COVID-19 changed visitor management as hospitals have intensified security to mitigate the threat from the virus itself and physical threats from humans. Visitor management had gained increased attention before COVID-19, but the pandemic amplified this focus (Freidenfelds, 2021). During the peaks of the pandemic, many hospitals strictly controlled visitation. Exceptions were sometimes made for critically ill patients. However, hospitals should employ clear criteria for determining which patients have visitors. In times of less restrictive visitation policies, consistent enforcement is also critical. If officers give latitude to some people in terms of visiting hours, for P a g e | 8
example, visitors may become agitated or aggressive (Larkin, 2021). Visitor management policies should also adapt to changing transmission and morbidity metrics. Healthcare organizations have tightened and relaxed restrictions based on metrics of community transmission. Although security teams have adjusted to these dynamics, the pandemic prompted unprecedented changes to policies related to visitor management. Toward the beginning of the crisis, hospitals needed more staff at entrances to control the influx of people. Security officers and staff from other departments worked together to carry out health screening. Effective communication was particularly important during this time, as visitor management teams had to be updated regularly on new protocols. In trying to address visitors’ responses to these policies, security officers had to interact with them in a new way. One new essential function was managing people’s expectations. In trying to pare down the crowd in the waiting area, an officer at a Dublin hospital asked the son of a patient to leave. The officer did not realize the son was there to translate for his father, which confused the father and son. This type of scenario presented an added challenge for security personnel.
HCFs limited not only the number of visitors but their points of access. At Mater hospital in Dublin, points of entry fell from 23 pre-pandemic to three (Personal Interview with Zachary Chambers, 2021). The hospital did not allow children to visit. ED convenience entrances for staff were eliminated or reduced to funnel all people entering the building through manned entrances and properly secured points of ingress. A non-random sample of healthcare security leaders throughout Europe, Asia, and North America reported that 24-hour visitor access has become more difficult to secure in this period of heightened tension (Personal Interviews, 2021). Concurrently, security departments are hindered by continued staffing shortages, a problem exacerbated by the pandemic. A non-random sample of healthcare security leaders in Europe, Asia, and North America interviewed for this whitepaper reported that reducing hours of access has allowed them to protect staff more effectively. HCFs will need to make their own decision about whether resuming around-the-clock access at some point is worth the additional security risks. This decision will depend on the resources available, an evaluation of current violence statistics, and the level of risk determined to be acceptable.
COVID-19 AND AUGMENTED SECURITY MEASURES
Healthcare organizations have utilized a range of safety and security measures during the COVID-19 pandemic. Among the most ubiquitous tools used throughout the world are ID verification, on-the-spot health screening, increased personnel coverage, thermometers, and additional surveillance equipment. Some hospitals installed CCTV or card readers in sensitive areas such as drug storage rooms or entrances from car parks. Most health organizations required people entering the building to answer health screening questions and affirm they do not pose a risk to others at the facility. These questionnaires sometimes coincided with temperature checks, either with thermal cameras and/or handheld thermometers. One lesson the pandemic reinforced is that policies for screening should be clearly delineated and applied consistently, not at the discretion of security officers. An interdepartmental team should communicate regularly to adjust the policies as needed (Freidenfelds, 2021). Hospitals need to decide which positions will be responsible for health screening. Will it be security staff, nurses, or greeters? Managers should account for any training that personnel may need for tasks outside of their comfort zone (IAHSS, 2020b). To harmonize access control and screening procedures, there should be a direct line of communication between security and the command structure (IAHSS, 2020b).
Telethermographic systems (thermal cameras) for fever checks have become more widespread in HCFs in response to the pandemic. Some security directors purchased this technology without understanding its proper application, operation, and training requirements. Thermal imaging has the potential to aid security teams during pandemics or other emergencies, as well as non-emergency situations. However, HCFs need to carefully consider a number of factors when deciding when and how to use it. Thermal cameras should be used in combination with thermometers because currently available thermal cameras measure surface temperatures, not core body temperatures (Baratta, 2021).
Telethermographic systems can serve effectively as the first layer of temperature measurement when used in combination with devices that consistently and accurately gauge body temperature. The technology can be especially useful for buildings with a shortage of a handheld thermal measurement devices, as long as there is a recognition of its limitations (U.S. FDA, 2020). The cameras capture surface temperatures within a margin of error of 1–3 degrees Fahrenheit. A person’s previous environment (i.e., outside, hot room, or car) can influence body temperature. Testing has demonstrated inaccuracy when measuring more than one person simultaneously. Even if it accurately measures temperature, infected individuals who are asymptomatic will not be identified (U.S. FDA, 2021). Additionally, using thermal cameras to screen people entering an area or building is a relatively new phenomenon in the healthcare sector and security personnel will need to participate in training to understand the installation and technological operation of these systems. Healthcare organizations should weigh the costs and benefits of these technologies against alternative methods such as increased staffing, investing in more handheld thermometers, symptom screening and other disease detection approaches. When feasible, managers should take the time to evaluate each tool’s effectiveness, staff training requirements, financial cost, and privacy and data protection risks.