A noticeable change is occurring at the front entrance to hospitals. Currently, many facilities allow incoming visitors, contractors and others to enter hospitals from multiple access points – adjoining medical office buildings, side doors, delivery doors, as well as the front door, without questioning or stopping anyone. Visitors still stop at information desks inquiring about patient locations but many people just pass by without mention of their destination or purpose. This security gap is closing at more and more hospitals due to multiple reasons, including infection control.
Infection Control Training
Some facilities have moved to increase security due to local and even internal incidents. Two Florida hospitals took aggressive security stands after the Pulse nightclub shooting incident in Orlando. Both the Arnold Palmer Hospital for Children and the Winnie Palmer Hospital limited the number of facility entry points and added metal detectors as part of the screening process. Another Florida hospital quickly installed new security procedures after a patient killed a doctor.
Security officers are now armed at many facilities and some hospital systems are augmenting safety by training staff members on how to de-escalate potentially violent situations. A nurse was assaulted in a supply room by a patient facing criminal charges; a security guard and another nurse coming to her aid were also injured. According to police reports, Richmond Virginia hospitals reported over 200 thefts from patients in area hospitals over a two year period. Health systems are hitting a tipping point of security enhancement needs to protect patients as well as clinical staff.
Employees at one northeastern hospital signed a petition demanding security upgrades after a worker was mugged in a parking lot. The local police department was asked to review the facility and reported too many open entrances to the facility. The hospital responded and is now spending on the security upgrades to make the facility safer for staff, patients and visitors.
Some rural hospitals state that changes are necessary, since police response can be longer than 10 minutes in some areas. Children’s Hospitals normally have the best security because their patients are mostly defenseless. Entry at children’s healthcare facilities has narrowed to a limited number of doors where a waiting security officer will direct visitors to the official check-in station. Large hospitals with multiple access points have narrowed entry points by making them only badge-accessible for approved staff. However, some hospitals still have a relatively open-door policy that allows an outsider to travel freely in the facility and merely count on signage and an occasional volunteer to question their purpose.
Don’t Forget to Include Contractors
Not only are visitors being scrutinized, vendors and contractors performing work in the facility are also subject to criminal checks and specialized training requirements. Hospitals have recently recognized contractor badges as approval for vendors to travel unstopped anywhere in the facility. A freely wandering contractor employee stole patient belongings and others pawned tools taken from the hospital’s maintenance shop. Patient medications have also been a target and hospitals are now installing locks on patient belonging closets. Facility departments are also tightening requirements. Specialized infection control awareness training is becoming a mandate for contractors prior to working in the facility.
The back door and the loading dock are common entrances where vendors and contractors enter to perform their tasks. Some facilities require workers to check in at the engineering office to pick up a generic facility badge, while others have yet to require workers to wear any identifying badge. From the Infection Preventionists’ perspective workers performing duties in the facility should understand proper routing and work area preparations to protect the surrounding patient population. Small projects that are not covered by an Infection Control Risk Assessment (ICRA) are normally performed without any specific limitations. The hospital is counting on the contracted workers to know proper work practices and to follow them no matter where in the facility they are working. Proper work practices are just as much an aspect of security, by providing a safe work environment as well as preventing dust from becoming airborne.
CMS is Involved
The Centers for Medicare and Medicaid Services (CMS) is also weighing in on security and safety issues. CMS warned one hospital that it would terminate them from the Medicare program unless they corrected safety issues that placed patients in “immediate jeopardy”. Hardly a week goes by without a story of a security incident at a hospital. One facility, in a stable area of town, mentioned that it is not uncommon to have six to seven security-involved problems per week. Hospitals are tightening access and beefing up security to keep patients, staff and visitors safe.