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Precaution Guidelines Updated for Visitors of Inpatients with Infectious Diseases


Hospitalists may soon see changes in precaution protocols for some hospital visitors, thanks to a revised set of guidelines published by the Society for Healthcare Epidemiology of America (SHEA). The guidelines include recommendations for visitors to patients hospitalized with infectious diseases.

"Up until now, visitors have been wearing contact precautions just like healthcare providers—gowns, gloves, masks, sometimes respirators," says lead author L. Silvia Munoz-Price, MD, PhD, enterprise epidemiologist at the Institute for Health and Society of the Medical College of Wisconsin based in Milwaukee. "We looked at the evidence for these policies. Using our judgment, a literature review, and a survey of our membership, we came up with new guidelines."

Among SHEA's recommendations are two major changes:

  • Visitors of patients diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE) don't need gowns and gloves if those pathogens are endemic in the region and the institution;
  • For cases involving Clostridium difficile infection and extensively drug-resistant gram-negative organisms, contact isolation precautions are still recommended; and
  • Visitors of patients under airborne isolation precautions do not need N95 respirators. Healthcare workers still need the protective masks, but because the masks only function when fitted properly to an individual, the masks loaned to visitors are probably ineffective.

"We've been asking visitors to wear N95, even though we know most likely it’s doing nothing," Dr. Munoz-Price says. "Now we're saying, stop doing that."

If visitors have had enough exposure to the patient at home, they can wear surgical masks or maybe no precautions at all, she adds. If visitors have not seen the patient for weeks, visitation may have to be restricted.

Dr. Munoz-Price notes that hospitalists should be aware of these revised guidelines and know that they apply only to visitors.

"Even though family members are not wearing contact precaution gear, that doesn't mean that hospitalists shouldn't," Dr. Munoz-Price says. "It's extremely important that hospitalists be compliant with their protocols and not be influenced by what we're doing with visitors." TH

Suzanne Bopp is a freelance writer in New Jersey.

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