................................................................................... 24
72 Height ............................................................................................................................................ 24
73 Shower Curtains ................................................................................................................................ 24
74 Selecting shower curtains ............................................................................................................. 24
75 Shower curtain parking ................................................................................................................. 24
76 Hanging shower curtains .............................................................................................................. 24
77 Shower curtain changing .............................................................................................................. 25
78 6.0 General guidance ............................................................................................................................ 26
79 Exposed surfaces............................................................................................................................... 26
80 Fire propagation................................................................................................................................ 26
81 Electrostatic charges ......................................................................................................................... 26
82 Quietness and smoothness in operation .......................................................................................... 26
83 Resistance to mechanical wear......................................................................................................... 26
84 Low-weight release systems ............................................................................................................. 27
85 Cubicle curtain track release systems ........................................................................................... 27
86 7.0 Risk assessment .............................................................................................................................. 28
87 8.0 Fitting and maintenance ................................................................................................................. 29
88 Fitting ................................................................................................................................................ 29
89 Testing and training ...................................................................................................................... 30
90 Maintenance ..................................................................................................................................... 30
91 General.......................................................................................................................................... 30
92 Replacement parts ........................................................................................................................ 30
93 Housekeeping ............................................................................................................................... 30
94 Hygiene and cleaning .................................................................................................................... 31
95 Appendices............................................................................................................................................ 32
96 Appendix 1 ........................................................................................................................................ 32
97 References ............................................................................................................................................ 33
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98 Acts and Regulations ......................................................................................................................... 33
99 Technical Standards .......................................................................................................................... 33
100 British Standards ............................................................................................................................... 33
101 End notes .............................................................................................................................................. 34
102
103
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104 Glossary
BS British Standard
BRE Building Research Establishment
CAS Central Alerting System
CDM Construction, Design and Management
DiMHN Design in Mental Health Network
EFA Estates and Facilities Alert
HTM Health Technical Memorandum
HBN Health Building Note
ISO International Organisation for Standardisation
MDRO Multi-drug resistant organisms
PAS Publicly Available Specification
PSRF Patient Safety Response Framework
QAC Quaternary ammonium compound
SIF Serious Incident Framework
105
106 Terminology
107 In this HBN the following definitions apply:
Cubicle curtain track system A component assembly to support curtains forming cubicles.
Track The horizontal member which supports the runners and the
curtains.
Suspended track Track fixed at a level significantly below the ceiling soffit.
Ceiling fixed track Track fixed directly to the ceiling soffit.
Track height Dimension from finished floor level to underside of track.
Parking of curtains The drawing back and bunching of curtains to predetermined
positions when not in use.
Loading device A device to facilitate the removal and replacement of
curtains.
Low weight release system Designed to reduce the possibility of patient self-harm, this is
(ligature reduction) a system that will securely retain the load for which it is
designed, but when an abnormal load is applied, it will
release the load.
108
109
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110 Executive Summary
111 [To be finalised following technical engagement.]
112 This update of the NHS Technical Standard on curtains and tracking places greater emphasis on
113 patient safety than the previous version (which was published as part of the now-archived Building
114 Components series, see Introduction below).
115 It should be read in conjunction with the following documents:
116 HBN 00-11i, which is a new document providing design guidance for the NHS on reducing
117 ligatures and general patient safety in healthcare environments.
118 DiMHN / BREii “Design Guide for products installed and used within building and facilities,
119 used for the care of Mental Health – Test Methods and performance categorisation and
120 criteria”. [Update title if it changes before publication.]
121 The reader’s attention is drawn to the following concerning patient safety.
122 Policy and regulatory overview
123
124 The policy and regulatory context includes the following:
125 The Health and Social Care Act 2008 - Code of Practice on the prevention and control of
126 infections and related guidance Infection control:
127 https://www.legislation.gov.uk/ukdsi/2014/9780111117613/contents
128 Care Quality Commission (CQC):
129 https://www.cqc.org.uk/guidance-providers/regulations-enforcement/regulations-service-
130 providers-managers
131 Never events:
132 https://improvement.nhs.uk/documents/2266/Never_Events_list_2018_FINAL_v5.pdf
133
134 Patient safety alerts
135
136 It can be helpful for commissioners and design teams to view recent patient safety alerts in order to
137 inform the developing design. These are available on the Central Alerting System and include Estates
138 and Facilities alerts. These can be accessed at:
139 England:
140 https://www.cas.mhra.gov.uk/Home.aspx
141 Wales:
142 http://www.nwssp.wales.nhs.uk/estates-and-facilities-alerts-efa-
143 Northern Ireland:
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144 https://www.health-ni.gov.uk/articles/niaic-estates-and-facilities-alerts
145 Scotland:
146 http://www.hfs.scot.nhs.uk/publications-/iric-safety-alerts/?show=20&set=2
147
148 Estates and Facilities Alerts identifying issues to do with tracking include:
149 EFA/2010/009: Flush fitting anti-ligature curtain rails: ensuring correct installation
150 EFA/2010/003: Cubicle Curtain Tracks; Anti-ligature curtain rails (including shower
151 curtains), risks from incorrect installation or modification.
152 EFA/2019/003: Anti-ligature’ type curtain rail systems: Risks from incorrect installation or
153 modification
154 A new Patient Safety Response Framework (PSIRF) is being developed to replace the current Serious
155 Incident Framework (SIF) and is due to roll out in 2021. More information is available on the NHS
156 Improvement website at https://improvement.nhs.uk/resources/about-new-patient-safety-incident-
157 response-framework/iii
158 Information on patient safety alerts can be found at:
159 https://improvement.nhs.uk/resources/patient-safety-alerts/. There is also a useful video on NHS
160 National Patient Safety Alerting System on the site.
161
162 Acknowledgements
163 [To be inserted]
164
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165 1.0 Introduction to Health Building
166 Note 00-10 Part E
167 Background
168
169 1.1 HTM 66 was first issued in 1989 and produced by NHS Estates as a subset of the Building
170 Components topics. It formed part of a suite of documents that was intended to set and
171 maintain appropriate standards for the specification of construction for the common
172 elements (e.g. doors, windows, flooring, ceilings) in health buildings. HTM 66 covers design
173 guidance on cubicle curtain tracking (such as track height, spacing and location of fixing points,
174 different configurations of cubicle layouts) and the user requirements of that tracking (such
175 as fire propagation, strength, cleaning and disinfection). The document was moderately
176 revised in 2005. This revision introduced text on low-weight release systems for reducing the
177 risk of patient self-harm, following the report of the Chief Medical Officer in 2000 (An
178 Organisation with a Memory) that instructed mental health trusts to remove all non-
179 collapsible bed and shower curtain rails by March 2002.
180 1.2 HBN 00-10 Part E replaces HTM 66. It should be read in conjunction with the following
181 documents:
182 HBN 03-03iv, which is a new document providing design guidance for the NHS on
183 reducing ligatures and improving general patient safety in healthcare environments.
184 DiMHN / BREv “Design Guide for products installed and used within building and
185 facilities, used for the care of Mental Health – Test Methods and performance
186 categorisation and criteria”. [Update title if it changes before publication.]
187
188
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189 2.0 Scope and status of this document
190 2.1 HBN 00-10 Part E is one of a series of HBNs which provide specifications and design guidance
191 on building components for health buildings. It offers guidance on the technical design and
192 output specifications in healthcare environments of:
193 curtain cubicle track;
194 window curtain tracks;
195 shower curtain tracks.
196
197
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198 3.0 Mental health environments
199 3.1 It should be noted that if tracks and curtains are to be fitted in a mental healthcare
200 environment that other considerations such as location, observation and usage should be
201 considered.
202 3.2 If tracks are to be fitted within an area used for mental healthcare, then care should be taken
203 on the type of track used. If the system uses a conventional slotted track it may be possible
204 for items to be lodged in the slot within the rail to create a ligature anchor point.
205
206
207
208 3.3 If conventional slotted tracks are used, then gliders from other systems will fit and might be
209 used. If these incorrect gliders are introduced, then the system may not release when weight
210 is attached leading to a greater risk of ligature and self-harm.
211 3.4 Where magnetic track is used, ie where it detaches from the wall and ceiling it is important to
212 ensure that the falling track will not lodge on to adjacent furniture, thus leaving it suspended
213 at height.
214 3.5 Curtain rail systems are in continuous development by specialist manufacturers and there are
215 now some available which do not use a slotted track, designed with runners / gliders to slide
216 on the outside of the rail profile with the rail being securely fixed to the wall.
217 3.6 It should be noted that all curtains offer the opportunity to form a ligature, therefore it is
218 important to ensure that the rail does not offer an anchor point for that ligature.
219
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220 4.0 Ensuring that building components
221 are fit for purpose
222
223 4.1 This HBN was prepared for publication in March 2020. The main sources of data used in the
224 preparation of this HBN are listed in the references section. Readers should always ensure
225 that they use the latest or new edition of all building legislation, British Standards and other
226 relevant legislation and guidance, which may post-date the publication of this document.
227 4.2 The content of this HBN does not diminish either the manufacturer’s responsibility for fitness
228 for purpose of products or the design team’s responsibility for selection and application of
229 products to meet project requirements.
230 4.3 Design teams are reminded of their obligations under the Construction, Design and
231 Management (CDM) Regulations 2015 to ensure safe construction.
232 4.4 First preference should be given to products and services from sources which have been
233 registered under ISO 9000 quality assurance system procedures or other certification
234 schemes.
235 4.5 Suppliers offering products other than to British Standards should provide evidence to show
236 that their products are at least equal to such Standards.
237 4.6 Additionally, care must be taken in the mental health environment to ensure that every effort
238 is made to reduce ligature anchor points and ligature risk and therefore specialist components
239 manufactured for use in those environments should be used where the track is to be installed
240 in a patient area.
241
242
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243 5.0 Cubicle curtain track
244 Constituent parts
245
246 5.1 Each cubicle curtain track system may comprise the following elements, all of which
247 contribute to patient privacy, dignity and safety:
248 track;
249 wall fixing devices;
250 direct-to-ceiling fixings – vertical hangers – V-hangers;
251 bay connectors;
252 end stops;
253 gliders or runners;
254 low-weight release systems (reducing ligature risk) for mental health environments
255 and other spaces as required (See section on Low-weight release systems).
256
257 Materials
258
259 5.2 All parts must be of corrosion-resistant materials. Choice of materials should be such that they
260 do not suffer metal corrosion or polymer degradation. Consideration should be given to the
261 age of existing products, as deterioration can happen over time. A planned preventative
262 maintenance policy should be in place. No constituent part should contain material:
263 known or reasonably believed to constitute a health hazard under normal conditions of
264 use;
265 which will give off toxic products in the event of a fire.
266
267 Strength
268
269 5.3 The weakest components in the system should be the gliders or runners particularly where
270 ligature reduced products have been used which are designed to fail in the event of weight
271 being added.
272 5.4 All curtain track suspension (braced or unbraced) should have a breaking strength of not less
273 than 180 kg between upper and lower fixing points at any location within the collapsible
274 subsystem (see also section on low-weight release systems) for rails used in mental health
275 settings.
276
277
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278 Height
279
280 5.5 There are a number of factors to be considered in determining cubicle curtain track height
281 and the related form of suspension or direct fixing to the ceiling:
282 One of the most important considerations is the effect of curtains, whether drawn or
283 parked, on natural and artificial lighting.
284 Design teams should also consider the appearance of track and curtain configurations
285 within and around the cubicles. Track height may need to coordinate with window head
286 height or glazed screen depending on configuration.
287 5.6 For suspended track installations, track height will normally be 2100 mm.
288 5.7 Ceiling-fixed track applications are normally limited to ceiling heights of up to 2700 mm.
289 5.8 Many manufacturers work to these standard heights.
290
291 Layouts
292
293 5.9 Space within and around cubicles should take account of the dimensional guidance contained
294 in the HBN series, especially HBN 04-01 – ‘In-patient accommodation – options for choice’ and
295 HBNs 00-01-04, which cover common activity spaces.
296 5.10 With the move towards single bedrooms in the mental health sector as identified in HBN 03-
297 01 – Adult acute mental health units, (section 8.40)vi there is less likelihood of cubicle tracking
298 being used in dormitories to form bays. Should the area be dormitory style in a mental health
299 facility then consideration should be given on how to separate the beds in a safe manner.
300 5.11 Cubicle curtains are usually required for privacy and dignity for certain clinical requirements,
301 they should not be used for activities of daily living.
302 5.12 Generally, cubicle tracking will be used more frequently as a single privacy curtain in areas
303 where patients are accompanied by staff, such as the treatment rooms and assisted
304 bathrooms. This does not mitigate the use of reduced ligature tracking as there may be
305 occasions when a patient is alone for short periods of time.
306 5.13 Examples of single- and multiple-bay cubicle layouts and their relationship to walls or
307 partitions are given in Figures 1 and 2 below.
308
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309 Figure 1 Single bay cubicles
One sided
Two sided
310
311 Three sided
312
313 Figure 2 Multiple bay cubicles
314
One sided
315
316 Two sided
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317
318
319 Track suspension
320
321 5.14 In both suspended and ceiling-fixed track systems, the spacing and location of fixing points
322 should be strictly in accordance with the manufacturers’ recommendations. See also section
323 on fitting when locating in mental health accommodation.
324 5.15 Suspended track must be restrained to prevent horizontal movement by:
325 direct fixing of track to flank walls or partitions;
326 tie-bars;
327 V-hangers fixed to the ceiling;
328 any combination of these as appropriate to the layout;
329 5.16 Note that V-hangers have a very limited application. A tie-bar with wall fixing provides much
330 more effective lateral restraint.
331 5.17 Tie-bars comprise lengths of track which are not fitted with gliders or runners; this ensures
332 consistency of appearance and standardisation of fittings.
333 5.18 Ceiling-fixed track needs no restraint to prevent horizontal movement.
334 5.19 Hangers supporting track are generally of rod construction. However, wire hangers are
335 preferred when the hanger is longer than 1000 mm or when raking hangers must be used
336 because a ceiling fixing is not practical (for example, a weak membrane in an existing ceiling).
337 5.20 Obtain advice from the manufacturer whenever unusual project conditions apply.
338 5.21 Some examples are given in Figures 3–5. In Figure 3, wall fixings at one end of front rail (with
339 tie-bar where necessary) provide adequate lateral support for up to eight cubicles. Beyond
340 that, the track manufacturer should be consulted.
341
342 Figure 3 Tie-bar
343 TB (tie-bar)
344
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345 5.22 In Figure 4, V-hangers provide lateral restraint on inner tracks of up to three cubicles when no
346 wall fixing on front rail can be provided. Beyond three cubicles, the track manufacturer should
347 be consulted.
348 Figure 4
349
350 5.23 As shown in Figure 5, where the arrangement of windows, engineering services and bedhead
351 units permits, curtains may be parked on an extension of the track fixed parallel to a wall and
352 supported by a wall bracket. This support is as effective as the normal wall fixing which is used
353 where track meets wall at 90°.
354 Figure 5
355
356 Cubicle Curtains
357
358 Selecting cubicle curtains
359
360 5.24 Commissioning and design teams must cooperate when selecting curtains, particularly when
361 deciding on the thickness, colour and fullness of curtains and the adequacy of suspension
362 tape.
363 5.25 Disposable curtains may be considered for use in certain areas, particularly in clinical areas
364 where infection control may be an issue and can be procured through the NHS Supply Chainvii
365 Net zero carbon targets should be considered when choosing between disposable and
366 laundered curtains.
367 5.26 Materials which are anti-microbial, anti-bacterial and/or anti-sporidal may be considered to
368 assist in infection control, particularly in areas at risk of cross infection, but it should be noted
369 that HBN 00-09viii states: “Although a range of antimicrobial-impregnated products (such as
370 surface coatings, paints and curtains) is available, there are, at present, no definitive data to
371 support their efficacy in reducing HCAIs.”
372 5.27 Research undertaken in 2018 on “Effectiveness of antimicrobial hospital curtains on reducing
373 bacterial contamination—A multicenter study”ix found that an antimicrobial curtain with QAC
374 plus polyorganosiloxane but not an antimicrobial curtain with built-in silver effectively
375 reduced the microbial burden and MDRO contamination compared with the standard curtain.
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376 5.28 Infection control within healthcare settings and minimising the risk from hospital acquired
377 infections is a major issue with cubicle curtains, usually located in clinical areas being one of
378 the possible carriers of infection. Reference should be made to HBN 00-09: Infection control
379 in the built environmentx for guidance.
380 5.29 Research carried out in 2008 concluded that ‘Hospital privacy curtains are frequently
381 contaminated with healthcare-associated pathogens which can easily be acquired on hands’
382 – (Donksey et al)xi
383 5.30 Design decisions are a local decision but must comply with all relevant guidance and legislation
384 particularly regarding fire retardancy.
385 5.31 All curtains are treated with a fire-retardant tested in accordance with BS 5438-1:1976.xii
386 5.32 Reference should also be made to:
387 Firecode HTM 05-03C – Textiles and Furnishings – section 5 Furnishings xiii
388 BS 5867 Part 2 Type Cxiv
389 BS 5867-2:2008 – Fabrics for curtains, drapes and window blinds. Flammability
390 requirements. Specification.
391
392 Cubicle curtain parking
393
394 5.33 A key consideration in detailing layouts is the parked position of cubicle curtains, either along
395 a wall or at right-angles to it:
396 Curtains parked along a wall allow maximum observation, but are less easy to draw, and
397 call for careful detailing to avoid obstruction of adjacent engineering service outlets.
398 Curtains parked at right-angles to a wall reduce observation but, by the same token,
399 increase privacy. They are easier to draw and less likely to obstruct adjacent engineering
400 terminals.
401 Part of the curtain can be parked behind the bedhead, but it is unlikely that projection of
402 the curtain from the wall can be eliminated entirely.
403 5.34 Parked curtains will obviously take up some of the working space of bed areas, and the parking
404 space will vary depending on the fullness of the material:
405 As a general rule, track required to park the curtains will be about 15% of track length
406 when cotton fabric is used.
407 For example, a bed space 2900 mm deep and 2500 mm long, assuming curtains for one
408 side and the end are to be parked, will require 810 mm of track for parking.
409
410 Hanging cubicle curtains
411
412 5.35 Gliders or runners should be designed to enable attachment of curtains to rails by hooks,
413 hangers or buttons.
414
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415
416
417 Cubicle curtain changing
418
419 5.36 Cubicle curtains are a proven source of bacterial cross contamination (Rutala, 2013)xv. Cubicle
420 curtain changing should be governed by an operational policy relevant to the area in which
421 the curtains are located and the activities being undertaken within that area.
422 5.37 Speed and efficiency of the procedure are of great importance to the smooth running of the
423 department and should minimise:
424 loss of cubicle function;
425 hindrance to other user activities by restricting or blocking circulation spaces;
426 disturbance of patients;
427 operator fatigue and the associated risk of accidents when working at or near ceiling
428 height; and
429 risk of cross-infection due to movement of soiled curtains.
430 5.38 In areas with a high risk of cross-infection consideration should be given to the use of
431 disposable curtains, some which come with loading devices, and can reduce these problems
432 by enabling staff to change curtains more quickly and transferring the hooking and unhooking
433 stages to normal working height. One device per floor is usually adequate. They:
434 allow an untrained operative to load a curtain complete with gliders or runners;
435 are for use on suspended or (with minor adaptation) on ceiling-fixed track;
436 give full control of feed-on of gliders or runners.
437 5.38 Soiled curtains are usually unloaded straight into a container on the floor, the gliders or
438 runners being run off the track when an end-stop is removed to fit the loading device.
439 5.39 Curtains are changed at the end of the cubicle furthest from the patient’s head, and the fitting
440 and removal of gliders or runners to the curtains takes place entirely outside the patients’
441 area.
442 5.40 The accuracy and frequency with which hooks or buttons are spaced along the operative width
443 of the curtain is a key factor in ensuring that the curtain will draw easily around track bends.
444 This will be achieved if the hooks or buttons are fitted to the curtain before delivery to the
445 cubicle. The use of curtains with predetermined hook or button positions should be
446 considered.
447
448 Window curtain track
449
450 Constituent parts
451
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452 5.41 Each window curtain track system may comprise the following elements, all of which
453 contribute to patient privacy, dignity and safety:
454 track;
455 wall fixing devices;
456 end stops;
457 gliders or runners;
458 low-weight release systems (reducing ligature risk) for mental health environments
459 and other spaces as required (see section on low-weight release systems).
460
461 Track suspension
462
463 5.42 In the mental health environment curtains are often located in patient only areas (such as
464 bedrooms) where observation may be intermittent. Care should therefore be taken in
465 ensuring that the track is as free from ligature anchor points as possible and that the track
466 cannot be easily removed to be used as a weapon.
467 5.43 Reference should be made in mental health settings to HBN 03-01 – section 9.11 which states:
468 “The mountings or tracking of curtains should not provide a ligature opportunity. They
469 should not be removable to cause harm”.xvi
470 Whilst collapsible tracking may be the preferred option in the majority of mental health
471 environments, this may not always be the most appropriate for the patient group, for
472 example in forensic services, and consideration should be given to the advantages and
473 disadvantages of both fixed or collapsible before decisions are made.
474
475 Materials
476
477 5.44 All parts must be of corrosion-resistant materials. Choice of materials should be such that they
478 do not suffer metal corrosion or polymer degradation. Consideration should be given to the
479 age of existing products, as deterioration can happen over time. A planned preventative
480 maintenance policy should be in place. No constituent part should contain material:
481 known or reasonably believed to constitute a health hazard under normal conditions of
482 use;
483 which will give off toxic products in the event of a fire.
484
485 Strength
486
487 5.45 Decision making on the type and strength of curtain tracking to be used should consider the
488 following:
489 location of the curtains (eg acute or mental health facilities);
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490 room in which they will be used;
491 length of tracking required;
492 weight of the preferred curtaining material.
493
494 Height
495
496 5.46 The track would generally be located 10cm to 15cm above the window with approximately
497 15cms to either side of the window recess where possible.
498
499 Window Curtains
500
501 Selecting window curtains
502
503 5.47 Commissioning and design teams must cooperate when selecting curtains, particularly when
504 deciding on the thickness, colour and fullness of curtains and the adequacy of suspension
505 tape.
506 5.48 When choosing curtaining material, particularly for bedrooms in mental health, consideration
507 should be given to the decorations in the bedroom and colour psychology when deciding on
508 colour and patterns. The quality and thickness of the curtains should also be considered in
509 terms of light seepage and look.
510 5.49 Curtaining to windows also assists in reducing noise levels, which in mental health facilities
511 can assist in reducing aggression and violence. HTM 08-01 Acoustics, section 2.113xvii identifies
512 the importance of materials to assist in noise reduction.
513 5.50 Location and activities to be undertaken within the room should be considered. Together with
514 decisions on whether curtains are the most appropriate window covering for the area under
515 discussion.
516 Window curtain parking
517
518 5.51 When curtains are parked, they should not obstruct vision or restrict daylight, (see hanging
519 window curtains).
520
521 Hanging window curtains
522
523 5.52 HBN 00-10D – Windows and associated hardware, section 3: natural light states: “In addition
524 to considering the position and size of the window in relation to the use of a space, the
525 designer should consider the effect of obstruction to vision and restriction of daylight by
526 framing members of the window and curtains or blinds.”
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527 5.53 There are a variety of hangers, gliders, hooks and buttons available to hang curtains, the
528 choice will be a local decision. Gliders should not be mixed but should be those recommended
529 for the rail. In the mental health environment, care must be taken to ensure that these are of
530 a type termed ‘anti-ligature’. Some gliders are colour coded and if these are in use, the colours
531 should not be mixed on one rail as this can affect the release mechanisms on reduced ligature
532 tracking.
533 5.54 With use curtains can often loose hangers resulting in the curtains drooping and failing to
534 cover the window as required. Issues of this nature should be rectified as soon as possible. In
535 the mental health environment, it can be useful to record how many hangers and the type of
536 these are on each curtain, this assists in replacements being compatible.
537
538 Window curtain changing
539
540 5.55 An operational policy for inspection of curtains, to ensure that all hangers and gliders are
541 present and that curtains do not droop on the rail should be in place. Regular changing of
542 curtains in line with infection control policies should be in operation.
543
544 Shower curtain track
545
546 Constituent parts
547
548 5.56 Each shower curtain track system may comprise the following elements, all of which
549 contribute to patient privacy, dignity and safety:
550 track;
551 wall fixing devices;
552 direct-to-ceiling fixings – vertical hangers – V-hangers;
553 end stops;
554 gliders or runners;
555 low-weight release systems (reducing ligature risk) for mental health environments
556 and other spaces as required (see section on low-weight release systems).
557
558 Materials
559
560 5.57 Thought should be given to the requirements for the track in terms of temperature and
561 humidity within the area. All parts must be of corrosion-resistant materials. Choice of
562 materials should be such that they do not suffer dissimilar metal corrosion. No constituent
563 part should contain material:
564 known or reasonably believed to constitute a health hazard under normal conditions of
565 use;
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566 which will give off toxic products in the event of a fire.
567
568 Strength
569
570 5.58 Decision making on the type and strength of curtain tracking to be used should consider the
571 following:
572 location of the curtains (eg acute or mental health facilities);
573 length of tracking required.
574
575 Height
576
577 5.59 A standard shower curtain is approximately 180 cm long, therefore the shower track should
578 be located at approximately 190 cm to 196 cm from the floor so that the curtain does not
579 touch the floor, but sits inside and over the shower tray (where used) to avoid water seeping
580 onto the floor.
581
582 Shower Curtains
583
584 Selecting shower curtains
585
586 5.60 In the mental health environment where rooms are en-suite single bedrooms there should be
587 no reason for a shower curtain to be located within the en-suite which should be designed as
588 a ‘wet room’ to ensure water drainage from the shower. If shower curtains are required in
589 other areas (for example in a staff shower room) commissioning and design teams should
590 consider the location for the curtains, whether it is a locked room, staff only area or an area
591 where patients will be accompanied by staff, before deciding on the appropriate curtains.
592
593 Shower curtain parking
594
595 5.61 Shower curtains should be gathered to one side of the rail when not in use. They should
596 remain within the shower tray area to ensure that water does not drip on the floor outside.
597
598 Hanging shower curtains
599
600 5.62 Curtains should be hung using the correct hangers for the system in use.
601
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602 Shower curtain changing
603
604 5.63 Shower curtains should be replaced in line with infection control guidelines.
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6.0 General guidance
Exposed surfaces
6.1 All surface finishes should be capable of withstanding the range of temperature and humidity
conditions encountered in healthcare environments.
Fire propagation
6.2 All structural parts of a system should be non-combustible as defined in BS 476-4:1970xviii, but
combustible materials may be employed for small non-structural parts.
6.3 Fabrics for curtains should comply with the specifications contained in BS 5867-2:2008.xix
Electrostatic charges
6.4 No system should, to any appreciable extent, develop or shed electrostatic charges.
Quietness and smoothness in operation
6.5 No quantifiable criteria are available for quietness and smoothness in operation, but systems
should be selected with these two important requirements in mind.
6.6 Particular consideration should be given to the operation of gliders or runners at
approximately 100 mm centres around bends of minimum radius.
6.7 During installation, care must be taken to avoid stepped joints where it is necessary to join
track.
Resistance to mechanical wear
6.8 Gliders and runners and track-wearing surfaces should be capable of withstanding at least
20,000 cycles of curtain movement without appreciable loss of quietness or smoothness in
operation, or visible wear.
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Low-weight release systems
Cubicle curtain track release systems
6.9 For some years, it has been recognised that a means of suicide among in-patients in mental
health units is using curtain or shower rails as a ligature point.
6.10 In 2000, the Department of Health report ‘An organisation with a memory’xx instructed mental
health trusts to take steps to remove all non-collapsible bed and shower curtain rails in mental
health in-patient units. In summary, the report identified that following action should be
taken:
Identify and remove all non-collapsible bed, cubicle and shower curtain rails and window
curtain rails in mental health in-patient settings.
Replace with collapsible-type bed and shower curtains.
System manufacturers should provide installation drawings showing positions of hangers.
Ensure any new system does not introduce new risk:
The tracking must be designed to collapse when non-vertical loads are applied to it.
The system must incorporate anti-deflection devices as required to ensure that only
full collapses, not partial, occur.
Flexible dust covers should be cut into maximum 150 mm lengths. Alternatively, a
solid cover can be used.
Once installed, ensure regular maintenance checks and load tests are carried out
according to manufacturers’ instructions.
6.11 There are standard weight requirements for reduced ligature tracking which should be
considered in conjunction with the patient group. For example: and eating disorder service
may require a lower weight limit.
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7.0 Risk assessment
7.1 Risk assessment for ligature points for tracking should form part of an overarching risk
assessment policy. The CQC Brief guide for Inspection teams – Ligature points gives context
and requirements for inspection teamsxxi. This document also states: “There are no specific
requirements over the management of ligature risks in hospital facilities outside of the mental
health sector, although services that may deal with mentally disordered patients (such as A&E
departments) should be aware of the risks and have management plans to meet them.”
7.2 The National Confidential Inquiry into Suicide and Safety in Mental Health document Safer
Services: Toolkit for specialist mental health and primary carexxii also includes a checklist
showing how safer wards can be achieved which includes removal of non-collapsible curtain
rails and low-lying ligature points.
7.3 The DiMHN / BRE document “Informed Choices Testing Guidance for Products in Mental
Health Facilities" (2020) [re-check title in case it changes before publication] states: “Regular
inspections and risk assessments are necessary to help ensure buildings and rooms are safe
for those patients intent on self-harm or escape and who have large amounts of time and
ingenuity to plan and execute those plans”.
7.4 Risk assessments, particularly in the mental health environment, should be carried out using
this document for reference. A risk assessment template can be found at Appendix 2.
7.5 Risk assessment should consider if, when released some load-release products can be used as
a weapon. Consideration may need to be given to balancing the risk of ligature against the
risk of a part or a whole of the product being used as a weapon.
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1 8.0 Fitting and maintenance
2 Fitting
3
4 8.1 Suspended ceilings should not be used in a mental health environment accessible to patients
5 as they offer the opportunity for anchor points for ligature.
6 8.2 See HBN 03-01 section 10.65 which states: “Grid-type suspended ceilings should not be
7 designed into service user-accessible areas” and 10.66 “Removable suspended ceiling panels
8 should not be used, as they provide spaces for the concealment of prohibited objects and are
9 sometimes constructed with materials that can be used for self-injury”.
10 8.3 Correct product installation of tracking, particularly reduced ligature tracking is important to
11 the performance of the product.
12 8.4 The importance of correct fitting and testing should not be underestimated and has been
13 recorded in three Estates and Facilities Alertsxxiii:
14 EFA/2010/009: Flush fitting anti-ligature curtain rails: ensuring correct installation
15 EFA/2010/003: Cubicle Curtain Tracks; Anti-ligature curtain rails (including shower
16 curtains), risks from incorrect installation or modification
17 EFA/2019/003: Anti-ligature’ type curtain rail systems: Risks from incorrect installation or
18 modification
19 EFAs also cover:
20 EFA/2018/005: Assessment of ligature points
21 EFA/2019/003 – issued 11 March 2019 stated: “‘Anti-ligature’ type curtain rail systems
22 can be used as a point of ligature when installed incorrectly or not assessed as part of
23 overall environmental health and safety risks. Recommendations are given on selection,
24 installation, periodic inspections and user checks in mental health inpatient facilities or
25 wherever ligature reduction is risk assessed as required.”
26 8.5 Reference should be made to the Never Events list 2018xxiv. Number nine on the list refers to
27 mental health and the “failure to install functional collapsible shower or curtain rails”
28 8.6 Reference should also be made to HBN 03-01: Adult acute mental health facilitiesxxv sections
29 9.11 Blinds and Curtains, and 9.13 and 9.14 Fixings.
30 8.7 Suspended ceilings should not be used in a mental health environment accessible to patients
31 and therefore no tracking in a mental health facility will be fixed to a suspended ceiling. See
32 HBN 03-01 section 10.65 which states: “Grid-type suspended ceilings should not be designed
33 into service user-accessible areas” and 10.66 “Removable suspended ceiling panels should not
34 be used, as they provide spaces for the concealment of prohibited objects and are sometimes
35 constructed with materials that can be used for self-injury”.
36
37
38
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39 Testing and training
40
41 8.8 All tracking should be tested annually as per manufacturer’s instructions to ensure that
42 changes made to the configuration or environmental conditions have not adversely affected
43 performance.
44 8.9 Each reduced ligature system is different in the means of deploying when load is added,
45 therefore it is important that accredited training from the manufacturer is undertaken before
46 testing takes place.
47
48 Maintenance
49
50 General
51
52 8.10 An operation and maintenance manual should be compiled by the project architect and
53 should be handed to the maintenance staff immediately following the practical completion of
54 the contract.
55 8.11 The manufacturer’s recommendations in respect of periodic inspection and maintenance
56 should be followed to ensure that acceptable levels of performance are maintained. See above
57 Testing and Training
58 8.12 It is important that there is a clear policy that covers ensuring that components have not become
59 redundant or worn or superseded by safer systems. An inspection and replacement policy should be
60 in place.
61
62 Replacement parts
63
64 8.13 When replacing any part of the tracking system, it is essential that the correct part for that
65 system is used, ie gliders should be compatible with the system in place and not of a different
66 type / make.
67
68 Housekeeping
69
70 8.14 The patient environment can become uninviting and not enhance the care being offered,
71 particularly when hangers are lost or broken and curtains no longer fit the window correctly
72 letting in light where they should not and making the area look uncared for. Housekeeping
73 duties should include a regular inspection of curtains to see where attention is required to
74 ensure that issues are corrected quickly.
75
76
77
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78 Hygiene and cleaning
79
80 8.15 The design, materials and workmanship of a system should be such that when installed it will
81 not generate dust or dirt. The construction should be capable of withstanding the cleaning
82 regimes in use by the organisation and in accordance with the requirements identified in PAS
83 5748:2014xxvi and in the Health and Social Care Act 2008 (Regulated activities) Regulations
84 2014: Regulations 15: Premises and equipment.
85 8.16 PAS 5748:2014 is a new “model cleaning contract” for hospitals and has three key elements:
86 the National Standards of Cleanliness (introduces measures for HCAI cleaning and
87 disinfection);
88 the NHS Cleaning Manual (sets out best practice methods for cleaning);
89 cleaning frequencies (these should be determined to address the element of risk
90 identified in accordance with the National Standards of Cleanliness and taking into
91 account any further advice and guidance in the model cleaning contract and the NHS
92 Cleaning Manual).
93
94
95
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Appendices
Appendix 1
Risk Assessment Template (Excel)
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References
Acts and Regulations
(The) Building Regulations 2000 (SI 2000: 2531) and subsequent amendments
(The) Construction (Design and Management) [CDM] Regulations 2015 and subsequent amendments
(The) Health and Social Care Act 2008 Code of Practice on the prevention and control of infections
and related guidance
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file
/449049/Code_of_practice_280715_acc.pdf
(The) Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
https://www.legislation.gov.uk/ukdsi/2014/9780111117613/contents
Technical Standards
Health Building Notes https://www.gov.uk/government/collections/health-building-notes-core-
elements
Health Technical Memoranda https://www.gov.uk/government/collections/health-technical-
memorandum-disinfection-and-sterilization
ProCure 22- Repeatable Rooms https://procure22.nhs.uk/repeatable-rooms-and-standard-
components-app/
Fire safety measures for health sector buildings
https://www.gov.uk/government/publications/suite-of-guidance-on-fire-safety-throughout-
healthcare-premises-parts-a-to-m
British Standards
British Standards https://shop.bsigroup.com/Navigate-by/Standards/
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