This inquiry caught my attention as an Infection Control Practitioner of 26 years. I have witnessed the evolution of isolation practices and recommendations from the Centers for Disease Control and Prevention (CDC) over the years and want to inform you that the guidelines are in revision now since the last revision was in the early 1990's. These national guidelines that are written by the Hospital Infection Control Practices Advisory Council (HICPAC) of the CDC drive the expected practices for isolation for regulatory agencies such as the JCAHO. The individual states' legal requirements for hospital licensing and the federal Centers for Medicare an Medicare Services (CMS) set law that requires compliance with their standards. and conditions of participation. Unfortunately, these laws do not make exceptions for parents in pediatric settings and expect hospital policies and practices to reflect these requirements.
The ultimate goal of infection control policies and practices that necessitate isolation for patients with suspected or diagnosed communicable diseases and infectious processes is prevention of transmission of infection to the other patients, staff and visitors. Isolation should be initiated only when needed and appropriate, maintained consistently by all who enter the room and discontinued as soon as safely possible. Many parents understand and actually feel safer knowing that the patient with a suspected or known patient is in isolation to protect their child from the illness. I find that when the parents are told at the time of the admission about isolation and the reasons for the practices, for the most part, they are understanding and comply. Visitor restrictions need to be discussed at the time of admission and any exception based on compassionate care circumstances needs to be discussed and agreed upon with the patient's nurse, MD and the Infection Control staff.
Outbreaks in hospitals of communicable diseases are not unusual when isolation is not maintained. I refer you to the TB literature in 1993 to read of hospital outbreaks in NY city. Many other instances can be found if you search nosocomial infections/outbreaks/hospitals.
As a nurse, you have great influence on the parent's understanding and participation in isolation. Your explanation of reason for the safety and well being of the other patients as well as the child needing isolation is generally appreciated by parents.
I sincerely hope this information is useful to you. The CDC website is http://www.cdc.gov
the American Academy of Pediatrics website is http://www.aap.com
Quote from skap
I work in a pediatric hospital and as of May 1st we will have a policy in place due to the Department of Public Health that when a parent or anyone visiting is in the room with their child that is in isolation they will have to wear all of the isolation gear we would have to wear.
That means if they are in isolation for RSV, the parent will have to wear a mask, gown and gloves the entire time they are in the room with their child, including sleeping. If the mask becomes soiled or moist (usually within 15 minutes) they will have to change them that often. If they have rotavirus or MRSA, they would have a gown and gloves. At first there would be a "refusal" letter the parent could sign, but now the hospital has decided that we will not be able to let parents "refuse", which leaves me the question of how do we enforce?
If I go into a room and a parent or visitor isn't wearing the appropriate isolation garb, what am I going to do but encourage their compliance? I can't force them to wear it, and I can't force them to stay in their rooms. In addition no visitors under the age of 12 will be allowed to visit. I find this to be difficult for families too. We have kids that stay in the hospital for 2 weeks or more at a time. One family comes to mind where the father has to work so they bring their younger child to the hospital to stay with the sister and mom while dad works, and then dad comes after work and goes home with the sibling.
I do see the positive and negative side of this issue and policy, but mainly the negative. Their standpoint is that it will help stop the spread of nosocomial infections. Parents/visitors press the elevator buttons, visit the cafeteria, use the restrooms in the halls and that is what they believe is helping to spread infection from child to child while they are in the hospital.
What do you think of this policy? Does your hospital do anything similar? Would you do this as a parent (especially while sleeping there)?
I just think our patient/family satisfaction scores are going to go down the tubes!