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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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

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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

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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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