Isolation Precautions for Visitors

Publication Date: April 10, 2015
Last Updated: September 2, 2022

Recommendations

All visitors should perform hand hygiene prior to entering a patient room and immediately after leaving the room.

Notes:

  • Either hand washing with soap or water and proper use of an alcohol-based hand rub are acceptable means of hand hygiene.
  • Institutions should ensure that sinks and alcohol-based hand rub stations are easily accessible to visitors.
  • Visitors should be educated on the importance of frequent hand hygiene in the hospital setting and on the available options and proper techniques for performing hand hygiene.
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For parents/guardians/visitors with extended stay in a patient’s room including overnight visitation, isolation precautions may not be practical. The risk of infection for parents/guardians/visitors is likely reduced if they practice good hand hygiene and any additional benefit of wearing gowns and gloves in these scenarios of prolonged exposure is unclear.
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In special situations, in which patients acquire new transmissible infections after admission to the hospital, protection of parent/guardian/visitor by the use of isolation precautions may be considered.

Notes:

  • Examples of such scenarios could include parents of children with hospital onset of C. difficile infection or colonization/infection with extensively antibiotic-resistant Gram negative bacilli (e.g. Klebsiella pneumoniae carbapenemase [KPC]).
  • If parents or other visitors are assisting health care personnel (HCP) with providing care, standard precautions should be utilized, including the use of gowns and gloves, if contact with blood, body fluids, or non-intact skin is anticipated.
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In situations in which heightened horizontal transmission is detected (e.g. outbreak or increased baseline rates) or a novel, potentially virulent pathogen is suspected or identified (e.g. Ebola virus, Middle East Respiratory Syndrome Coronavirus (MERS-coV), Severe Acute Respiratory Syndrome (SARS), etc.), enforcing isolation precautions among visitors (including parents/guardians/siblings) should be prioritized.
  • Note: Hospitals should consider restricting non-essential visitors, limiting the number of visitors at any one time, as well as developing policies and infrastructure to monitor and enforce adherence to appropriate isolation precautions among visitors in these circumstances.
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Methicillin resistant Staphylococcus aureus (MRSA) and vancomycin resistant enterococci (VRE)

For endemic situations with MRSA and VRE we recommend not using contact isolation precautions for visitors in routine circumstances.
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If visitors to patients with MRSA or VRE will be interacting with multiple patients, they may be at greater risk for transmitting pathogens between patients and should use isolation practices in a fashion similar to that of HCP.
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  • Note: This might be the case for visitors of patients with long inpatient stays, such as after transplantation, in which multiple families and patients might have more frequent and closer interactions with each other.

Drug-resistant Gram-negative Organisms

Utilization of contact precautions should be considered for visitors to patients either colonized or infected with extensively drug-resistant Gram-negative organisms (e.g. KPC, carbapenem resistant Enterobacteriaceae [CRE]).
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Enteric Pathogens

For visitors of patients infected with enteric pathogens (e.g. C. difficile, norovirus), we suggest the use of contact isolation precaution.
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Droplet Precautions

For visitors to rooms of patients on droplet precautions, we suggest the use of surgical masks. However, visitors with extensive documented exposure to the symptomatic patient prior to hospitalization such as parents/guardians/family members may be excluded from these precautions since they may either be immune to the infectious agent, or already in the incubation period. Among pediatric patients, further considerations should include interference with bonding. Isolation requirements should be considered on a case-by-case basis in some circumstances (e.g. highly virulent pathogen). Additionally, healthcare facilities should generally restrict visitation by any ill individual or family member (e.g. active cough, fever).
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Airborne Precautions

For visitors to patients on airborne precautions we recommend the use of surgical masks. An alternative is an N-95 respirator. However, this equipment is best used with training and fit testing.

Notes:

  • Visitors with extensive documented exposure to the symptomatic patient prior to hospitalization, such as household contacts, may be excluded from these precautions since they may be either immune to the infectious agent or already in the incubation period.
  • When prior extensive exposure is not documented and N-95 or higher respiratory protection is recommended for the patient, consideration should be given to limiting visitation for those who have not been fit-tested. In these instances, education of visitors is important, and facilities should clearly document these communications.
  • As previously noted in the recommendations for droplet precautions, further considerations should include interference with bonding.
  • Hospitals should consider restricting entry of visitors that are symptomatic (e.g. active cough, fever).
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Recommendation Grading

Overview

Title

Isolation Precautions for Visitors

Authoring Organization

Society for Healthcare Epidemiology of America

Publication Month/Year

April 10, 2015

Last Updated Month/Year

October 16, 2024

Supplemental Implementation Tools

Document Type

Consensus

External Publication Status

Published

Country of Publication

US

Document Objectives

This document is intended to help healthcare facilities develop or modify policies related to the use of isolation precautions by visitors. 

Target Provider Population

Adult and pediatric acute care hospitals

Inclusion Criteria

Male, Female, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings

Hospital

Intended Users

Epidemiology infection prevention, healthcare business administration, nurse, nurse practitioner, physician, physician assistant

Scope

Counseling, Management, Prevention

Keywords

Isolation Precautions, Visitors

Methodology

Number of Source Documents
44
Literature Search Start Date
February 1, 2014
Literature Search End Date
June 1, 2014