Focusing on Families and Visitors Reduces Healthcare Associated Respiratory Viral Infections in a Neonatal Intensive Care Unit

Linam, W. Matthew; Marrero, Elizabeth M.; Honeycutt, Michele D.; Wisdom, Christy M.; Gaspar, Anna; Vijayan, Vini

A recent survey of visitor restriction policies and practices in pediatric facilities found that 88% of facilities had some form of visitor restriction policies in place. 14 There are limited data regarding the overall effectiveness of visitor restrictions or which strategy is most effective. Age-based restrictions limit exposure to children who may have inadequate respiratory hygiene but do not address the role contagious adult visitors play in HARVIs. Limiting the number of visitors to a small cohort of key individuals determined by the family (including children) may be more effective than age restrictions. Washam et al 26 recently described a 37% reduction in HARVIs after standardization of visitor restriction policies that included restricting the number of visitors during a hospitalization. It is also important to identify potentially contagious individuals and prevent them from visiting until symptoms improve. A recent study by Mermel et al 27 reported relatively fewer HARVIs in units that performed visitor screening compared with units that did not screen. Unfortunately, these investigators did not measure compliance with visitor screening. We implemented a similar process to screen family members and visitors before entry into the NICU. Although Unit Secretaries asked symptomatic family members and visitors to defer visitation, these episodes were not documented, which limited our ability to assess the full effectiveness of the screening process. In addition to screening, during the 2017-2018 and 2018-2019 influenza seasons, visitation was restricted to 2 parents/caregivers. This intervention likely provided additional protection for patients. Hospitals must balance the decreased family-centeredness of more restrictive policies with the challenges of implementing visitor screening when developing a visitor management plan. Finally, since respiratory viruses circulate throughout the year, processes must also provide year-round protection.