The modern hospital ward is, in its unique way, a medical marvel. To us, it may seem like a commonplace space. Yet, the practice of gathering patients in an open ward allows medical staff to monitor and care for them safely and efficiently. However, there are some drawbacks – the most concerning being cross-contamination risks and lack of privacy.
These issues are generally addressed by the use of fabric or paper hospital curtains. These curtains attach to a track in the ceiling around each bed and can be drawn open or closed. The curtains are used when staff needs to conduct an examination, have a private discussion with a patient, or protect against vapor-borne pathogens.
Hospital curtains are ubiquitous, not just inside patient wards but in other medical settings like surgeries. It might not occur to the average observer that any improvements are possible.
In recent decades, medical privacy screens made out of solid, movable panels have become widely available. These screens offer a considerable advantage in any healthcare setting due to their ease of configuration and use, mobility, and the simplicity of their sterilization process.
For a detailed look at the practical differences between hospital curtains and solid hospital dividers, read on. This article will look into hospital curtains and examine medical privacy screens. Then, it will compare the two solutions as deployed in clinical settings.
An Overview of Hospital Curtains
In the United Kingdom., hospital curtains are widely used as separators inside patient wards and care homes, health and beauty treatment centers, and educational settings. Curtains can be attached to a permanent ceiling-mounted track using various methods, such as eyelets and hooks, velcro, buttons, snaps, zippers or even plastic spokes that thread into dedicated grooves within the track.
Ubiquitous curtains can be ordered in disposable fabric, paper or permanent synthetic material. Both permanent and disposable curtains are fire-retardant and can be ordered with an additional antimicrobial coating.
Some curtains come with features that help the cleaning team uphold suitable hygiene protocols, such as an area on the curtain where staff can write the date of its installation. Staff members can usually tell with one glance when it is time to replace the curtain with a fresh one.
Limitations of Hospital Curtains
Although they have been with us for so long that they are part of the public imagination, hospital curtains, both permanent and disposable, are not suitable for a clinical environment. The reason why is due to their risk of microbial contamination. To more fully understand this concern, it’s necessary to move from considering curtains in the abstract—the way they are presented in sales brochures—into the real world.
Quickly Contaminated by Frequent Handling
Imagine an occupied bed on a hospital ward encircled by a curtain. That curtain will need to be opened and closed dozens of times a day by all the professional staff members who need access to the patient and their space. Cleaners, doctors, nurses, carers and people delivering food and clearing waste will all need to enter the area. In the process, they grab the curtain with their hands at any random spot that they find convenient and awkwardly push or pull it out of the way. They’ll most likely touch it again on their way out.
Contact with the curtain isn’t limited to the hands; the curtain may brush up against limbs, clothing, and equipment brought into or out of the patient area. With every push and pull, the risk of contamination increases from the staff or patients. In turn, these individuals will come into contact with others and contaminate them – and the problem spreads outside the hospital environment.
And that is just considering the behavior of professional staff within a clinical setting. These staff members undertake rigorous training to minimize the risk of cross-contamination. They also likely have a higher baseline level of consciousness of where they are in space, what they touched and what they will potentially handle.
Patients also have visitors from the community who enter the hospital setting without having the benefit of such training. These visitors may bring external pathogens that are transmitted to the curtain. The curtain is probably one of the most frequently touched items in the ward and poses a risk of transmitting dangerous pathogens.
In 2011 a U.S. study looked into this risk. Researchers from the University of Iowa Carver College of Medicine tested 43 curtains on 30 different surgical and medical wards twice a week for three weeks. The results showed that 26 percent of the curtains contained antibiotic-resistant Staphylococcus aureus bacteria, and 44 percent had Enterococcus bacteria, some of which were resistant to antibiotics.
A more recent 2019 study took samples from curtains in six nursing homes and rehabilitation centers in Michigan. Of 611 curtains sampled, researchers found that 28% were contaminated with drug-resistant microbes.
Harboring Dangerous Microbes
Although medical curtains are intended to be regularly replaced for cleaning or disposal and have antimicrobial coatings, they still come with a risk. Due to their nature as pleated hangings made of cloth or paper, they are microbe magnets. Unlike a hard, smooth surface, paper or cloth cubicle curtains have tiny pits, troughs and gaps in the weave or between fibers.
Mechanically, they are more apt to retain foreign material such as vaporized sputum particles. Anybody who has ever tried to remove cat vomit from a sofa knows that it’s much easier to remove it from a tiled floor than it is from textiles.
The track for hospital curtains is also problematic. Depending on what type of curtain is present in a facility, the track system may have deep slots and grooves or a complex array of eyelets or hooks attached to the ceiling itself. Curtain tracks are usually made of metal, plastic and rubber. These materials can, in theory, be well sterilized.
However, the hard-to-access interior areas of the track might not get thoroughly and regularly cleaned. Because of this, there is a chance of spreading infectious material from the old, disposed-of curtain to the new curtain straight out of its clean bag. One might suppose that infectious material would be unlikely to reach as high as the ceiling track. Still, even a simple cough can spread such material far and wide.
Curtains Cannot Be Cleaned In Situ
The porous surface of paper and fabric, even if coated with antimicrobial substances, means that they are more likely to collect contaminants. This is why it is so important to change them out or clean them frequently. Unfortunately, unlike hard-surfaced medical dividers, fabric or paper curtains cannot be cleaned in situ in a clinical setting. The curtains can be removed and—depending on their material—either carefully disposed of or sent to the laundry for complete hygienic cleaning. Yet when one considers a highly overworked cleaning staff in a potentially overcrowded hospital or surgery, this may happen less often than is ideal.
Getting a large, unwieldy curtain off the narrow threads of a stiff track, or unhooked from dozens of eyelets a few inches from an awkwardly tall ceiling, is not always going to be the highest priority task for busy people.
In some settings, changing the curtains may be relegated to deep cleaning sessions that don’t happen nearly often enough. This means that dirt and pathogens are more likely to accumulate. And that there is a higher risk of cross-contamination. Cross-contamination is the process by which material that could contain pathogens is transferred, unwittingly, between items.
The Risk of Cross-Contamination
Clinical settings have several practices and technologies to combat cross-contamination. A surgical instrument can be thoroughly cleaned and sterilized and packaged safely, for instance. For furnishings, regular cleaning between patients has two aspects—the physical cleaning task, such as scrubbing or wiping, and the chemical work of germicides.
Cleaning staff are trained rigorously and provided with reliable products to do their work. The result is highly effective for hard, smooth surfaces such as floors, walls, cabinets or examination tables. Hospital curtains, which cannot be cleaned in situ due to the porous nature of the surface, will be left with potential cross-contamination more often and for more extended periods.
A patient or professional can brush against the curtain unwittingly, thus carrying the contamination with them. They can then re-contaminate other surfaces as they move about the space. Even if a contaminated curtain is left in place for only a few hours, there are dozens of potential opportunities for cross-contamination to take place.
An example of good practice guidelines on regular cleaning and disinfecting can be found at the Northern Ireland Institute of Infection Control. Their manual describes three cleaning standards—regular cleaning as a matter of course and enhanced cleaning to combat an ongoing hospital outbreak. The highest standard of cleaning, terminal cleaning, is reserved for when a patient dies of known infection. All of these levels of cleaning will be faster, more efficient and more complete when curtains are replaced with screens.
An article in PubMed explains the grave risks that can be posed when cleaning and disinfecting are not performed to an adequate standard. It notes:
“Hospital surfaces are frequently contaminated with important healthcare-associated pathogens. Contact with the contaminated environment by healthcare personnel is equally as likely as direct contact with a patient to lead to contamination of the healthcare provider’s hands or gloves that may result in patient-to-patient transmission of nosocomial pathogens. Admission to a room previously occupied by a patient with MRSA, VRE, Acinetobacter, or C. difficile increases the risk for the subsequent patient admitted to the room to acquire the pathogen. Improved cleaning and disinfection of room surfaces decreases the risk of healthcare-associated infections.”
A letter by critical care physicians in India, published in the Indian Journal of Critical Care Medicine, warns that even proper laundry procedures do not necessarily remove resistant pathogens from curtains:
“Numerous human pathogens have been identified in hospital and clinic curtains. These include Micrococcus species (sp.), Bacillus sp., Escherichia coli, coagulase-negative Staphylococcus, and Staphylococcus aureus. Some of these bacteria may still persist even after the laundry of curtains and become potential causes of infectious diseases, particularly in hospitalized patients with attenuated immune systems.”
The Use of Antimicrobial Coatings on Hospital Curtains
To mitigate the problem of cross-contamination, manufacturers of hospital curtains will often include an antimicrobial coating on the curtain’s surface. This coating can take many forms, such as layers of germicidal chemicals, or can incorporate elements that can inferior the biological functions of microbes, such as silver or zinc ions. The coating can be applied after the curtain manufacturing process, or it can be impregnated into the material of the curtain.
Manufacturers offering antimicrobial coatings claim that they kill or disrupt microbes on contact, lengthening the time they can go between cleanings or replacements. This process also works on lowering the risk of cross-contamination when the patient privacy curtain is in situ.
It is helpful to be cautious about these claims, evaluating them with a practical, real-world outlook concerning infection control. The immediate concern is that in situations with incomplete infection control, whether someone contracts an infection can be a matter of statistics and chance. No matter how effective an antimicrobial coating is, it cannot be as effective as the physical removal of contaminants from a hard surface that can be repeatedly cleaned with antimicrobial products.
To offer an example, consider a patient that coughs vigorously. When that happens, a thick piece of viscous sputum sticks to a medical curtain impregnated with silver ions. While the part of the sputum immediately touching the silver-impregnated curtain may be subject to the effects of the antimicrobial coating, the rest is not. The sputum is unaffected in this area and is ready to cross-contaminate patients and staff, who can unwittingly spread pathogens even further.
Furthermore, overworked staff may have a false sense of security with regards to the antimicrobial properties of the curtain and may not inspect it thoroughly or replace it frequently enough. Curtains are commonplace in our homes, and people are used to simply grabbing any part of the curtain to open or close it. This means that any part of the curtain may have been touched, and cleaning staff must inspect the entire curtain for signs of contamination.
A Closer Look at Antimicrobial Coating Claims
There is another claim to examine with regards to antimicrobial coatings—that they destroy nearly all germs on the fabric. In the context of a controlled study, the layer may destroy the pathogens in a Petri dish. Still, in a clinical setting, there is a risk of developing resistant strains of those same pathogens. In the wild, medical science is fighting an ongoing battle with pathogens. Scientists continually need to develop new strains of antibiotics and to create new antivirals and vaccines. Part of medical strategy in this ongoing battle is to minimize opportunities for pathogens to evolve defenses.
The Journal of Hospital Infection published a research review in 2020 that examined this claim. The review found studies that indicated risks associated with resistance on antimicrobial surfaces, either from novel mutations or by species-sorting, which is the process by which only inherently resistant species survive and flourish on the antimicrobial surface.
Furthermore, most studies that look at this problem take place in labs and don’t study the risk of breeding resistant bacteria in a clinical setting, where there are far more variable factors at play than in the controlled environment of a scientific study.
Unfortunately, a medical privacy curtain with antimicrobial properties is an ideal environment for pathogens that are resistant to the coating to evolve and flourish. The use of these coatings should be rationed to essential settings, such as a surgical theatre. They should not be used on curtains when each one risks developing resistant microbes that could spread.
The Petri-dish-versus-real-world problem also arises more broadly, as some antimicrobial coatings have not been thoroughly studied in clinical settings. Novel coatings that haven’t received complete human trials could have unexpected consequences when in close contact with vulnerable patients.
It’s also helpful to look at the claims of medical privacy curtain manufacturers from a salesperson’s perspective. The very fact that manufacturers so strongly emphasize the presence of antimicrobial coatings on their products indicates a widespread acceptance of the fact that the curtains, by their nature, pose a risk of cross-contamination.
An Introduction to Medical Privacy Screens
While curtains are a ubiquitous part of our hospital experience, medical privacy screens are becoming more and more widespread in a variety of clinical settings. Medical privacy screens consist of a metallic frame—anchored to a wall and retractable, or fully mobile—and rigid, durable panels. Silentia—a leading maker of medical privacy screens—equips all screens with a convenient handle to serve as a point of contact for moving, closing and opening the screens.
Unlike floor-to-ceiling curtains, these hospital dividers come in three standard heights but most often are about as tall as an office cubicle, meaning that they can feel less isolating and restricting to patients while maintaining visual privacy. The screens can be manufactured in a wide variety of colors and can even have images of the purchaser’s choice printed on the screen panels. Most importantly, the screens, made of hard plastic and metal, can be fully cleaned in-situ, using the standard cleaning supplies and methods used on other hospital furnishings.
An In-Depth Look at Cleaning Medical Privacy Screens
In a hospital or other clinical setting, cleaners are highly trained and essential members of staff who are extensively trained in thorough cleaning and the use of hospital-grade cleaning products. Their regime consists of both traditional cleanings—focused on the removal of contaminants and dirt—and sanitization, which focuses on the removal of pathogens.
Some surfaces and devices in a hospital or clinic will need special cleaning regimes, such as bedsheets, which are laundered, or surgical instruments, which are sterilized by specialist technicians. The majority of cleaning will be done with bucket and mop or with specialist sprays, soaps, sponges and wipes. Using a few pieces of equipment and some well-rehearsed techniques, cleaners can get everything sanitary reliably, and supervisors can tell quickly when something needs re-doing.
When it’s time for a deep clean, disassembly of solid medical dividers such as those provided by Silentia is easy. The wheeled apparatus is entirely removable and can be washed in a hospital dishwasher, cleansing and disinfecting. Made of metal and stiff, durable polymers, the screens lack the continuous surface full of crevices characteristic of curtains. No disinfection scheme is perfect, but anything that can significantly reduce hospital-acquired infection can save lives and resources.
Everything in a hospital, from beds to drinking glasses, should be designed with infection control in mind. Curtains have been an exception to this rule, needing to be laboriously removed for cleaning or disposal. Once hospital screens are installed, reducing their infection risk can be done with the same equipment and techniques as the rest of the surfaces in the room.
Deep cleaning regimes are the most effective way to reduce pathogen risk, but in-between deep cleans, spot-cleans help ensure that the space is safe. Between patients, cleaning staff may focus on high-traffic surfaces such as doorknobs and examination benches during a spot-clean. Hospital curtains don’t fit easily into this process because they can be handled anywhere, and there is no way of telling where they have been touched.
With medical privacy screens, the presence of a clearly visible, easy-to-use handle means that most people will touch it at a single point of contact. Staff performing a spot-clean with limited time can focus on the handles. The hard surfaces of the screens can clearly show even slight soiling, and most contaminants can be easily removed with the use of a damp cloth.
Future-Proofing Medical Privacy Solutions
Given the variety of challenges facing the healthcare sector—from staffing to space to hospital-borne infection risk—the time of cleaning staff and the flexibility of clinical teams and spaces are extremely important. Medical privacy screens have the advantage of being portable and easy to use; a single staff member can retract or extend a static screen, and mobile screens can quickly be used to create a separate room in a multipurpose space.
For a longer-term solution, the Silentia Easy-Click concept can be used to install wall, floor and ceiling mounts quickly. Once the mounts are installed, the hospital screens can be deployed or recalled in the space of a few moments.
With medical screens, customers also benefit from the availability of more aesthetic choices. While the decor of a hospital is not a primary consideration, it is important. Aesthetic settings may have a significantly positive effect on patients and can also help them feel positive. The presence of welcoming colors and friendly art can help calm and reassure patients as well.
For example, inside the rooms and wards for children and memory-care patients, decor can improve quality of life and reassure frightened patients. Silentia even offers screens with photos or graphics chosen by the customer—a great way to enhance the professional appearance of a clinical setting and reinforce branding.
Anybody who’s been a patient in an open ward with curtains knows that they let every sound through, while blocking out the entire view, floor to ceiling—or, at best, offering a view of passing feet! This experience can be disorienting and stressful for patients. Medical privacy screens offer better acoustic isolation from the beeps and clatter of the ward while allowing a view over the top, so patients can identify people who approach—a far more comfortable arrangement.
Side By Side Comparison: Curtains vs. Screens
Any product that can save staff members a few seconds or reduce the effort in the clinical setting is essential. Although seconds may seem insignificant, when added up over a day, that product in place can mean more time and energy is available to care for patients safely and competently. Here are a few thought experiments about essential tasks in a clinical setting and how the presence of medical privacy screens—instead of curtains—makes that all-important bit of difference.
A doctor examines a patient in an emergency department outfitted with disposable medical curtains. The patient is sick, and vomit spatters the curtain. The patient is moved to a ward, and cleaning staff must prepare the space for the next patient. The staff member assigned to clean the area is not confident with removing the curtain and struggles to remove and replace it, meaning they take longer to complete the cleaning of the area. Patients and doctors cannot use the space for longer, affecting wait times for the entire E.D.
If medical privacy screens are installed, the cleaner can use the same products they are using for the walls and floor, quickly ensuring all the mess is removed. The screens are cleaned on-site, without the need to take time to replace them. The space is returned to use more quickly, meaning more patients can be seen.
Over time, the use of screens instead of curtains saves money—in terms of staff time, and in savings of laundry, for reusable curtains, and waste disposal, for paper ones. This money can be put back into patient care and good infection control.
Privacy and Dignity
In a clinical setting, privacy may be needed very quickly if a patient turns to the worse or someone is disoriented and needs to be kept calm. With curtains, the patient must go to the area where the curtains are installed. Fully mobile medical privacy screens such as these models offered by Silentia can be moved anywhere at short notice.
During the oversubscribed winter months, a ward sister must temporarily place patient beds in hallways and is tasked with making these arrangements as private and restful as possible. She can bring medical privacy screens to the area, giving patients back some dignity and peace. If the hospital uses curtains, these are generally static and cannot be easily deployed in ad-hoc situations. The patients will get the full force of the noise and movement in the hallway.
A hospital is struggling with an outbreak of infection. Well-practiced infection control protocols are activated, including testing of samples taken from all rooms in the building and a thorough deep clean. In a hospital outfitted with curtains, this massive project will take longer due to the necessity of removing curtains from the space and laundering or replacing them. Due to the risk of curtains breeding infection, it could even be the case that the outbreak began there. In a hospital outfitted with medical privacy screens, the screens are less likely to be breeding infection and can be cleaned in place, with reliable, known techniques and equipment—saving time and resources.
We are at a crucial inflection point in healthcare. Medical teams and staff members around the world are battling hospital-borne infections, including resistant strains of streptococcus and C difficile. In addition to this, the advent of highly infectious SARS-COV-2, the pathogen that causes COVID-19, has made infection control a high priority in clinical settings.
All of this is taking place against a backdrop of financial and staffing challenges in U.K. healthcare, where hard-working teams are asked to do more with less and to be flexible in their ways of working and using their spaces. Whether you need to create a private area in a chaotic environment quickly, you need to find efficiencies in cleaning, or you need to combat infection, upgrading your dividers from curtains to screens will help.
Given the challenging circumstances of healthcare today, it’s a good time to move your setting—whether it’s a hospital, a clinic, or even a beauty business—away from curtains and towards professional-looking, sanitary and hard-wearing privacy screens from Silentia. The customer care team is deeply experienced in choosing the best products for you and helping you design a flexible, clean and safe environment that works well for patients and staff.