In the Journals

Visitor, staff restrictions vary in US hospitals

Although most U.S. hospitals had visitor restrictions in place for pediatric facilities, a smaller percentage had staff restriction policies regarding respiratory syncytial virus, according to a set of studies published in Infection Control & Hospital Epidemiology.

Alice L. Pong, MD, a clinical professor of pediatrics in the division of pediatric infectious diseases at the University of California, San Diego and Rady Children’s Hospital, and colleagues conducted a survey of pediatric infectious disease consultants through the Infectious Diseases Society of America (IDSA) Emerging Infections Network (EIN) regarding visitor restriction policies in pediatric hospitals.

“Most respondents reported some type of visitor restriction policy based on the factors of age, symptoms and outbreak; however, there was variation in scope, implementation, enforcement and awareness by physicians,” Pong told Infectious Diseases in Children.

The IDSA EIN emailed 334 member physicians between July 12, 2016, and Aug. 15, 2016, with 170 pediatric physicians responding (51% response rate). One hundred-four physicians reported being somewhat familiar with their visitor restriction policies and practices (VRPP), with 88% of those respondents reporting having VRPP in all inpatient facilities.

Respondents reported age-based (74%), symptom-based (97%) and outbreak-specific (75%) restrictions. According to the researchers, 24% of respondents reported having seasonal restrictions as well, with the incidence of RSV and influenza as a primary factor. 

The physicians reported that VRPP was communicated to families at admission (87%) and in hospital signage (64%), whereas the policies were related to staff through email (77%), by meetings (55%) and signage in staff-only areas (49%). Nursing staff had the primary responsibility of enforcing VRPP (80%), followed by registration clerks (58%), unit clerks (53%), the prevention infection team (31%) and clinicians (16%).

The respondents said that active surveillance of hospital-acquired respiratory infections (62%) and health care worker exposures (28%), along with patient and family satisfaction measurements (29%), measured VRPP success.

“There is considerable variation in visitor restriction policies in pediatric hospitals, and further study related to effectiveness of restriction strategies is needed,” Pong concluded.

Photo of Leonard Mermel
Leonard A. Mermel

In a separate study, Leonard A. Mermel, DO, ScM, AM (Hon), FSHEA, FIDSA, FACP, a professor at the Warren Alpert Medical School of Brown University and medical director of the department of epidemiology and infection control, Rhode Island Hospital, and colleagues measured hospital sick leave policies and visitor restriction policies. They sent a survey to 99 U.S. Society of Healthcare Epidemiology of America Research Network members between Oct. 11, 2017, and Nov. 11, 2017.  Fifty-two members (53% response rate) completed the survey.

Thirteen percent of respondents (n = 7) reported that their hospitals did not have a visitor restriction policy. Thirty respondents reported hospitalwide visitor restriction policies. Of 15 hospitals with localized visitor restriction policies, the most common were neonatal ICU (n = 12), newborn nursery (n = 8), pediatric ICU (n = 7) and adult hematology/oncology (n = 7).

Thirty-three respondents (63%) reported that their staff restriction policy was based on respiratory viral symptoms, with 30 having policies for areas beyond the ICU and locations in the hospital caring for immunocompromised patients. Seven of the 33 respondents whose hospitals had a policy restricting direct patient care with respiratory viral symptoms did not have an on-call system to provide shift coverage for affected health care personnel.

“Hospital-acquired respiratory viral infections are an underappreciated significant cause of morbidity and mortality,” Mermel told Infectious Diseases in Children. “Nationally, we need a greater appreciation of the risk posed by such infections in hospitalized patients; a more robust effort aimed at screening hospital visitors for signs and symptoms suggestive of a respiratory viral infection (eg, otherwise unexplained cough, sore throat, runny nose); and changes to sick leave policies so that hospital staff are not penalized for staying home with such infections.” by Bruce Thiel

Disclosures: The authors report no relevant financial disclosures.

Although most U.S. hospitals had visitor restrictions in place for pediatric facilities, a smaller percentage had staff restriction policies regarding respiratory syncytial virus, according to a set of studies published in Infection Control & Hospital Epidemiology.

Alice L. Pong, MD, a clinical professor of pediatrics in the division of pediatric infectious diseases at the University of California, San Diego and Rady Children’s Hospital, and colleagues conducted a survey of pediatric infectious disease consultants through the Infectious Diseases Society of America (IDSA) Emerging Infections Network (EIN) regarding visitor restriction policies in pediatric hospitals.

“Most respondents reported some type of visitor restriction policy based on the factors of age, symptoms and outbreak; however, there was variation in scope, implementation, enforcement and awareness by physicians,” Pong told Infectious Diseases in Children.

The IDSA EIN emailed 334 member physicians between July 12, 2016, and Aug. 15, 2016, with 170 pediatric physicians responding (51% response rate). One hundred-four physicians reported being somewhat familiar with their visitor restriction policies and practices (VRPP), with 88% of those respondents reporting having VRPP in all inpatient facilities.

Respondents reported age-based (74%), symptom-based (97%) and outbreak-specific (75%) restrictions. According to the researchers, 24% of respondents reported having seasonal restrictions as well, with the incidence of RSV and influenza as a primary factor. 

The physicians reported that VRPP was communicated to families at admission (87%) and in hospital signage (64%), whereas the policies were related to staff through email (77%), by meetings (55%) and signage in staff-only areas (49%). Nursing staff had the primary responsibility of enforcing VRPP (80%), followed by registration clerks (58%), unit clerks (53%), the prevention infection team (31%) and clinicians (16%).

The respondents said that active surveillance of hospital-acquired respiratory infections (62%) and health care worker exposures (28%), along with patient and family satisfaction measurements (29%), measured VRPP success.

“There is considerable variation in visitor restriction policies in pediatric hospitals, and further study related to effectiveness of restriction strategies is needed,” Pong concluded.

Photo of Leonard Mermel
Leonard A. Mermel

In a separate study, Leonard A. Mermel, DO, ScM, AM (Hon), FSHEA, FIDSA, FACP, a professor at the Warren Alpert Medical School of Brown University and medical director of the department of epidemiology and infection control, Rhode Island Hospital, and colleagues measured hospital sick leave policies and visitor restriction policies. They sent a survey to 99 U.S. Society of Healthcare Epidemiology of America Research Network members between Oct. 11, 2017, and Nov. 11, 2017.  Fifty-two members (53% response rate) completed the survey.

Thirteen percent of respondents (n = 7) reported that their hospitals did not have a visitor restriction policy. Thirty respondents reported hospitalwide visitor restriction policies. Of 15 hospitals with localized visitor restriction policies, the most common were neonatal ICU (n = 12), newborn nursery (n = 8), pediatric ICU (n = 7) and adult hematology/oncology (n = 7).

Thirty-three respondents (63%) reported that their staff restriction policy was based on respiratory viral symptoms, with 30 having policies for areas beyond the ICU and locations in the hospital caring for immunocompromised patients. Seven of the 33 respondents whose hospitals had a policy restricting direct patient care with respiratory viral symptoms did not have an on-call system to provide shift coverage for affected health care personnel.

“Hospital-acquired respiratory viral infections are an underappreciated significant cause of morbidity and mortality,” Mermel told Infectious Diseases in Children. “Nationally, we need a greater appreciation of the risk posed by such infections in hospitalized patients; a more robust effort aimed at screening hospital visitors for signs and symptoms suggestive of a respiratory viral infection (eg, otherwise unexplained cough, sore throat, runny nose); and changes to sick leave policies so that hospital staff are not penalized for staying home with such infections.” by Bruce Thiel

Disclosures: The authors report no relevant financial disclosures.