Bioethics in Brief is a newsletter of the Center for Bioethics and Humanities, committed to promoting clinical health care and health policy which is patient-centered, compassionate, and just. Opinions expressed in the newsletter are those of the authors and do not represent the position of the Center.
Pandemic Flu and Hospital Visiting Hours
H1N1 flu dominated the news in recent months. While the current tide of infections is waning, public health officials expect further waves to follow. Hospitals have responded with vaccination clinics, installation of hand sanitizers, staff education, and increasing orders for masks, gloves, and gowns. Doctors’ offices removed magazines from waiting rooms. Syracuse hospitals crafted more restrictive visiting policies.
For example, at University Hospital the following changes to visiting hours went into effect:
limiting the duration of visiting hours to between noon and 8 pm (immediate family previously had 24-hour access to patients)
banning children 17 and under
University Hospital policy stated:
“Exceptions to the revised general visitation guidelines regarding the number of visitors and age limits as well as hours of visitation can only be made at the discretion of the Hospital Administrative Supervisors” [emphasis in the original].
Specification of how this message should be conveyed to family and friends and how they would access such an appeal were not clear. The policy was relaxed December 9, but children were still banned.
According to CDC estimates, H1N1 disproportionately affects children age 0-17 compared to seasonal flu (http:// www.cdc.gov/h1n1flu/estimates_2009 _h1n1.htm). Yet, children (24 percent of the US population) account for a minority of H1N1 cases (36 percent of an estimated 22 million cases over a 6 1⁄2 month period beginning April 2009), hospitalizations (37 percent) and deaths (14 percent).
The majority (55 percent) of people falling ill from H1N1 are between 18-64, and they account for 75 percent of deaths during the reporting period. Of the estimated 22 million who fell ill, the risk of being hospitalized was slightly less than 0.5 percent (1 in 200), and the risk of dying is slightly less than 2 in 10,000 (0.018 percent).
How are these estimates relevant to visiting policies? Restrictive visiting policies raise several ethical concerns about the clarity of the goals of restrictions, the contribution of loved ones to patient well-being, and the appropriate use of science in setting policy.
Policy Effectiveness in Question
It is difficult to write good regulations that account for individual circumstances, and never more so than in a setting of fear and rapidly changing facts. Policy writers should be clear as to whom they are trying to protect. Are they protecting the visitors, the staff, or the patients? Given the prevalence of the H1N1 virus throughout the community, visitors and staff are exposed in many high risk places outside the hospital, including day care centers, children’s museums, malls, and playgrounds. Proper precautions should be taken to protect visitors and staff from patients with known influenza. It can be argued that restricting the presence of visitors across the board in the hospital for this reason is a disproportionate and likely ineffective approach.
Persons who have had H1N1 or who have been immunized pose little risk of communicating H1N1 to patients. More adult visitors than children will be infectious at any given time. Why not ban adults? Do we restrict children because it is more socially acceptable to do so? Or does peer-reviewed data substantiate the perception of particularly high risk from children in the acute care hospital setting? What is the
evidence that allowing an adult to visit only between noon and 8 is safer than allowing them 24 hour access?
Patient safety and well-being are broader concepts than patient exposure to H1N1. The Institute of Medicine has reminded us that hospitals can be very dangerous places, and visitor presence is an important safety check for hand washing, patient identification, and ambulation in a room with multiple tubes, wires, and poles. Loved ones are often essential parts of decision-making, communication, patient care and healing. Families commonly stand vigil so as to speak to physicians when they round; will physicians commit to rounding only between noon and 8 p.m. when families are allowed to visit?