Infection Control & Hospital Epidemiology


Table 1. Visitor Restriction and Staff Sick Leave Policies Responses


Does the Hospital Have a Visitor Restriction Policy? (N=52) Yes, hospital-wide Yes, localizeda


Adult intensive care unit Hematology/oncology units General hospital units Medical-surgical units


Neonatal intensive care unit Newborn nursery


Pediatric intensive care unit No No. (%)


30 (58) 15 (29) 4 7 2 2


13 8 7


7 (13)


What factors is the visitor restriction policy based upon? (N=45)a Age of visitor


Influenza vaccine status of visitor Season (eg, respiratory viral season) Signs and symptoms of visitor No restriction policyb


26 (58) 1 (2)


31 (69) 40 (89) 1 (2)


Does your hospital have a policy requiring staffwith respiratory viral infection symptoms to be evaluated by employee/occupational health? (N=52)


Yes No


I don’t know


23 (44) 26 (50) 3 (6)


What factors will restrict employees from direct patient contact after evaluation by employee/occupational health? (N=40)a


Symptoms (eg, rhinorrhea, sore throat, cough, fever) Positive respiratory viral testing Influenza vaccine status Not specified in policy


37 (93) 19 (48) 3 (8) 1 (3)


Are fever and respiratory symptoms required as conditions when limiting staff from direct patient contact? (N=44)


Yes No


I don’t know


23 (52) 15 (34) 6 (14)


Does the hospital have a staff restriction policy for respiratory viral symptoms? (N=52)


Yes


Hospital-wide Localizedc


Cardiac intensive care unit Bone marrow transplant unit


33 (63) 30 3 1 1


Table 1. (Continued ) Responses


Hematology/oncology unit Neonatal intensive care unit Pediatric intensive care unit


No No response


1007


No. (%) 3


2 2


18 (35) 1 (2)


Does the hospital have an on-call system with shift coverage for sick healthcare personnel? (N=52)


Yesa


Attending physiciansd House officers


Licensed independent practitioners (physician assistants and nurse practitioners)


Nursing No I don’t know


24 (46) 7


14 6


8


12 (23) 16 (31)


aResponses could include >1 answer. bVisitors are screened; sick visitors encouraged to postpone visit. cSome hospitals had >1 localized unit with staff restriction policies for respiratory viral


symptoms. dTwo institutions indicated that they have on-call policies for sick attending physicians that


are contingent on the size of their division; smaller divisions do not have an on-call system with shift coverage.


environments and resources.3 Recent studies suggest that the implementation of such policies, specifically visitor restriction policies, can reduce HARVIs.4 Hospitals should also provide an on-call system with shift


coverage for ill HCWs, which should be known to all staff, and adherence should be encouraged by senior leadership. Unfortu- nately, as many as 23% of respondents reported not having an on-call system with shift coverage for ill HCWs and >30% reported that they did not know whether their institution had such an on-call system. Several survey respondents indicated that their policies are seasonally based, but in a previous study, we showed that HARVIs occurred year-round.5 Hospitals should ensure that these policies are enforced beyond the respiratory viral season. The implementation of visitor and sick leave policies within the


hospital will require the acknowledgment by hospitals that HARVIs can negatively affect patients who are sick and recovering in the hospital.6 Senior leadership and healthcare staff will have to support each other to ensure that these policies are adhered to, and they must provide effective ways to safeguard against these hospital- acquired infections in resource-limited settings. As with any culture shift, behavior change should begin early in the education of healthcare staff through reinforcement in the classroom and during rotations.7 Because the survey was distributed through the SRN, results


may reflect sampling bias. Furthermore, our survey was not previously validated. Despite these limitations, we hope that our survey findings stimulate discussions regarding cultural changes to our healthcare system that prevent ill HCWs and visitors from having direct patient contact.


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