Printed from the blog of Lori Greene, AHC/CDC, CCPR, FDAI
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Email: lori_greene@allegion.com, Blog: www.idighardware.com or www.ihatehardware.com


Feb 10 2015

Murals in Health Care Occupancies

Category: Egress,Health CareLori @ 12:06 am Comments (16)
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Garden Last summer I wrote a post about the practice of disguising doors in memory care units, to help prevent patients from “eloping.”  I included many examples of doors with painted or adhesive murals, disguising doors as bookcases, gardens, wheat fields…basically anything other than an exit that might tempt a patient.  I researched the codes at that time, and there was nothing that would allow the use of murals to disguise exits.  It goes against the familiar IBC requirement:  “Means of egress doors shall be readily distinguishable from the adjacent construction and finishes such that the doors are easily recognizable as doors. Mirrors or similar reflecting materials shall not be used on means of egress doors. Means of egress doors shall not be concealed by curtains, drapes, decorations or similar materials.”

But the other day I found a surprise in the 2015 edition of NFPA 101 – The Life Safety Code (I didn’t find a similar section in the IBC).  Although this code is not widely used yet, it does include a paragraph in both the new and existing health care chapters that would allow murals to disguise egress doors (this section also appears in Chapter 19 for existing health care):

18.2.2.2.7* Doors permitted to be locked in accordance with 18.2.2.2.5.1 shall be permitted to have murals on the egress doors to disguise the doors, provided all of the following are met:

1. Staff can readily unlock the doors at all times in accordance with 18.2.2.2.6.
2. *The door-releasing hardware, where provided, is readily accessible for staff use.
3. *Door leaves, windows, and door hardware, other than door-releasing hardware, are permitted to be covered by the murals.
4. The murals do not impair the operation of the doors.
5. The location and operation of doors disguised with murals are identified in the fire safety plan and are included in staff training.

The section above references section 18.2.2.2.5.1, which allows doors to be locked in a means of egress where required for the security or protection of patients, as long as staff can unlock the doors.  Doors must be capable of being unlocked by either a) remote control, b) keys carried by staff, or c) other reliable means available to staff at all times.  According to Annex A,  this method might be acceptable for psychiatric units, Alzheimer units, and dementia units, along with forensic units and detention units.  The annex also mentions pediatric units, maternity units, and emergency departments as examples of areas which might justify controlled egress.

With the addition of the new NFPA 101 section on murals, the same doors that are allowed to have controlled egress may also be disguised by murals.  Patients with mental illness can become fixated on exit doors, so disguising the door may help to create a more calming environment and reduce the chance for elopement when staff members use the door.  (Note: I edited this from the original with the help of one of my readers. – LG)  Annex A notes that murals should not obscure exit signs,vision panels, or operable hardware, or affect the fire resistance rating if the opening is a fire door assembly.  The door manufacturer must be contacted to confirm whether the mural being used is acceptable for fire doors.  Remember, the use of murals in these units is allowed by the 2015 edition of NFPA 101, but is not addressed in the IBC.

~~~

There are a wide variety of door mural designs available, including over 100 from an Etsy store called FromEUWithLove.  Given the change to NFPA 101, don’t be surprised if you find what appears to be a brick wall or approaching wildlife the next time you visit a memory care unit.

Basketball  Horse

Photos courtesy of FromEUWithLove on Etsy.

16 Responses to “Murals in Health Care Occupancies”

  1. Cda says:

    Interesting

    Wonder who brought forth that change?

  2. cda says:

    Note also, it is allowed in existing:::

    101 2015 edition:

    19.2.2.2.7* Doors permitted to be locked in accordance with 19.2.2.2.5.1 shall be permitted to have murals on the egress doors to disguise the doors, provided all of the following are met:

    (1)
    Staff can readily unlock the doors at all times in accordance with 19.2.2.2.6.

    (2)*
    The door-releasing hardware, where provided, is readily accessible for staff use.

    (3)*
    Door leaves, windows, and door hardware, other than door-releasing hardware, are permitted to be covered by the murals.

    (4)
    The murals do not impair the operation of the doors.

    (5)
    The affected smoke compartments are protected throughout by an approved, supervised automatic sprinkler system in accordance with 19.3.5.7.

    (6)
    The location and operation of doors disguised with murals are identified in the fire safety plan and are included in staff training.

  3. cda says:

    18.1.1.1.4 The requirements established by this chapter shall apply to the design of all new hospitals, nursing homes, and limited care facilities. The term hospital, wherever used in this Code, shall include general hospitals, psychiatric hospitals, and specialty hospitals. The term nursing home, wherever used in this Code, shall include nursing and convalescent homes, skilled nursing facilities, intermediate care facilities, and infirmaries in homes for the aged. Where requirements vary, the specific subclass of health care occupancy that shall apply is named in the paragraph pertaining thereto. The requirements established by Chapter 20 shall apply to all new ambulatory health care facilities. The operating feature requirements established by Section 18.7 shall apply to all health care occupancies.

    “””Does not seem to limit what setting the doors are in”””

    18.2.2.2.5.1* Door-locking arrangements shall be permitted where the clinical needs of patients require specialized security measures or where patients pose a security threat, provided that staff can readily unlock doors at all times in accordance with 18.2.2.2.6.

    • Lori says:

      Thanks Charles. I did mention new and existing in the post, but I just added an additional note referencing the code section to help clarify.

  4. Louise says:

    okay, you got me.
    where’s the lever or release mechanism on the brick wall w/ basketball hoop?

  5. Greg says:

    “If the door is allowed to be locked in the direction of egress, I’m not sure why it would also need to be disguised. Maybe the use of murals is meant as an alternative to controlled egress, but as the code is written, both could be used.”

    Patients with mental illness can become fixated on exit doors, so by disguising them it creates a calming environment. It also lessens the chance for elopement when staff use the door as the patients don’t stand by the door waiting for it to open.

  6. Joel Niemi says:

    The examples shown are, at least, clearly different from the adjacent walls. Better than the hide it/match the wall approach seen in other settings. Still, training staff to know that these are doors is important

  7. Gerry says:

    This is great info, thanks all for sharing. My concern is for the actual product that is used. Is it safe for use from a fire safety perspective? I work in Alberta and all films and decorative materials must be approved for use, meeting CAN/ULC S-109 standards. I have not yet seen a product that is approved for use on a fire rated door. It’s a super idea for our at risk patient and clients but how do we achieve the desired results safely?

    • Lori says:

      Hi Gerry –

      I had the same question. When I talked to UL, I think there was only one company who had listed something similar (not for this use specifically) but I don’t think the murals that many facilities are applying to doors are listed for use on a fire door. I’m not familiar with the requirements for wall coverings or whether these products would be an issue for a non-fire-rated door with a flammable layer applied to it. I guess the fire doors could be painted with similar designs and be code-compliant, but the applied film is obviously less expensive, less disruptive, and easier to maintain.

      – Lori

      • Gerry says:

        Lori, thanks for your prompt reply!! I am always concerned when new products just show up, installed, with being proven that they are safe for use in care or hospital setting. I’m glad that I stumbled across your blog! and i’ll keep researching. _ gerry

  8. Rudy L. Raynes, ASFM says:

    The murals would not be allowed in Health Care facilities that fall under the Federal Government guidelines. They are still using the NFPA 2000 code. Until the Federal Government adopts the NFPA 2015 they would not be allowed.

    • Lori says:

      That is correct, Rudy. As with all new code requirements, they don’t apply unless that code has been adopted by the AHJ for that project’s jurisdiction.

      – Lori

  9. Jerry Austin says:

    I often wonder what research would lead to the conclusion that some mentally confused person would be calmed by the image of horse charging through what was a doorway. It seems to me that sometimes bad changes occur because the change is based on nothing other than someone’s desire to be responsible for a change. I don’t really trust the basis for the mural change. I am glad to see someone is concerned about how such a large plant-on (to use what is probably now an archaic term for things mounted on fire doors, like signs) might affect the door. This has been studied and objects mounted on fire doors can change heat transfer enough in some cases to cause the door to destructively warp in a fire, enough change to cause the latch to fail as the door bows in the frame.

    When I worked in healthcare, I had to resist hundreds of requests that made little or no sense. Like the request to carpet and decorate a 10 story stairwell so it would be “more friendly to people who would then use the stairway instead of the elevator.” The bare cement stair could not have been safely and successfully carpet due to its construction. I felt worst than that, the surface would be transformed from a very sound an safe walking surface into one less safe, particularly with evacuation being its use. It did not get done.

    • Lori says:

      I’m guessing that most memory care units aren’t ordering the charging horse decal, but you never know! 🙂

      Thanks, as always, for sharing your insight.

      – Lori

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