Can visitors be 'forced' to wear PPE?

[Double-Helix]

We recently had a patient with an influenza requiring droplet isolation. Visitors (the parents) flatly refused to wear a face mask in the room, despite frequent education. The parent did sanitize their hands before entering/leaving the room but did leave several times to use the bathroom and get something to eat. Our nurse manager attempted to address it with the parents as well, but to no avail, and the parents actually ended up getting very upset.

With the JC expected to come to our unit any day, this raised the question on our unit- Can visitors be forced to wear PPE when visiting patients with infectious disease? Especially the parents of a minor child. What would be the steps to take to enforce this? Call security and have the parents escorted from the hospital?

[Mommy&RN, BSN, RN]

Our visitors are not required to wear ppe.

[wooh, BSN, RN]

We don't make them wear anything in the room. We do encourage good hand hygiene and wearing a mask outside the room.

As for forcing the issue? Good luck with that.

[SummitRN, BSN, RN]

​Visiting is a privelege, not a right. If you don't abide by the rules, the privelege is revoked and if you refuse to leave, the nice men in the grey uniforms will help you find the exit.

I agree but the situation becomes sticky when it is parents and a minor child.

[llg, PhD, RN]

With the parents of a minor child ... you might be on firmer footing saying something like, "If you refuse to follow the isolation guidelines, then you must stay in your child's room to protect the other patients and visitors." (No cafeteria -- they can bring their own food and drink.) That may be a compromise they can live with as it gives them a choice.

[redhead_NURSE98!, ADN, BSN]

I kind of feel like everyone in the hospital is an invitee, and if they're not going to follow instructions that are designed to keep patients, employees etc. safe, they could be considered no longer welcome and asked to leave. Almost no visitor follows our contact precautions, even c. diff., even after being educated. But if every employee who comes into their room doesn't follow the rules, why should they be compelled to?

[SaoirseRN]

If it is C-diff, I suggest it strongly. For other droplet precautions, depending on the reason, I may say it could be to their benefit to at least wear a mask. For other types of isolation (contact), if they don't want to wear it, I ask them to sanitize their hands when they leave and refrain from visiting anyone else/ using common areas, with the rationale explained. Most often people are agreeable to compromises with the provision of a reasonable explanation.

For airborne precautions, I'm a little more of a stickler, but that has much to do with controlling who goes into the room and how often the negative pressure is disturbed.

[psu_213, BSN, RN]

With the JC expected to come to our unit any day, this raised the question on our unit- Can visitors be forced to wear PPE when visiting patients with infectious disease?

It's funny you should use the example of TJC. Apparently our hospital got "dinged" (whatever that means) by the state health dept. because there were people visiting their family member (the pt.) who was on contact isolation and the visitors were't wearing a gown while in the room. This maybe a bit of overkill on the part of the state, but it is more than enough justification for making the family members wear the PPE.

[NicuGal, MSN, RN]

If you don't garb up you don't get to visit....doesn't matter who you are.

[hiddencatRN, BSN, RN]

I can understand parents not wanting to wear PPE in the room with their child. Since they were exposed already, as long as they've been given the information, I think it's reasonable to allow them to make that decision in the room.

HOWEVER, since they HAVE been exposed to what the patient has and continue to expose themselves, I also think it's completely reasonable to have them wear the PPE outside the room. If they need to run to the cafeteria or vending machine, pop that mask on. Is there a general family lounge on the floor? They're on the same precautions the patient is so no hanging out in the lounge space without a mask. Going to the public restroom? Mask. They can decide what risks they want to take on themselves, but they don't have the right to pollute the wider hospital environment.

[mariebailey, MSN, RN]

Coming from the perspective of a TB case manager, please do not permit visitors refusing to wear PPE to visit an infectious TB patient in an AII room. #1: It sets a precedent; it will be very difficult for us to enforce isolation & protect the rest of the community when they are discharged if health care providers did not insist on it in the hospital.

#2: While some household contacts may have been exposed/infected already, this is not always the case. It is not just their problem if they become infected; it is a public health threat. #3: If that visitor is immunocompromised in some way, you are setting him or her up for progressive TB with a poor prognosis. They may not realize the grave consequences, but, since you do, have some compassion & protect them from themselves.

I would imagine my reasoning applies to many other communicable diseases as well.

[NicuGal, MSN, RN]

Sure they know they were exposed, but we require them to garb up so that they don't spread it around by contact. They come out of that room, go to the ice machine, go to the breast pumping room, go to the bathroom, go to the gift shop, then the cafeteria. And there you have all the points of contact and possibility of spreading whatever they are in contact with. Sure they wash their hands but Junior has coughed, spit, oozed and whatever else on Mommy, Daddy and Grandma.

So, garb up or no visit.

[PacesFerryBSN]

​Visiting is a privelege not a right. If you don't abide by the rules, the privelege is revoked and if you refuse to leave, the nice men in the grey uniforms will help you find the exit.[/quote']

Wow! Where do you work? Where I work, people end up doing whatever the heck they want because of the feedback scores.