New isolation/visiting policies at our hospital, are they going to be at yours???

  1. 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!

    Thanks,
    skap
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  2. 5 Comments

  3. by   suzanne4
    I work in a pediatric hospital, and yes the parents need to follow the same isolation practices that we abide by. Parents leave by the same elevators that other parents use, and they are touching the same buttons...........
    How do you know that they aren't going to be going to the cafeteria?

    We have a family centered facility, and you do not hear a complaint from the parents. They are aware that we are protecting their other children this way also. Most facilities have a "No visit by children under 12" rule at this time of year due to RSV. We had it over 15 years ago in Phoenix at all of the hospitals that had pediatric units even. It is for the protection of all involved.
    And very rarely have I even heard a complaint, actually none at all once they understand why you are doing this............that it is for their benefit.
  4. by   skap
    Quote from suzanne4
    I work in a pediatric hospital, and yes the parents need to follow the same isolation practices that we abide by. Parents leave by the same elevators that other parents use, and they are touching the same buttons...........
    How do you know that they aren't going to be going to the cafeteria?

    We have a family centered facility, and you do not hear a complaint from the parents. They are aware that we are protecting their other children this way also. Most facilities have a "No visit by children under 12" rule at this time of year due to RSV. We had it over 15 years ago in Phoenix at all of the hospitals that had pediatric units even. It is for the protection of all involved.
    And very rarely have I even heard a complaint, actually none at all once they understand why you are doing this............that it is for their benefit.

    Glad to hear something positive! I'm glad to know that it is working where you work. I only hope the same for our hospital. Thanks for your reply....

    skap
  5. by   Tweety
    It's already the policy where I work. All visitors are to gown and glove same as the nurses, for the same reason - to keep the infectious agent in the room. The bugs can get on their clothes (c. diff is very good for that) or skin and they can in a round about way infect another patient.

    I'm not sure how to enforce it, but it's best to enforce it from the get go and have the staff put up a united front. "Well the first shift didn't make me do this" will not foster compliance.

    I think if you explain the rationale, be consistent from the beginning, i.e. all shifts, all the time, then you won't have any problem. I've found most visitors to be reasonable.

    So many visitors and family members feel rules don't apply to them however. When I ask someone "do you know you should be wearing gown and gloves?"....."Yes, but.........." It's frustrating.

    Good luc.
  6. by   barefootlady
    It has always been a policy here for visitors and family to wear whatever protective garb the nurse wore if they were visiting a patient in isolation. Do you mean this was not always the case at your facility? How could that be? Isolation is a physicians order and it is put into practice to protect patients, staff and visitors against bugs. If visitors here refuse to follow rules, then they are asked to leave and not come back until isolation is discontinued. I am sorry but I am scratching my head about this one. I don't understand why/how they are allowed to ignore isolation precautions.
  7. by   Terri Rearick
    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!

    Thanks,
    skap

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