After reading this article, you will be able to:
- Describe visitor policies that comply with infection control best practices
- Justify the importance of visitor education
- Indicate what personal protective equipment visitors should wear for patients with isolation precautions
With Joint Commission standards requiring patient and visitor education on healthcare-associated infections (HAI), coupled with the emergence of H1N1, hospital visitation policies have become a hot topic for infection prevention.
Although the CDC and OSHA offer guidelines for employees caring for patients under isolation precautions, neither agency gives concrete recommendations for visitors who will be in the same room as the patients. Depending on the nature of the interaction with the patient, employees will wear gloves, isolation gowns, surgical masks, or N95 respirators. However, because visitors are not typically providing care, isolation gowns and gloves are largely unnecessary, says Terry Burger, BSN, RN, CIC, CNA, BC, director of infection prevention and control at Lehigh Valley Hospital in Allentown, PA.
“If a visitor is going to go in the room and visit with a loved one and will not be touching everything, touching their wounds, or touching any open or draining secretions, from our perspective, it is not imperative that they sit there during their visit in isolation with [personal protective equipment (PPE)],” Burger says. Instead, educating visitors about isolation precautions allows them to fully understand their role in preventing infections.
Protecting other patients
Burger says because most visitors are healthy, she is far more concerned about transmitting infections to other patients in the hospital who may have compromised immune systems. Rather than forcing everyone to wear PPE at Lehigh, it’s more important to educate visitors on proper hand hygiene and restrict them from visiting other patients in the hospital.
“It’s not like because they kiss them they now have MRSA,” Burger says. “What we really instruct them to do is [practice] good hand hygiene. If they are going to be touching their loved one, then they have to make sure they are washing their hands before they go to the cafeteria or they go to the gift shop or anywhere else.”
For patients who are on droplet precautions, such as influenza or meningitis, visitors are offered PPE. For tuberculosis patients, visitors are required to wear an N95 respirator. “In terms of contact, we’re a little bit more lenient with that,” Burger says. “By and large, most [visitors] have been around these [patients] day in and day out. What we are much more adamant about is that they not leave that patient and go to another patient room.”
Communicating with the visitor
Many visitors who walk into a medical facility may not be aware of the precautions a friend or family member is under or understand why those precautions are in place. The most important thing is to educate them on infection control policies and have PPE available for them, says Patty Burns, BSN, RN, CIC, infection control coordinator at St. Elizabeth Medical Center in Edgewood, KY. “We talk to them about how it is transmitted, how they want to stand back and not be right in front of the patient, and definitely to use hand hygiene when they leave,” Burns says. “Also, when they themselves have any sort of respiratory illness, they should not be visiting.”
Burns says infection preventionists at St. Elizabeth educate nurses, and the nurses educate visitors and gauge each situation. If the visitor is a family member who has been around the patient consistently at home, he or she is probably already aware of the precautions.
“If it’s a husband and wife situation and they have been living in the same house, and now all of a sudden the person is in isolation, it seems kind of silly to make the person put a mask on,” Burns says. “So we talk to them about the risks, do [they] want [a surgical] mask and how to deal with that. It comes down to communication with the visitor.”
Preventing flu transmission
With the addition of H1N1 to seasonal flu, visitor education and protection has become even more important. Burger and Burns use appropriate signage that prompt visitors to wear a surgical mask if they are coughing or sneezing and to use hand sanitizer whenever possible.
Burns says the Greater Cincinnati Health Council has worked with surrounding hospitals so that all 40 facilities in the area are using the same signs. Hospital visitors are used to seeing these signs not only in medical facilities, but also on the local news, so they are aware of the precautions as soon as they walk in.
“We have hand sanitizer everywhere, and now we have those cough etiquette stations [at every entrance] with a lot of education right there telling them how to cough [and] how to use tissues,” Burger says. “And they are filled with tissues, hand sanitizer, and surgical masks.”
Burns says staff members have strictly enforced a year-round policy prohibiting visitors under 14. “I say it is [because of H1N1], but it is actually our visiting rule 365 days a year, but we usually don’t stress it or go as far with enforcement,” she says.
St. Elizabeth has signs in the waiting room that ask visitors to restrict children under 14 from visiting loved ones. Recently, the hospital has also posted stop signs that strictly prohibit children from going beyond certain points of the hospital. Staff members are enforcing these guidelines now that H1N1 is prominent. “In our community right now, H1N1 is widespread and it has been for three weeks, so chances are many people do have it and shouldn’t be visiting, so we’ve been stressing that a lot,” Burns says.
Joint Commission compliance
Designing a visitor education plan for isolation precautions and for flu season also satisfies Joint Commission requirements to provide education to patients and their families about HAI transmission. Using signs that educate visitors about the flu as they walk into your facility and having nurses talk with visitors and patients about proper precautions would fulfill some of those requirements, says Burns. “The Joint Commission just wants to make sure patients and their families are receiving the information they need, and this is a perfect example of the fact that we need to share information with them,” she says.
Adapted from Briefings on Infection Control, December 2009, HCPro, Inc.
Areas of importance
In many facilities, you won’t find visitors completely dressed in gowns, masks, and gloves because they are not providing care. However, Terry Burger, BSN, RN, CIC, CNA, BC, director of infection prevention and control at Lehigh Valley Hospital in Allentown, PA, says there are a few situations in which infection control policies should follow escalated precautions:
- The burn unit. Patients in this unit are under very strict precautions because they are far more susceptible to infections. In this case, visitor personal protective equipment is strictly enforced.
- The neonatal ICU (NICU). Isolation patients in the NICU are treated with more precautions because of their susceptibility, Burger says.
- Direct patient contact. Visitors will sometimes help care for the patient, particularly if the patient is a child; a family member may bathe him or her. Visitors should follow the same protocols as healthcare workers.