QUESTION:        Can a hospital require visitors for a patient in isolation who has an infection resistant to antibiotics (e.g., C. diff) to use personal protective equipment while visiting the patient to limit the risk of spreading the infectious disease?

ANSWER:            The short answer is that there is no prohibition on such a requirement.  However, the requirement, and the reasons for the requirement, should be specified in hospital policies.

CMS requires “a hospital [to] have written policies and procedures regarding the visitation rights of patients, including those setting forth any clinically necessary or reasonable restriction or limitation that the hospital may need to place on such rights and the reasons for the clinical restriction or limitation.”  CMS’s guidance on this requirement specifically recognizes “infection control issues” as a circumstance in which a clinically necessary or reasonable restriction may be imposed.

The CMS rules also require hospitals to establish “an active program for the prevention, control, and investigation of infections and communicable diseases.”  According to CMS’s guidance, a hospital’s infection control program must address “[m]itigation of risks associated with patient infections present upon admission” and include “[a]ppropriate use of personal protective equipment including gowns, gloves, masks and eye protection devices.”

State hospital licensing regulations which address the issue are generally consistent with the CMS rules.  As an example, the Arizona Hospital Licensing Regulations instruct that hospitals are required to have “[p]olicies and procedures…[t]o prevent or minimize, identify, report, and investigate infections and communicable diseases that include:…iv. Using personal protective equipment such as gowns, masks, or face protection….”

The literature on the subject supports the opinion that a requirement for visitors to don personal protective equipment while visiting patients in isolation is “clinically necessary” or a “reasonable restriction.”  For example, a July 2015 article (“Precautions Guidelines for Hospital Visitors”) in the American Journal of Nursing cited recommendations from the Society for Healthcare Epidemiology of America.  According to the article:

For visitors’ protection, the authors recommend contact precautions (gowns and gloves) when enteric pathogens, such as Clostridium difficile or norovirus, or extensively drug-resistant pathogens, such as Klebsiella pneumoniae carbapenemase, are not widely prevalent in the community or when their prevalence is unknown.  Those visiting multiple patients should follow contact isolation precautions and use personal protective equipment.

In conclusion, there is no prohibition on requiring personal protective equipment for visitors of patients in isolation.  This would likely be considered a “clinically necessary” and/or “reasonable restriction” on visitation and part of a hospital’s “infection control program.”  The hospital’s policies and procedures should explicitly spell out this requirement, when it applies, and the reasons for it.