As a manufacturer of medical screens, Nöjerm knew their products offered many advantages over conventional rail-hung hospital curtains but they wanted to highlight the benefits to decision-makers in the healthcare sector.
We recommended a series of blog posts, comparing the alternatives in an open debate to help hospital facilities teams, ward managers and other healthcare professionals make an informed decision.
The Curtains vs. Screens Debate
#1 – Starting the Debate
There was a time when hospital wards were large, open spaces with no consideration for patient privacy, and then the idea of the cubicle curtain was born.
But with healthcare-acquired infection (HCAI) and pandemics now an ever-present reality, privacy curtains are drawing criticism for their potential to harbour and spread contamination.
To tackle this problem, many hospitals are now converting to hospital privacy screens as these are easier to clean, more versatile, more durable, and offer better infection control than curtains.
Over the coming weeks, we will be publishing a series of informative, objectively written blogs that will compare the features and benefits of hospital curtains versus medical privacy screens.
We hope that this debate will give both product types a fair hearing so that infection control teams, estates managers and health trust directors may be able to make informed decisions that will shape the future of their wards, consulting rooms and other patient care areas.
As the series progresses, we will include links to access all previous blogs in case you missed or would like to re-read them, so please keep watching this space to follow the debate on Hospital Curtains vs Medical Privacy Screens.
#2 – Capital & Operational Costs
The subject of cost ranks high with hospital facilities and estates managers, and this is important when we consider the burden that the current pandemic is putting on their finances.
As the winter brings seasonal flu, norovirus, and season-related injuries and medical complications, we can anticipate these costs will rise further.
So maybe this is a good place to begin our debate.
To compare the relative costs of hospital curtains and medical privacy screens, we turned to independent research carried out on these products within the healthcare sector.
The study amortised capital expenditure over six years and based ongoing cost calculations on the curtains or screens being cleaned once a month. It also considered a third option – disposable hospital curtains – which would be replaced monthly.
The initial outlay for hospital curtains was found by the researchers to be similar for the washable and disposable types. But while medical privacy screens cost almost four times as much as curtains, by the time the installation
costs were added, the total investment dropped to just one and a half times that of curtains.
However, as screens are substantially more durable, they are less likely to need repair or replacement. Their modular design also means that if there is any damage, only the affected panel needs to be replaced.
Screens will therefore quickly repay this modest additional investment and reap the benefits of lower ongoing maintenance costs.
One significant cost-saving feature of medical screens is that they can be cleaned easily and quickly, in situ and at floor level, using conventional cleaning and antibacterial chemicals.
Hospital curtains are not so easy. Unhanging and rehanging generally require access steps. Washable curtains need to be transported to another location for cleaning, washed, and then returned. Even disposable curtains need to be removed for safe disposal or incineration. All these processes take time and incur costs.
The research concluded that it costs 7.5 times as much to clean curtains as to clean screens while replacing disposable curtains costs 6.4 times as much.
By writing off the capital investment over six years and combining it with the cleaning costs during that period, the research revealed the total cost of installing and maintaining medical privacy screens was just 57.6% of washable
hospital curtains and 68.9% of disposable hospital curtains.
Costs not included
While studying the results of this research, we realised that some costs may have been omitted.
For example, there was no record of repair and maintenance costs. As we have already mentioned, screens are so much more durable than curtains that they are less likely to suffer damage.
We also observed that the results did not refer to the cost of disposal or incineration of used disposable curtains.
Another factor that can indirectly have a financial impact on hospital facilities management is the risk of contamination and cross-infection, but that is another subject we will be covering later in this series.
#3 – Space Optimisation
Hospital Curtains In Open-Bay Wards
Patient privacy on public-sector hospital wards has traditionally been created by using curtains on fixed-rail systems to subdivide open bays into multiple patient areas – a cheaper and more practical alternative to giving each patient a separate room.
Rail and curtain systems have, however, led to reduced flexibility in increasing available bed spaces on the ward. If more bed spaces are required, the rails must be repositioned or replaced to create smaller cubicles.
This takes time (which might be scarce if there is a sudden or exceptional demand for more bed spaces), disrupts the smooth operation of the ward (or forces its temporary closure while work is being carried out), and incurs
Medical Screens Are A Totally Mobile Alternative
CleanScreen® from nöjerm can be deployed without the need for permanent fixings, using durable medical-grade castors to move easily into position and folded away, concertina-style, when not in use.
The system also offers a greater level of patient privacy than curtains. The solid construction of the panels allows for no translucency, even when strongly backlit, and standing at almost two metres high and raised only 90 mm above the floor, they create a complete visual barrier. The panels also offer better sound-muffling properties than curtains.
If CleanScreen is to be transported over longer distances between buildings or to another site, or placed into long-term storage between use, a separate trolley is used to keep the screen compactly folded and to protect its castors
Thinking Outside The Ward
It isn’t just in the general hospital ward where health services value the space optimisation of CleanScreen medical
Emergencies such as pandemics, natural disasters and large-scale acts of terrorism require increased patient handling facilities in most departments, including A&E, assessment and treatment areas, radiology and other screening departments, and critical care.
The versatility of a mobile system like CleanScreen means that temporary facilities can be quickly and easily set up in other areas of the hospital, or indeed at other locations such as sports halls and community centres, without
tools or tradesman skills. These can be used for large-scale operations such as screening and vaccination programmes, or even to create a measure of privacy for victims requiring temporary accommodation.
When demand for services returns to normal levels, CleanScreen can be folded away and placed in compact storage, or redeployed to another situation or location.
What Does The Future Hold for Healthcare Space Requirements?
Once the coronavirus pandemic has been brought under control, will the demand for bed spaces return to pre-pandemic levels and mass treatment centres become a thing of the past?
Both seem unlikely. We are thankful that effective Covid-19 vaccines have been developed, but the scientific community and the World Health Organisation have been warning us for several years about the danger of superbugs developing that are resistant to all antibiotics.
In addition to the threat of further pandemics, we now live in a highly unstable world. Extreme weather conditions, terrorism and political unrest are all becoming familiar themes in the news. Once largely confined to certain regions
of the globe, these are now very real threats that the UK must also prepare for.
Two secrets of effective crisis management are speed and versatility. CleanScreen offers rapid, adaptable optimisation of patient treatment and accommodation facilities.
#4 – Infection Control
Long before the 2020 Covid-19 coronavirus pandemic came to the UK, healthcare-acquired infections (HCAI) were a cause for concern. Among these, Methicillin-resistant Staphylococcus aureus (MRSA), methicillin-sensitive
Staphylococcus aureus (MSSA), Clostridium difficile (C. difficile) and Escherichia coli (E. coli) are the most common, all posing a serious and often fatal risk to patients, staff and visitors.
As a result, NHS trusts have already implemented HCAI prevention and control procedures in hospitals and treatment centres. But with Covid-19 placing a new and almost overwhelming strain on infection control teams and equipment, further measures are urgently needed to contain the risk of contamination.
Contamination Rate of Hospital Curtains
Hospital curtains are traditionally made from cotton or a polyester-cotton blend: inexpensive to make and easily laundered along with used bedding and similar articles. But their woven texture and close proximity to patients and
nursing staff makes them a prime location for bacteria, transferred as airborne droplets and in contact with hands, clothing and even the disposable PPE worn by doctors and nursing staff.
In April 2012, the US Department of Internal Medicine and the Carver College of Medicine published the findings of research into the pathogenic contamination of hospital privacy curtains. This revealed some disturbing statistics, including:
- 92% of all curtains showed signs of infection within one week of being hung in place
- 95% of all curtains became contaminated on at least one occasion, including 21% with MRSA and 42% with vancomycin-resistant enterococcus (VRE)
The researchers concluded: “Privacy curtains are rapidly contaminated with potentially pathogenic bacteria. Further studies should investigate the role of privacy curtains in pathogen transmission and provide interventions to reduce
New Antimicrobial Technology
Some curtain manufacturers addressed this problem by treating the fabric during manufacture with built-in antimicrobial technology. While this may be beneficial in negating the threat of some forms of bacteria, it is less likely to be as effective against antimicrobial-resistant strains.
By their very nature, curtains are not easily cleaned in situ so these pathogens will remain on and in the fabric of curtains until they are removed and properly decontaminated. This means that they remain a potential source of infection and cross-contamination not only while in use but also during transportation to hospital laundry facilities and while being handled.
Screens with Inbuilt Antimicrobial Technology
Similar pathogenic technology is used in the manufacture of plastic panels for medical privacy screens such as CleanScreen from UK manufacturer Nojerm. But screens have a fourfold advantage over curtains with the same
- The extra thickness of the plastic allows for a greater amount of antimicrobial agent to be activated across
- the same surface area.
- This higher concentration of antimicrobial agent ensures it remains effective for a longer period
- The rigidity of CleanScreen panels enables them to be thoroughly cleaned with more effective
- decontamination chemicals
- Neutralising the pathogens in situ reduces the risk of infection spreading to other people and areas.
#5 – Cleaning
Earlier in this debate, we looked at infection control, with a particular focus on antimicrobial technology. While this is a vital element in preventing the spread of bacteria, it will always be a second line of defence to regular and effective
cleaning. Here we will compare the methods used to clean both hospital curtains and medical privacy screens, and discuss their practical effects on running a safe and efficient healthcare environment.
Are Disposable Hospital Curtains A No-Clean Option?
Disposable curtains are replaced, rather than washed and reused, but this doesn’t mean they require no cleaning, as regular vacuuming is still required to remove surface dust. Soiled disposable curtains must however be replaced
as effective cleaning is not possible.
While disposable curtains are designed to last for up to six months (providing there is no visible soiling), more recent healthcare guidelines recommend hospital curtains are changed more frequently to prevent cross-contamination.
In the most critical areas of patient care, or if there is an outbreak of severe infection, it is even recommended that fresh curtains are used for each patient. In these instances, disposable curtains are no longer a financially sustainable
Cleaning Reusable Hospital Curtains
Hospital laundry systems ensure traditional reusable curtains are cleaned efficiently and effectively, and even their antimicrobial properties will survive multiple washes.
These curtains also require regular vacuuming between washes, and if soiling occurs they must be immediately removed and sent to the laundry.
The Downsides of Vacuum Cleaning
We have already seen that both disposable and reusable hospital curtains require regular vacuuming, but this cleaning method has its disadvantages.
Risk of airborne spread
Unless the vacuum cleaner has been fitted with appropriate filters, microscopic particles will be released into the air, increasing the risk of airborne infection and contamination.
Even with filters, the air movement created by the vacuuming process will increase this risk.
Risk to cleaning personnel
Emptying collector bags that potentially carry infectious particles places cleaning personnel at risk.
Increase in noise pollution
Regular vacuuming increases noise levels that might cause distress in critically ill patients.
Do Medical Privacy Screens Scrub Up Better?
When it comes to cleaning, medical privacy screens offer many advantages over curtains. For a start, their rigid panel construction and lockable castors mean they stay in place while they are being cleaned, even when pressure is
applied to remove more stubborn marks.
Their close molecular structure makes it harder for dirt to become ingrained in the surface, and easier to remove, compared with the woven texture of curtains.
Using appropriate cleaning and disinfectant chemicals, applied to a cloth or as impregnated wipes, any kind of soiling can be removed from a rigid hospital screen. This can be carried out immediately and in situ, reducing the risk of infection spread through delay and handling. Cleaning with a moist cloth also eliminates the need for vacuum cleaning and its associated risks.
#6 – Privacy
Why Is Privacy Screening Important?
Every patient has a right to expect a reasonable level of privacy, confidentiality and dignity while they are in NHS care. Privacy when dressing, attending to personal hygiene or receiving care; confidentiality when discussing their
condition and treatments with medical staff, and dignity when in suffering or during their last hours.
But the widespread use of open, multiple-bed wards means that ensuring this privacy is often a challenge for ward managers. Conventional hospital curtains are certainly a step in the right direction, but are they enough?
How Private Are Hospital Curtains?
As a visual barrier
Ceiling-suspended hospital curtains are generally installed with a gap of 9 – 15 inches between the bottom of the curtain and the floor, presumably for reasons of practicality.
- When medical teams need to quickly address a medical emergency, they don’t want trailing curtain fabric getting entangled with bed wheels or the castors on freestanding medical equipment.
- Low-hanging curtains are also an obstacle to floor cleaning and polishing equipment.
However, this will reduce the patient’s privacy, which may also be compromised by:
- Translucence. While hospital curtain fabrics are reasonably good at blocking light they aren’t entirely opaque and strong backlighting – for example, from a window or reading light – can create unwanted silhouettes.
- Movement. Curtains are designed to be temporarily drawn to one side by staff entering and leaving a cubicle, but staff or equipment brushing against the curtain in a confined space can accidentally create a gap in the curtain.
As an audible barrier
Hospital curtains are primarily designed as a lightweight visual barrier and as such have poor sound-muffling properties, as anyone who has been an in-patient on an open ward will confirm.
From conversations between patients and medical staff to the audible bodily functions of the bed-bound, this lack of privacy causes embarrassment and discomfort on both sides of the curtain.
How Do Medical Privacy Screens Compare?
As a visual barrier
Medical Privacy Screens such as CleanScreen from Nojerm are constructed from solid panels that offer 100% opacity, even when backlit.
CleanScreen mobile screens are raised just 90 mm (just over 3.5 inches) from the floor, leaving ample space for floor cleaning yet presenting no trip hazard, and optimising patient privacy.
The system’s rigid panels and lockable castors prevent any gaps from appearing in the visual barrier, even in confined spaces.
As an audible barrier
The reduced gap between the panels and the floor, combined with CleanScreen’s multi-layered panel construction, means the system places excellent sound-deadening qualities at the heights where it is most needed.
#7 – Summing Up
Our regular readers will know that in 2020 we decided to compare the advantages of hospital curtains and medical privacy screens.
We identified the key factors that influence decisions made by healthcare trusts, facilities teams, ward managers and other healthcare professionals and then in a series of articles, discussed how the various products performed against these factors in an open debate.
Our findings are as follows:
The initial costs (purchase and installation) of screens is about 1.5 times that of curtains, but this additional investment is quickly repaid by lower operational costs.
An independent study calculated that over six years, screens cost 42.4% less than washable hospital curtains and 31.1% less than disposable hospital curtains.
However, the study also failed to include additional costs such as
- repair and replacement (this is likely to be significantly higher with curtains as they are less durable)
- disposal and incineration of disposable curtains
- financial penalties imposed on failure to contain healthcare-acquired infections (HCAI)
Space Optimisation and Versatility
While curtains occupy little space when folded back, they are restricted to the fixed locations of curtain tracks.
Increased pressure on healthcare facilities has highlighted the importance of versatility. Freestanding, mobile screens can quickly and easily create additional assessment, treatment and bed spaces in any location, yet be compactly stored off-site when not in use.
Infection Control and Cleaning
While many hospital curtains are now treated with antimicrobial agents, this is moulded into the plastic of CleanScreen privacy screen panels for longer-lasting efficacy.
Privacy screens can also be cleaned in situ. Curtains are removed and taken away to be cleaned, which increases the risk of wider contamination.
Curtains require regular vacuum cleaning to remove surface dust. This increases the risk of spreading airborne contamination. The hard surfaces of privacy screens can be wiped clean with appropriate cleaning and disinfectant
chemicals, resulting in more effective cleaning and lower risk of airborne infection spread.
Screens provide a better visual barrier and noise-absorbing characteristics than curtains: important factors in ensuring the privacy, confidentiality and dignity of patients.
While reusable hospital curtains are widely used in the public healthcare sector, in many instances these are being replaced by disposable curtains.
Curtain track systems are still being installed in new-build and refurbishment hospital projects, but the evidence falls clearly in favour of medical privacy screens as the most cost-effective, versatile, low-maintenance and hygienic
If you are tasked with reviewing, renewing, specifying or procuring healthcare privacy screening systems and would like an objective comparison of the options available to you, we hope you find this a valuable resource.