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).
