Infection Control & Hospital Epidemiology Few studies have evaluated the impact or effectiveness of


VRPP on the prevention of transmission of pathogens in the hospital setting. The Centers for Disease Control and Prevention (CDC) recommends screening visitors for illness but does not provide specific guidance regarding implementation or para- meters for VRPP.12 We developed and distributed an electronic survey to char-


acterize VRPP in pediatric healthcare facilities prior to the 2016– 2017 North American viral respiratory season.


Methods


The Infectious Disease Society of America’s Emerging Infections Network (EIN)13 is a provider-based sentinel network of infec- tious disease clinicians who regularly engage in clinical practice and are members of either the Infectious Diseases Society of America (IDSA) or the Pediatric Infectious Disease Society (PIDS). The EIN was established in 1995 through a cooperative agreement with the CDC. From July 12 to August 15, 2016, staff at the EIN coordinating center (Iowa City, IA) distributed a survey via e-mail to 334 physician members of the EIN who provide infectious disease care for children. Nonresponding members received a second query 2 weeks later, followed by a third query after 4 weeks. Respondents were asked about their familiarity with their primary institution’s VRPP, the specifics of their VRPPs, including whether restrictions are symptom-based, age-based, seasonal-based, and/or outbreak-based, the units where policies were enacted, how they were communicated to patients, visitors, and staff, and how compliance and effectiveness was assessed. Statistical analyses were performed using SAS ver- sion 9·4 software (SAS Institute, Cary, NC).


Results


We received responses from 170 pediatric physicians (a 51% response rate), and 44 (27%) indicated that they were unaware of their institution’s VRPP. Table 1 shows demographic character- istics of respondents. Among the 170 responses, all US Census Bureau Divisions were represented (Table 1). Survey respondents (86 of 170, 51%) were more likely than nonrespondents (57 of 164, 35%) to have>15 years of postgraduate clinical experience (P=·029). Of those who responded, 104 (61%) reported being at least


somewhat familiar with the details of their institution’s VRPP. Subsequent analyses are based on the responses of these indivi- duals. A form of visitor restriction was in place on all inpatient units in the facilities of 92 (88%) of respondents (Table 2). A form of visitor restriction was in place in the outpatient clinic of 9 respondents (9%), in the emergency department of 5 respondents (5%), in the day surgery department of 6 respondents (6%), and the radiology department of 3 respondents (3%). Furthermore, 12 years of age was the most common age below which age-based restrictions were in place (9 of 14 respondents specified an age limit). Upper-respiratory infections, rash, fever, cough, and diarrhea were identified as symptoms for which visitors were excluded. Outbreak-based visitor restrictions were reported by 78 (75%) for seasonal influenza, enterovirus D68, and for other local outbreaks. The incidence of respiratory syncytial virus (RSV) and influ-


enza was a primary factor impacting seasonal VRPP. Specifically, 21 respondents (20%) reported using RSV and influenza


Table 1. Practice Data for All 170 Respondents Variable


US Census Bureau Division New England Mid Atlantic


East North Central West North Central South Atlantic


East South Central West South Central Mountain Pacific Canada


Years since ID fellowship <5


5–14


15–24 ≥25


Primary hospital type Community hospital Nonuniversity teaching University Other


Pediatric hospital type Freestanding children’s hospital Children’s hospital within a hospital Pediatric ward(s) within a hospital


Note. ID, infectious diseases.


incidence to begin the implementation of seasonal restrictions, and 17 respondents (16%) used incidence of influenza only. Communication of VRPP to families occurred upon admission according to 89 respondents (87%) and periodically throughout hospitalization through signage placed in patient care areas according to 65 respondents (64%). Most respondents (n=76, 75%) reported>1 mechanism for communicating VRPP. Com- munication to staff regarding VRPP occurred by e-mail according to 79 respondents (77%), whereas in-person meetings were used for staff communication according to 56 respondents (55%) and signage use was reported by 50 respondents (49%). Most respondents (n=69, 68%) reported the use of>1 communication mechanism. In addition, 63 respondents (62%) reported that the effec-


tiveness of their VRPP was monitored through active surveillance of hospital-acquired infections. In addition, 29 respondents (28%) reported using healthcare worker exposures to monitor effec- tiveness of VRPP, and 30 respondents (29%) reported that patient


969


No. (%) 10 (6)


24 (14) 25 (15) 10 (6)


30 (18) 8 (5)


11 (6) 15 (9)


33 (19) 4 (2)


29 (17) 55 (32) 39 (23) 47 (28)


8 (5)


49 (29) 108 (64) 5 (3)


86 (53) 63 (39) 14 (9)


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