Elevating standards, improving safety

Lifts are an essential means of providing vertical transport for all users, from the very young to disabled, elderly, and infirm people, and others unable to safely use stairs – but are one of the few types of transport available for continuous unsupervised use. They can also be among the safest modes of transport when designed and maintained to strict standards.

Hospital lifts are even more critical, providing access for patients in wheelchairs or beds travelling between theatres and wards, and are fundamental to maintaining efficient traffic flows for patients, staff, and visitors, inside large and complex buildings. A lift breakdown could result in clinical appointments being delayed, or worse, compromise emergency patient care.

The lifecycle of a lift is longer than most other forms of transportation and building equipment. Lift design thus has to be carefully considered, and the equipment precisely maintained to ensure ongoing safety, performance, and accessibility.

Specifying New Equipment

Lift manufacturers should work closely with the hospital management or users during a project’s design phase, to allow the precise usage requirements to be ascertained prior to manufacture, and enable the lift specialist’s experience to add value. While lift specifications are clearly set out in HTM guidance, hospital management personnel may not be aware of the latest advancements and innovations in lift technology that can significantly enhance security and traffic flows through a hospital.

As a starting point, look closely at how each lift will be used. It is important to separate different types of uses – passenger lifts for staff and visitors, bed heavy use at peak periods, requiring potentially more lifts. We would also expect these passenger lifts to be used to move staff, as well as hospital visitors, around the building, so would not only look at staff numbers and typical arrival and finish times, but also consider the location of staff changing facilities, which should ideally be near to the lifts. Patient movements – bed passenger lifts We would strongly advise keeping patient movements separate from the day-to-day running of the hospital, to preserve dignity and privacy, and facilitate infection control. Bed passenger lifts should be exclusively for patients’ use, and their operation to meet hospital and clinical Elevating standards, improving safety Technical guidance: Lifts in healthcare premises In our latest ‘technical guidance’ article, Richard Clarke, sales and marketing director at one of the UK’s leading lift and escalator specialists, Schindler, examines some of the key issues surrounding the specification, maintenance, and operation of lifts in hospitals to help ensure the highest standards of safety and reliability. 31 Health Estate Journal August 2014 passenger lifts for moving patients, and FM lifts for transporting hospital supplies and equipment.

 

Passenger Lifts

A major challenge in all hospitals is how to move visitors around, particularly at peak periods, when visiting times are restricted. We would recommend running a traffic simulation programme to assess the expected visitor numbers in order to calculate the number, size, and speed, of lifts required. This will help avoid queues forming in lift lobbies at peak times.

We need to know the number of patient beds and visitors allowed – two per patient for example – and whether visitors are allowed at any time, or only during set visiting hours. If the latter, there will be heavy use at peak periods, requiring potentially more lifts. We would also expect these passenger lifts to be used to move staff, as well as hospital visitors, around the building, so would not only look at staff numbers and typical arrival and finish times, but also consider the location of staff changing facilities, which should ideally be near to the lifts.

Patient Movements - Bed Passenger Lifts

We would strongly advise keeping patient movements separate from the day-to-day running of the hospital, to preserve dignity and privacy, and facilitate infection control. Bed passenger lifts should be exclusively for patients’ use, and their operation to meet hospital and clinical requirements should be discussed during the planning stages. When specifying bed passenger lifts, we look at the specification and size of hospital beds to be able to specify the correct car size. Hospital beds are now very sophisticated; we need to know what equipment the bed will have with it, and how many people will accompany a patient? We can then ascertain the lift door sizes, and lift car requirements.

Doors also need to be capable of staying open for longer when moving beds compared to standing patients. Using the latest lift technology, this facility can be automated, and door opening speeds varied according to each use.

FM Trolley LIfts fo Hospital Supllies

FM trolley lifts will transport supplies across the hospital. It is now typical to have ‘clean’ lifts for fresh linen supplies, medicines, and food, and ‘dirty’ lifts for used linen and waste. An option in large acute hospitals is for lifts to be linked to sophisticated robotic systems, which are then linked to the lift operating system. As part of the specification process, consideration must be given to the most appropriate finish for the lifts. We would advise stainless steel – which is highly durable, and easy to clean and repair – for hospital applications.

Priority COntrol For Lifts

Some hospitals will benefit from having a feature that allows lift control to be taken over. For example, where there is a helipad on a hospital’s roof, it is important to be able to have priority over a lift so it can remain on standby ready to receive the emergency patient and medical team as soon as the helicopter lands.

NHS Trusts are increasingly looking at how lifts can enhance security by giving staff the flexibility to take over access in emergency situations, such as major incidents, or a security breach. This means moving away from push-button operation to more sophisticated destination control technology, which allows faster, more efficient passenger flows, from predictive call entry, to touchless operation. These card-driven systems can adapt the lift to meet the user’s needs. The passenger simply presents a card at the port, and a screen will activate use of the lift.

Destination Control Technology

Destination control technology can allow, for example, patient beds to be tagged, so that when they are moved towards the lift, the car is automatically called, and the doors open. This technology can also be used to assist in wayfinding through the hospital. Lifts can also now interface with a hospital’s security systems – an important advantage for areas of restricted access, for example, on paediatric wards. Lift use can be limited to personnel carrying a security pass.

 

Selecting a Lift Manufacturer

The manufacturer’s standard product range should be fully HTM-compliant, and the onus is on the supplier to ensure that equipment complies with the European standard – EN 81, a statutory requirement. Two new statutory standards are being introduced:

• EN 81-20 sets out the safety rules for the construction and installation of passenger and goods passenger lifts (electric and hydraulic). This will replace both EN 81-1 and EN 81-2, and contains many technical amendments.
• EN 81-50 sets out the design requirements, calculations, examinations, and tests, of lift components. It replaces the information mostly found in the annexes of EN 81-1 and EN 81-2.

These new standards will have a three-year transition period. It will thus be July 2017 before new lifts put into service must comply with EN 81-20 and EN 81-50. During the transition period lifts can be installed either to EN 81-1, EN 81-2, or EN 81-20 and EN 81-50. The applicable installation standards, however, must be stated on the Declaration of Conformity provided to the lift owner at the time of handover.

A Strong Track Record

Healthcare professionals should also make sure that the lift supplier has a strong track record in the health sector. Look at what major hospital projects it has successfully delivered, and talk to its customers. Lifts for hospital applications are a very specialist area. We were brought in to replace lifts in one hospital building after only five years because the original supplier was not familiar with the issues and requirements of a demanding healthcare environment.

It is also vital to consider how the new lift will be maintained. Older equipment will have plant rooms, but it is now more cost-effective to specify machine room-less lifts. Be aware that maintenance may have to be carried out in the lift lobby, but these lifts are now the industry standard, although they can still be adapted to specific project requirements.

Sustainability Features

As with all other parts of a building, sustainability now influences lift specification and design, and the equipment can contribute to a scheme’s BREEAM rating. Energy-efficient features can include LED lighting, and standby mode for when a lift is not in use. Traffic simulations will also ensure optimum use and speed, and that too many lifts are not specified.

Ensuring Effective Lift Maintainance

Passenger safety must be paramount – whether for staff, patients, or visitors to a hospital. Protecting a Trust’s assets also makes good sense. A preventative maintenance regime is critical to maximising the availability of lift equipment, and to ensuring that it remains compliant with the latest mandatory safety standards and stringent codes of practice.

There have been instances where both NHS Trusts and lift maintenance companies have been prosecuted following avoidable loss of life for failing to adequately maintain lift equipment, so the importance of a strict schedule appropriate to the use of lifts cannot be strressed enough

Ten 'Key Areas'

I will now highlight 10 key areas to help healthcare estates professionals to ensure safe, efficient, and reliable lift operation:

1. A stringent maintenance programme
   This means the equipment will be regularly checked by a competent specialist, and in line with the lift manufacturer’s recommended maintenance schedule. Manufacturers’ recommendations will all vary, but should be detailed in the equipment’s Operation and Maintenance Manual. If the lift is newly installed, make sure that the document is passed to the hospital estates manager by the contractor or installer. A regular inspection routine delivered by a competent lift specialist should provide the assurance of both the relevant technical expertise, and the rapid supply of spare parts. Preventative maintenance is crucial to an effective regime, and to delivering peak performance and a safe running condition.

   These regimes must be specific, and tailored to the age, traffic flow, location, and vulnerability, of the lift. If correctly delivered, a proactive regime will improve the life of the equipment, extend the time between callbacks, maximise lift availability and reliability, and reduce the risk of passenger accidents and associated litigation.

   How critical is the lift’s use? A passenger bed lift transporting patients to theatre will clearly be more essential equipment, and therefore require more frequent inspections, than a lift in a car park, for example. Is the lift subject to heavy use, ‘24/7’, or is it a low demand unit used from 9.00 am to 5.00 pm, Monday to Friday, as in an office situation? An outdoor lift for a car park will also be more exposed to the elements than an internal lift, and will thus require more regular maintenance and checks. A good lift maintenance specialist can advise and draw up the most appropriate service schedule for each lift to minimise breakdowns, particularly in important locations, that could compromise safety and patient care.

2. Statutory Inspections
   Lifts carrying passengers require inspection by a ‘competent person’, with a maximum interval of six months between each inspection. ‘Goods only’ lifts must be examined at least every 12 months – an important legislative requirement that should be undertaken in accordance with the Lifting Operations & Lifting Equipment Regulations 1998 (LOLER). Ideally an independent third party, rather than the maintenance contractor, would carry out this inspection, to avoid any conflict of interest.

   Some major lift companies may carry out additional periodic safety inspections to offer further reassurance on performance, reliability, and safety – something that Schindler would strongly recommend.

    

   Other legislation applicable to lift equipment includes:

   • The Health and Safety at Work Act – to ensure safe working for staff and contractors.
   • PUWER – Provision and Use of Work Equipment Regulations – a lift in a communal area is classed as ‘work equipment’.
   • BS 7255 2012, which outlines best practice for a lift owner, and a lift maintenance contractor
   • CE Marking – Lift equipment has to be CE marked in accordance with EN81. This is a suite of standards for new lift installations.

3. Additional checks
   Alongside a specialist servicing and maintenance regime, we would advise estates managers to carry out a number of additional regular checks, which can be undertaken by the Trust’s own staff:

   • Ensure that the emergency communications system is working at all times. Check with the maintenance contractor whether the lifts have the facility for automatic remote checking every 72 hours. This feature is a statutory requirement for all new lift installations, but if an existing lift is not thus equipped, put in place a process for the system to be tested every three days.

   • Lighting should be checked regularly. Hospital lifts transport frail and vulnerable people, so any bulbs not working must be replaced promptly.

   • Check the levelling. The lift threshold should be level with each floor it opens out onto. Any significant variation will create a serious trip hazard, and issues for patient trolleys and beds, wheelchairs, and less mobile people. New lifts are designed to allowable tolerances of +/–6 mm, whereas existing installations have tolerances of +/–12 mm. Be aware that lifts can move over time, and that technology has significantly improved, so there will be fewer issues with newer equipment.

   • Make sure door tracks are kept clear at all times. The most common cause of lift breakdown is the doors failing to open or close. This is because the doors are the parts most likely to be interfered with or obstructed by passengers. To help avoid this, the hospital’s cleaning regime should include vacuuming out and regular cleaning of the tracks. The regime will need to be more frequent where a lift is sited close to a main entrance, rather than, say, in the hospital’s centre.

   • Regular checks on door safety devices should also be undertaken. These features ensure the doors reverse if an obstruction is detected, to prevent them closing on, and injuring, a passenger.

4. How to select a lift maintainance company

   • Assess the company’s overall technical competence. Be aware that not all service-providers will have the same levels of competence or familiarity with the equipment you have in place.
   • Many facilities managers are unaware that it is usual for a lift servicing company to be able to maintain equipment supplied by another lift manufacturer.
   • Ensure that the service-provider has sufficient resources and the local capacity to give you the frequency of maintenance your lift equipment will need; this will vary according to the lift location and usage.
   • Maintenance contracts are typically in place for 1-5 years, but could be fixed, in the case of a PFI project, for up to 25 years. The contracts vary in their coverage, from ‘maintenance only’, to including all replacement parts and breakdown costs.

      

5. Avoiding Obsolescence
   As well as ensuring good maintenance, avoiding obsolescence of parts is critical to minimising breakdowns. When specifying new lift equipment, look at the manufacturer’s policy on available parts for superseded products, or for when that model is no longer available. Schindler, for example, warrants that parts for any lift will be available for a minimum of 15 years after a product ceases to be manufactured. We have seen companies stopping supplying parts after just six months, and lifts having to be replaced after just two years – because parts were no longer available for repair. This should not be allowed to happen.

6. Use'as designed'
   Make sure each lift is used only for the purpose it was designed for. Is a lift designed to take patients on trolleys, for example? If not – but that is how it is now used – it will be more susceptible to damage and breakdown. Equally, consider whether, if a hospital building is being reconfigured, and departments are being relocated, the lifts are still fit for purpose? The equipment may need upgrading to ensure continuity of service.

7. Enhancing saftey in older lifts
   To reduce the risk of injury to passengers, consideration should be given to enhancing older lifts with multi-beam, non-contact safety edges to the car doors. Some door edges have green and red warning lights to show when the doors are closing, and when it is safe to enter the lift. Enhanced levelling systems can also deliver improved level access into and out of the lift car, and further reduce the risk of potential trip hazards.

8. What is design life?
   Typically lifts are designed for use for periods from 15-25 years, although there are instances, for example in interim and decant buildings, where a lift may only be required for five years or less. The lift should be adequately maintained, small repairs carried out, and parts replaced as needed. It may then be necessary to upgrade the lift equipment to bring it up to modern standards, or it could eventually be more cost-effective over the long term to replace the equipment with a new system.

9. Evolving technology, and risk assessments
   As with other building components, lift technology is continually evolving. Some more advanced features and innovations could be retro-installed, such as emergency communications systems. While these systems are not statutory requirements for existing lift installations, it is good practice to have them installed where feasible. Hospital buildings are used by vulnerable people, and the risk of claims can be minimised by having the appropriate safety equipment in place – such as passenger detectors on doors. It is worth noting that one single claim can be higher than the cost of fitting a safety device.

   A good maintenance contractor would carry out a risk assessment, and can advise on how a lift can be enhanced to improve safety in operation, and to reduce the risk of incidents and claims, as well as enhance the user experience.

10. Statutory Compliance
    Compliance with EN81 part 70 is a statutory requirement for new lift installations to ensure accessibility for persons with disability. This is also recommended, but not compulsory, for existing lifts. There may be a need to add features to the lift car such as a permanent chair, hand rails, audible communications for partially-sighted people, or visible indicators for passengers with hearing difficulties, and to ensure adequate car sizes for wheelchair users.

Maintaining the highest standards of lift safety

When undertaking any service or maintenance work on lift equipment, the estates professional or facilities manager must ensure safe access and working for contractors at all times. Health and safety regulations apply to all aspects of a building, including lifts. Advancements in lift technology mean equipment is now designed to protect the safety of contractors working to maintain or repair a system, so there should be switches, locks, and power isolators, in place. However, the older the lift equipment, the fewer safety devices there will be, making that ageing equipment more difficult to maintain. The lift owner should be aware of this potential additional risk, and should implement procedures to ensure safe working.

Importance of User Education

Educating users on lifts is really important. Door strikes most commonly occur when a passenger’s hand is stuck between two doors when that person has tried to enter a lift too late. Good quality safety edges to the door should prevent this up until the point where there is a gap of around four inches; passengers should then know better than to try to force entry.

the doors with hospital trolleys or beds will cause electronic components to misalign – the single most frequent cause of lift breakdowns. Again, user education among hospital staff and porters can help prevent this.

Lift users should never interfere with lift equipment – it is moving equipment, and should be respected at all times. The number of lift breakdowns in hospitals can definitely be reduced by users taking more care. Debris and litter should also be kept well away from a lift. Debris gathered in the lift pit will take additional time, and therefore cost, for the maintenance specialist to clear.

Passenger Release

How passengers are to be released in the event of lift doors failing to open is another key issue. Ideally, an alarm system should be connected to a communications centre or a working telephone line that is operated ‘24/7’. Schindler has a national communications centre, and, when automatically contacted by the alarm system in one of its lifts, staff will know the lift number and exact location to despatch an engineer to, to rescue the trapped passengers. While an increasing number of organisations, including NHS Trusts, now ask for local staff to be trained in lift release, our experience is that their depth of knowledge will be very limited, and indeed in some situations that lack of competency could make a situation much worse.

Avoiding Communication Breakdown

When lifts are inspected for insurance purposes, or under the Lifting Operations & Lifting Equipment Regulations 1998 six or 12-monthly statutory inspections, it is critical that any remedial action highlighted is passed to the maintenance company promptly. We have witnessed serious breakdowns in communication between the building operator and the lift maintenance company, which can compromise safety.

A good lift manufacturer will help specifiers procure the correct lift equipment at the inception of design to deliver a completely fit-for-purpose solution over time. The equipment then has to be maintained and updated according to current requirements and the manufacturer’s guidelines – and there are a number of codes of practice and legislation in place governing lifts in a healthcare environment. Compliance is crucial, as is the need to invest in the equipment to maximise uptime and, most importantly, to ensure staff, visitor, and patient safety, and a positive user experience.

Richard Clarke has over two decades of experience in the lift sector. He joined Schindler in 2009, having worked for a number of lift companies. Sales and marketing director at the company, where he oversees its product offering in the UK, and ensures product development in line with customers’ expectations and market changes, Richard Clarke is also responsible for new and existing installations, the company’s strategy planning, and marketing activity.