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Business News/ Opinion / Views/  Hospitals should rationalize their pandemic protocols

Hospitals should rationalize their pandemic protocols

The benefits of letting loved ones visit ICU patients have been found to outweigh infection risks

Photo: APPremium
Photo: AP

The second wave of covid in India laid bare many issues that plague the country’s system of healthcare. One such issue is how the system treats patients’ families and loved ones, who are often made to feel like intruders. This is painfully apparent in the restrictions that are usually imposed on visitors for patients in the intensive care units (ICUs) of hospitals.

Today, while the latest Omicron-variant threat is held up as a reason for enhanced caution vis-a-vis the pandemic, we must note that even before the covid outbreak, most ICU visitor policies were needlessly restrictive. Many ICUs permitted visitors for only 15 minutes a day, for example. The more generous ones allowed visitors for up to two hours.

As a physician and public health specialist, I often advise families to spend time with patients who are in the ICU. I have observed that even when they are able to enter the ICU, loved ones are typically made to feel unwelcome, rushed, and not provided with elementary courtesies like some place to sit.

There are various purported reasons for restrictions on ICU visitors. Among these are concerns of visitors bringing in other infections, the need for patients to rest undisturbed, the chance that family members may interfere with clinical tasks, and also the increased workload that hospital staff must bear in managing guests.

The covid pandemic has made a bad situation even worse, with most ICUs completely banning visitors from entry so as to minimize the risk of covid infection.

However, as of early December 2021, over 50% of all eligible adults in India have received two covid vaccine doses. Government seropositivity survey findings from July suggest that up to two-thirds of the population has been exposed to the covid virus. While Omicron does put us on alert again, given its peculiar characteristics, high levels of covid exposure coupled with significant vaccination coverage would argue for reduced stringency in comparison with the pandemic’s early phase.

It is important to recognize that being barred from seeing loved ones at their most vulnerable can be very distressing for both patients and families. Being unable to be with a loved one in the ICU also risks a trust deficit with the care team—and in medical institutions more broadly. The ICU ambience, with its constant lights, activity, equipment noise and medication procedures often results in delirium among ICU patients, which can raise their risk of death.

In contrast, when loved ones are at the patient’s bedside, with the family more involved in care-giving, we can get better outcomes. It reduces the patient’s anxiety, builds trust with the medical team and increases patient and family satisfaction. A study published in The Lancet: Respiratory Medicine in January 2021 covering ICUs across 14 countries showed that in-person or virtual family visitation significantly reduced the risk of delirium in patients—by as much as 27%.

When visitation is not possible, phone and video calls can be used as a means to connect families and patients. However, many ICU patients are too ill to operate digital devices themselves, or even with help. Reliance on technology can also exacerbate existing disparities. Patients who need support the most, such as children, the elderly and people from under-served communities, as also those with disabilities or mental health and/or cognition issues, may be least able to make good use of technology.

Studies over the years have shown that ICUs with expanded visitor hours have not seen increases in hospital-acquired infection rates. Given this evidence, efforts such as the Better Together campaign and the ICU Liberation campaign have been launched in the past decade in North America to urge hospitals to allow a loved one at the bedside round the clock.

Hospital visitor restrictions even affect decisions to seek hospital care. During one of my covid tele-consultations, one family refused to take a sick patient to the hospital. They feared that once the patient would get admitted, they would not get to see him again, and would be handed back a body wrapped in plastic.

Even if the Omicron variant’s worst-case scenario plays out and there are increased hospitalizations, we should not go back to the ICU visitor norms of 2020.

We have a higher vaccination rate now. We know that covid is mainly spread through air and not through touch. The use of masks and good ventilation can significantly reduce transmission risk. We know that being deprived of visitors causes direct harm to ICU patients. It is imperative now to enable the presence of loved ones at the bedside. To institute such changes, ICU staff will need support in determining visitor policies based on their own contexts. They may have varied limits on the number of visitors allowed and specific covid infection-control protocols deemed suitable.

Covid has changed our world in radical ways. We need to be equally radical in reclaiming compassion as a core value of patient care. There are practical ways to balance the needs of patients and families with the responsibility of ensuring their safety. Families and loved ones are not really ‘visitors’, but valuable partners in patient care. The presence of loved ones at a patient’s bedside would help empower family members to participate effectively in patient care—and in making healthcare safer and more humane overall.

Sonali Vaid is a physician, public health professional and founder of Incluve Labs

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Published: 14 Dec 2021, 10:28 PM IST
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