Flu hits hospital visitor policies

Baltimore Sun reporters

As Maryland's hospitals brace for the worst that the swine flu pandemic could offer, they are making big changes in the way they handle visitors - restricting children, limiting certain adult visitors and issuing face masks at entrances - in an effort to stem the virus' spread.

In a recent poll by the Maryland Hospital Association, 15 of 39 hospitals' representatives said they had already put new policies into place. Almost all of the others said they are considering a policy change but hadn't finalized the details.

Hospitals officials say the new restrictions are necessary for what is expected to be a severe and unpredictable flu season.

Children and young adults are particularly vulnerable to this new flu, succumbing to serious illness and complications at higher rates than adults. With less than ideal hygiene, children are also known to spread the flu fast. Limiting child visitors means keeping hospital staff healthy and shielding patients - both adults and children - from serious medical complications, administrators said.

"Children with asthma, with underlying medical conditions, who contract the H1N1 flu are at greater risk," said Dr. Steven Czinn, chief of pediatrics at the University of Maryland Medical Center, whose 120-bed Hospital for Children is restricting visitors to two adults and no children under 12. "And so, we really need policies in place to do whatever is possible so that children who are in the hospital being treated for other medical conditions are not at risk to visitors to contract the flu."

Administrators will make exceptions in some circumstances, and they realize the changes are difficult for families, Czinn said.

"We're trying to balance the benefits of having family members around with regard to the heeling process with preventing unnecessary potential exposure to flu virus."

Still, some patients are upset about the new guidelines. They say that instead of establishing blanket restrictions on children, hospitals should allow people to use common sense when visiting sick family members.

Kimberly Franklin, who is preparing for her scheduled C-section next week, had envisioned an intimate family moment taking place around her hospital bed: she, her husband and their 3-year-old son Connor welcoming a new baby boy to the family.

But because of a new policy, Connor won't be allowed at his mother's side. The policy at St. Joseph's Medical Center in Towson prevents children age 12 and under - including siblings - from visiting new moms and babies.

"All my hopes were dashed," said Franklin, 35, of Towson. "I was livid. ... I don't know of any parent of an older child who would let their kid come visit them if they have the flu. I just think it makes more sense to have kids tested for symptoms, have them wear a mask and Purell them up."

Franklin considered switching to a doctor she had never even met, hoping that another hospital would allow Connor to visit. But she soon learned hospitals across the Baltimore region were implementing similar policies.

St. Joseph's typically restricts children 12 and younger from the hospital's mother-baby unit during flu season from October through April, said Lisa Scheidelman, infection control practitioner, who works to prevent and monitor infections at the hospital. But this is the first time the hospital has banned young siblings.

The policy went into effect at the end of September and it's unclear when it may end. "Given that we have the H1N1 circulating and it's a ramped up flu season, we can't say when it's ending," she said.

Policies could tighten furtherScheidelman said the start of the new policy may be a "bumpy road" for new mothers eager to have their entire families with them after the birth of a new baby. But the change is necessary to protect the health of infants, their mothers and pregnant women, who are all at greater risk for complications from the virus, she said.

In addition, anyone with flulike symptoms may not visit new mothers or babies in the St. Joseph's unit, she said. Elsewhere in the hospital, fliers alert visitors to practice good hygiene by washing their hands often and sneezing into their sleeves. They also urge people not to visit the hospital if they have a fever along with a sore throat, cough or running nose.

Scheidelman said if the pandemic becomes severe, policies would be made more restrictive. Visitors would be limited to one patient per day. Hospital staff would keep strict logs of visitors and would screen them for fever at the hospital entrance.

In drawing up new restrictions, officials at Greater Baltimore Medical Center took into account guidance from the Centers for Disease Control and Prevention, which advises hospitals to schedule and control visits and screen visitors for respiratory illness.

"Visitors may be offered a gown, gloves, eye protection, and respiratory protection," according to the guidance.

At GBMC, children under 17, unless they are a parent, are not allowed to visit patient care areas. Visitors to the intensive care unit and other critical care areas must wear a surgical mask. Two adult visitors are permitted to visit postpartum units, and just one adult is allowed in other patient care areas of the hospital. Hospital visiting hours are limited to between noon and 8 p.m.

Michael Forthman, GBMC's vice president for facilities and support services, said he recognizes the changes may be challenging for patients and families, but they are necessary.

"There are so many people presenting with flulike symptoms, and we really don't know who has the flu and who doesn't," he said. "We really want to try to reduce the risk. Is it a perfect solution? No, but this is a way to reduce risk."

The hospital's emergency department already has been inundated with people complaining of the flu. Over the past 10 days, the number of people complaining of flulike symptoms increased 72 percent from the previous 10-day period.

"We've been talking about this flu since April, but this is now an event," he said. "With a busy [emergency department], we had to look at restrictions."

At Anne Arundel Medical Center, children 18 and younger cannot visit patient units, although exceptions can be made on a case-by-case basis and the restriction will be lifted "as soon as possible," said Justin D. Paquette, a hospital spokesman.

Signs were expected to be put up Monday throughout the hospital and fliers for visitors were expected at the front desk and in the emergency room.

"We expect that our patients will understand this temporary chance in light of the concern regarding influenza in our community," he said.

The hospital has produced two-minute Webcasts featuring its epidemiologist that answer questions about H1N1. The Web site will also be updated regularly with information pertaining to the flu.

For the staff, the hospital is sending weekly e-mails to provide updates and information on where and when they can get a vaccination. They also are offering tips on avoiding the flu at work and home, what to do if they get sick and when to wear a mask and what kind to protect themselves from patents with seasonal or H1N1 flu.

The Johns Hopkins Hospital and the Johns Hopkins Children's Center updated their policy Monday to restrict anyone 16 or younger from visiting. The hospital's H1N1 policy had been restricting those 12 and younger but changed the temporary limit to reflect the spread of H1N1, said David March, a spokesman.

The Maryland Hospital Association also is consulting with the state health department and its own leadership to determine if it will offer a set of guidelines for hospitals statewide, said Nancy Fielder, spokeswoman for the association.

In the meantime, the group is sharing policies that others are developing with other hospitals that ask.

All hospitals are encouraging visitors, as well as patients and workers, to wash their hands and get vaccinated as soon as possible. The H1N1 vaccine has just begun rolling out and more doses are expected this week for target groups that include workers and children.

The temporary changes to visitor policies may disappoint some patients and their families and friends, but Fielder said it's a patient safety issue. Those who are very sick and infants can't be vaccinated against the flu.

"The widespread coverage is helpful," said Fielder. "It makes people aware and gets them thinking about how their actions may impact others."

Flu-season policies Hospitals in the Baltimore region are establishing new visitor policies in response to the swine flu. Among them:

•Restricting child visitors and limiting the number of adult visitors

•Requiring visitors to intensive care units to wear surgical masks

•Urging people who have a fever with cough, sore throat or runny nose not to visit the hospital

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