NICU visitation policy-Are more visitors really better?

dawngloves, BSN, RN · Mar 23, 2005

I would like to see a decrease in who we let in. A parent can bring in whoever they want, two at a time. Sometimes it's like a parade of visitors. And we let in children over 4. We have outbreaks of MRSA, RSV, ect and they blame the nursing staff. I'd be in heaven if it was only parents and grandparents.

kitty29 · Mar 23, 2005

Our visitation policy also has evolved.

We have the policy written out and given to parents on admit.. The can have up tp 6 people visit if they want when they are not there, they can not change the names on the list routinely.

When the parents visit (any time in 24 hours) they can bring family with them, a total of two extra people are allowed at the bedside in addition to the parents at a time (so this would be 4 for twins, 6 for triplets, ect). We now let younger children in as long as they are not ill. We have a check list at the unit secretary's desk, and they will screen anyone first.

As far as info over the phone, only to parents.

Our biggest problem is on the day shift when there is so many little kids visiting. During the week we have a play nurse that we can send the sibs to if the parents need to do stuff with the baby. But we have some kid/parents who seem to think it is also my job to intertain their other kids....and That really bugs me.

We have had less problems with people having hissey fits because they cannot come in to visit the baby. We do teach appropriate interaction with the baby right away too. Some families get it and some don't. But on a whole it seems to work best having the parent's in charge of this.

MishlB · Mar 23, 2005

Parents and grandparents, as well as siblings if vaccines up to date; 2 at bedside at a time..noon to 2pm, 3-6pm, and 8-11pm. I dont like the kids coming in...it's an ICU for goodness sake.

Gompers, BSN, RN · Mar 23, 2005

After reading a thread on adult ICU/CCU visitation, I went back through the last 6 months of threads on this site. I didn't see a discussion on NICU visitation and would like some input on your unit's policy.
For years and years our unit allowed 24 hour visitation for parents and grandparents only. About 3 or 4 years ago the hospital required us to allow other visitors accompained by either parent and over the age of 14 to visit. Only 2 people are allowed at the bedside, but visitors can swap in and out. We require visitors to do a 3 minute scrub before entering, but there is no one there to make sure that they do it properly!
My concern is the increase we are seeing in infection among our babies. Granted the high acuity and understaffing play a roll in this. However, these are issues we have always dealt with in the more than 20 years I have worked. It's only been recently that we've seen more frequent cases of MRSA-either cultured or colonized-among our babies.
My questions to you: What is your unit's visitation policy? Visiting Hours? Cover gowns -yes or no? Does some one help visitors scrub?
Thanks for your input!
Sparky

Wow, ditto to almost everything you said. No one watches our visitors scrub in or out, and anyone can come visit! We limit to two at a bedside, and usually one of those people has to be a parent. Sometimes they'll allow grandparents to come in by themselves if the parents desire, but I hate that because sometimes the grandparents find out things (both good and bad) before the parents do and that's not right. Children can visit ONLY if they're siblings and have all their vaccination records with them. No cover gowns unless the baby already has MRSA or some other buggie. The thing is, EVERY TIME we have a MRSA baby and swab the parents, one of the parents is positive. I highly doubt the baby gave the parent MRSA. So maybe we need to go back to gowning and gloving for ALL babies???

Our visiting hours are pretty liberal. The only time parents can't visit is between 9am and noon, when the docs do their rounds. Otherwise they can come during the other 21 hours a day. Other visitors are only allowed between noon and 9pm. I wish we had a policy to send visitors out of the unit for a half hour every time we do nursing bedside report though. Not only is it a privacy issue (the bedsides are only six feet apart, so they do hear other babies' reports), but we are never alone to candidly speak to each other about issues with the babies and/or their parents.

FutureNrse · Mar 23, 2005

After reading a thread on adult ICU/CCU visitation, I went back through the last 6 months of threads on this site. I didn't see a discussion on NICU visitation and would like some input on your unit's policy.
For years and years our unit allowed 24 hour visitation for parents and grandparents only. About 3 or 4 years ago the hospital required us to allow other visitors accompained by either parent and over the age of 14 to visit. Only 2 people are allowed at the bedside, but visitors can swap in and out. We require visitors to do a 3 minute scrub before entering, but there is no one there to make sure that they do it properly!
My concern is the increase we are seeing in infection among our babies. Granted the high acuity and understaffing play a roll in this. However, these are issues we have always dealt with in the more than 20 years I have worked. It's only been recently that we've seen more frequent cases of MRSA-either cultured or colonized-among our babies.
My questions to you: What is your unit's visitation policy? Visiting Hours? Cover gowns -yes or no? Does some one help visitors scrub?
Thanks for your input!
Sparky

I've posted in the past about my nephew/godson who died several years ago, at less than one week old. He spent that whole week in the NICU, and your post made me recall how I felt about visitors. I really think that it should be very limited. Mom and Dad, should be allowed in at all times, but anyone else should be kept to a bare minimum. I know that I would have been terribly sad if I hadn't been able to see him, but if it was better for him that I not visit, I would have dealt with it.

At the time, I remember being concerned about the amount of visitors, and well...the type of visitors. My brother-in-law, the baby's father, had many family members there at any given time, and while they were nice folks, all there out of love for the baby, most of them weren't very clean. The younger adults had usually been drinking, though I wouldn't say they were drunk. There were many children, of all ages as well.

It did worry me. We were all instructed how to scrub before entering, but we were not watched, and I think we should have been. All of the children were allowed in at some point, and I was concerned because kids just naturally have colds and such. You get 15 or 20 kids together and chances are one of them has something contagious.

I don't recall the exact numbers, but we were allowed in, a few at a time, as long as Mom or Dad were present. I think it would be better to limit the visitors. Sick babies need rest, not visitors. Mom and Dad need to concentrate on the child, not on great aunt Mary. Depending on circumstances, other family and friends, can be allowed in, once, for a brief visit, especially if the child is terminal, but the bulk of the time should be just parents and child. If the NICU stay is to be a short stay, then other visitors shouldn't be allowed at all. They can wait until the child is transferred to a regular room, or goes home.

Last of all, nurses have enough to deal with as it is without having to worry about visitors. Hospitals should set the rules, and be firm about them, even hiring security to see them enforced, so nurses can spend their time doing what they're paid to do.

Just my two cents worth

Nyoro · Mar 23, 2005

This is my first post here, so hello! I'm not exactly a nurse, but I volunteer at our local level IV NICU, and end up doing just about everything you don`t need a license for - especially when it`s busy! I guess they trust me because of how long my son was there (born at 14 oz.)

I hope that I can provide a little insight into NICU practices in Japan.

In our NICU, only the mother and father are allowed in - 3 minute wash, and gowns. Masks are provided if you feel you may have been around someone sick, but it is suggested that "If you feel you need a mask, you probably don`t want to come in.". There is no one specifically watching the hand washes, but the washroom is visible to the NICU through a window, so you never know when someone will look. It works pretty well as someone is always near the window (It`s in front of the feeders). Visiting is 24 hours a day, but parents have to ring in via an intercom outside the entrance. If their baby is in the middle of something, they`re asked to come back a bit later.

I seriously can`t imagine letting grandparents in, let alone other people! Almost all the MRSA cases we have come from a carrier parent - we figure it is better the babies get it now than after they go home where we won`t be able to catch it quickly.

In all my time there, I have never seen a single case of RSV. (Both volunteer time, and the time my son was hospitalized.) It is probably just because RSV isn`t as prevalent here.

-Nyoro

BittyBabyGrower, MSN, RN · Mar 23, 2005

We have redone ours in the past year.

1. Parents have 24 hour visitation. They have to leave for report, unless they are feeding that baby, then we do report in the hall. When we get a new admit we do have them leave for a bit until we get baby on the warmer, etc. They can call anytime, have to give the band number over the phone. They must have their band on or have it cut off with a picture ID...no exceptions, even if we know who they are..no ID, no admittance period.

2. Grandparents may visit without the parents during the hours of 10-8p, they also must have photo ID and the parents have to have given their name to the secretaries. The parents can veto this part of the visitation. GPs are given no info.

3. Parents can bring only 2 extra people in a day. We have ID badges for them and when they are gone out of baby's bin then the visitors are done for the day. Choose wisely weed-hopper! Extra visitors can only come during the same hours as grandparents, but must be accompanied by a parent.

4. Siblings same as above, 1/2 hour visit limit to all kids over the age of 3.

We also go over the visitation with the parents and they sign a copy of it which goes in the chart...no more, well no one ever told me stuff.

We have had stupid parents come in with a cold...wear a mask but then take it off and kiss Jr and then he/she gets Influ A or RSV, then that kid gets shipped to the PICU. What is wrong with people?

LilPeanut, MSN, RN, NP · Mar 23, 2005

Some of this is so bizarre for me to comprehend as a former NICU parent.

My hospital had 24 hour visitation for the parents. Grandparents could come if attended by the parent during normal hospital visiting hours. No more than two people at the bedside though, so you had to switch them out. If the NICU was empty of visitors, they might let you have both grandparents there.

The part I find hard to believe is that handwashing is a problem. (I'm sure it happens, I just can't believe some parents are so stupid) Handwashing by visitors is largely monitored by parents and believe you me, I did not want my child getting sick, so I made sure everyone washed enough, plus I stressed how important hand washing was. I wasn't going to let someone to my child's bedside who could give him something that could kill him.

Deidre Shiobhan · Mar 23, 2005

My unit used to allow 24hrs visitation however due to SARS which happened some 2 years ago . We have changed the visitation timing , our visitors are only allowed to visit the babies between 1200hrs to 14000s and 1800hrs to 2000hrs daily . Only 2 visitors are allowed at any point of time , we only allowed parents or grandparents to visit . No other relatives , family members or friends are allowed , however in time of emergency or crisis whereby the baby is extremely sick and may expire anytime . We do allow flexibility .

We have not really see in any drop in our infection rate however we do feel a sense of privacy as parents are not there the entire day watching our every little movements and sometimes hinders our work.

We may not revert back to those days where we allow 24hrs visitation and most of our staff are quite happy with it .

fergus51 · Mar 23, 2005

Handwashing is a real problem in our unit. We also require a 3 minute scrub, parents allowed 24 hours, other visitors with the parents (2 total at bedside) between 12-9pm, kids over 3 if vaccinations are up to date. Our bigger problem has been a couple of parents with kids positive with MRSA GOING TO VISIT OTHER BABIES!!! I'm all for parents making friends with eachother, but parents with kids in isolation need to stay away from the other babies. Common sense is not always common, so it falls on nurses to police visitors.

KRVRN, BSN, RN · Mar 23, 2005

We allow 2 people at the bedside at a time, one person has to be either a parent or the designated support person (SP is defined by a signed form, and only if there's no dad involved). Parents are banded, support persons are not, they must have picture ID. Grandparents can't visit without the parents. Siblings of any age are permitted to visit, non-siblings have to be over age 12. We will allow more than 2 people if it is both parents visiting their baby with a sibling. Visitors are allowed to switch off.

We require a 3 minute wash but we don't police it. The staff isn't even required to do a 3 minute wash. As long as they did wash their hands we're happy with it. We don't require cover gowns unless the parent's clothes are very dirty (and then they usually self-police and decline to hold the baby anyway). We honestly don't get MRSA babies very often but when we do, we have them gown and glove.

Our unit is open for visitation 22 hours a day, only closed for shift change. We occasionally ask parents to leave if we are doing a procedure. We encourage parents to be present if we are coding their baby or actively working to save it. Nearby parents are asked to leave for privacy, and I've never had one argue since they can SEE that something bad is happening.

We are willing to be flexible for special circumstances. A baby being baptized or a baby being withdrawn from the vent will be allowed more than 2 visitors, for instance. A mom in the middle of breastfeeding will often be allowed to stay through shift change.