Infection Control & Hospital Epidemiology (2018), 39, 968–971 doi:10.1017/ice.2018.128
Original Article
Visitor restriction policies and practices in children’s hospitals in North America: results of an Emerging Infections Network Survey
Alice L. Pong MD1,2, Susan E. Beekmann RN, MPH3, Mekleet M. Faltamo BA4, Philip M. Polgreen MD, MPH3,5 and Andi L. Shane MD, MPH, MSc6,7; for the pediatric members of the Infectious Diseases Society of America Emerging
Infections Network 1Rady Children’s Hospital, San Diego, California, 2Division of Pediatric Infectious Disease, Department of Pediatrics, University of California, San Diego, California, 3Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, 4Emory University College of Arts and Sciences, Atlanta, Georgia, 5Department of Epidemiology University of Iowa College of Public Health, Iowa City, Iowa, 6Division of Pediatric Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia and 7Children’s Healthcare of Atlanta, Atlanta, Georgia
Abstract
Objective: To delineate the timing of, indications for, and assessment of visitor restriction policies and practices (VRPP) in pediatric facilities. Design: An electronic survey to characterize VRPP in pediatric healthcare facilities. Methods: The Infectious Diseases Society of America Emerging Infections Network surveyed 334 pediatric infectious disease consultants via an electronic link. Descriptive analyses were performed. Results: A total of 170 eligible respondents completed a survey between 12 July and August 15, 2016, for a 51% response rate. Of the 104 respondents (61%) familiar with their VRPP, 92 (88%) had VRPP in all inpatient units. The respondents reported age-based VRPP (74%) symptom-based VRPP (97%), and outbreak-specific VRPP (75%). Symptom-based VRPP were reported to be seasonal by 24% of respondents and to be implemented year-round according to 70% of respondents. According to the respondents, communication of VRPP to families occurred at admission (87%) and through signage in care areas (64%), while communication of VRPP to staff occurred by email (77%), by meetings (55%), and by signage in staff-only areas (49%). Respondents reported that enforcement of VRPP was the responsibility of nursing (80%), registration clerks (58%), unit clerks (53%), the infection prevention team (31%), or clinicians 16 (16%). They also reported that the effectiveness of VRPP was assessed through active surveillance of hospital acquired respiratory infections (62%), through active surveillance of healthcare worker exposures (28%) and through patient/family satisfaction assessments (29%). Conclusion: Visitor restriction policies and practices vary in scope, implementation, enforcement, and physician awareness in pediatric facilities. A prospective multisite evaluation of outcomes would facilitate the adoption of uniform guidance.
(Received 27 February 2018; accepted 4 May 2018; electronically published June 21, 2018)
Hospital-acquired viral infections are a notable source of mor- bidity and financial burden.1–4 Respiratory viral infections, par- ticularly RSV and influenza, are associated with significant morbidity and mortality.5,6 These organisms may be introduced into the hospital environment by hospital staff, patients, or visi- tors. In the pediatric setting, a visitor includes any individual who is not a patient or a member of a professional healthcare team and could include a parent or guardian, a sibling, or a family member with care responsibilities for the pediatric patient. A visitor may have had exposure to the patient prior to the hospital setting and
Author for correspondence: Alice Pong, MD, 3020 Children’s Way, MC 5041, San
Diego, CA 92123. E-mail:
apong@rchsd.org PREVIOUS PRESENTATION: These data were presented in part at IDWeek 2017 in
San Diego, California, on October 7, 2017 Cite this article: Pong A, et al. (2018). Visitor restriction policies and practices in
children’s hospitals in North America: results of an Emerging Infections Network survey. Infection Control & Hospital Epidemiology 2018, 39, 968–971. doi:10.1017/ice.2018.128
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
could be a symptomatic or asymptomatic source of a pathogen. Alternatively, a visitor may be at risk for infection following exposure to the pathogen. Family-centered care is a model that involves family members
in healthcare decisions and procedures and encourages the bed- side presence of family members.7 In particular, the benefits of sibling visitation have been described.8,9 While positively impacting care, bedside presence of visitors may increase opportunities for transmission of pathogens from family member to patient, from family member to staff, and/or subsequently, from staff to other patients. Visitor restriction policies and practices (VRPP) are often implemented with the intent to limit transmission of community-acquired pathogens in the hospital environment by restricting the presence of visitors.10,11 In many instances, VRPP are not supportive of a family-centered care model. Age-based VRPP are often based on chronological age and not developmental stage of the visitor.
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