Infection Control & Hospital Epidemiology (2018), 39, 1006–1009 doi:10.1017/ice.2018.131
Research Briefs
Visitor screening and staff sick leave policies in US hospitals Eric J. Chow MD, MS, MPH1,2, Michael A. Smit MD, MSPH2,3 and Leonard A. Mermel DO, ScM, AM(Hon)1,4 1Department of Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, 2Department of Pediatrics,
Warren Alpert Medical School of Brown University, Hasbro Children’s Hospital, Providence, Rhode Island, 3Division of Infectious Diseases, Hasbro Children’s Hospital, Providence, Rhode Island and 4Division of Infectious Diseases, Rhode Island Hospital, Providence, Rhode Island
(Received 27 February 2018; accepted 9 May 2018; electronically published June 21, 2018)
Patients are at risk of hospital-acquired respiratory viral infections (HARVIs) spread from ill healthcare workers (HCWs) and visi- tors.1,2 We assessed hospital staff sick leave policies and visitor restriction policies. A Society of Healthcare Epidemiology of America Research Network (SRN) survey revealed variability in screening of visitors for symptoms suggestive of respiratory viral infection and staff sick leave policies. Many hospitals had no policy restricting direct patient care for sick visitors or hospital staff.
Methods
A survey was sent to US SHEA Research Network (SRN) mem- bers between October 11 and November 11, 2017. The Rhode Island Hospital Institutional Review Board granted our survey exempt status.
Results
Of 99 SRN members, 52 completed the survey (response rate, 53%). The highest percentage of respondents was in the Northeast region (33%), and most worked in academic medical centers (56%) or hospitals affiliated with an academic institution (15%). Pediatric hospitals were the primary affiliation of 21 (40%) survey respondents, including stand-alone children’s hospitals and chil- dren’s hospitals within hospitals. Seven respondents (13%) noted that their hospitals do not
have a visitor restriction policy (Table 1). Of the 45 respondents in hospitals with a visitor restriction policy, 30 (67%) were hospital-wide and not limited to specific units. When visitor restriction policies were localized, they were most commonly in the neonatal ICU (12 of 15 localized policies), newborn nursery (8 of 15), pediatric ICU (7 of 15), and adult hematology/oncology units (7 of 15). Of the 45 hospitals with visitor restriction policies, 40 (89%) assessed visitor signs and symptoms, 26 (58%) assessed visitor age, and 1 (2%) assessed influenza vaccine status. In addition to these factors, 31 hospitals with visitor restriction policies (69%) indicated that their policies were put in place seasonally.
Author for correspondence: Dr Leonard Mermel, Division of Infectious Diseases, Rhode Island Hospital, 593 Eddy Street Providence, RI 02905. E-mail:
lmermel@lifespan.org Cite this article: Chow EJ, et al. (2018). Visitor screening and staff sick leave policies
in US hospitals. Infection Control & Hospital Epidemiology 2018, 39, 1006–1008. doi: 10.1017/ice.2018.131
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. A total of 33 respondents (63%) noted that they had a staff
restriction policy in their hospital system based on the presence of respiratory viral symptoms. Among them, 30 reported hospital- wide policies extending beyond ICUs and locations in the hospital caring for immunocompromised patients. In addition, 26 respondents (50%) noted that their hospital has no requirement for hospital staff with respiratory viral symptoms to be evaluated by employee and occupational health (EOH). If EOH evaluated staff members with respiratory viral symptoms and symptoma- tology was confirmed, 37 of 40 (93%) of those hospitals restricted direct patient care. Of these 37 hospitals, 23 (62%) required fever in addition to upper respiratory tract infection symptoms before direct patient care was restricted. Of 33 respondents whose hos- pitals have a policy restricting direct patient care with respiratory viral symptoms, 7 (21%) noted that there was no on-call system to provide shift coverage for such healthcare personnel. Although the Northeast, Midwest, South, and West regions
had similar rates of staff restriction policies for respiratory viral symptoms (65%, 60%, 67% and 63%, respectively), the require- ments for staff with respiratory viral symptoms to be evaluated by EOH were highest and lowest in the Northeast region (71%) and the West region (13%), respectively. Also, 20% and 58% of respondents in the Midwest and South regions required evalua- tion by EOH for respiratory viral symptoms, respectively. The West region had the lowest number of respondents reporting an on-call system to provide coverage when healthcare personnel are ill (25%); the South, Northeast and Midwest regions had rates of 58%, 47% and 47%, respectively. In the South and West regions, all respondents reported the presence of a visitor restriction policy, compared to 80% and 76% in the Midwest and Northeast regions, respectively.
Discussion
Hospital-acquired respiratory viral infections are a source of patient morbidity and mortality and universal implementation of visitor screening and HCW sick leave policies are important in reducing transmission of these infections in the hospital. Never- theless, our survey results show that many US hospitals have not implemented visitor restriction or staff sick leave policies. Implementation of a universal policy restricting ill HCWs from direct patient care may be challenging to hospitals, especially when extra personnel or financial resources are limited. In these situations, policies may have to be tailored to individual patient care units or services, taking into account their unique
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