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Isolation Precautions for Visitors (SHEA)

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Recommendations Î 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. Methicillin resistant Staphylococcus aureus (MRSA) and vancomycin resistant enterococci (VRE) Î For endemic situations with MRSA and VRE we recommend not using contact isolation precautions for visitors in routine circumstances. Î 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. 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 Î 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]). Enteric Pathogens Î For visitors of patients infected with enteric pathogens (e.g. C. difficile, norovirus), we suggest the use of contact isolation precaution. Droplet Precautions Î 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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