Isolation/Visitors

This subject has been the most controversial of all the issues with H1N1 in Obstetrics.  Hospitals are struggling to balance safety (with an unknown level of risk) with being "Family Friendly" for one of the most important occasions in one's life.  We will try to provide some balance but local factors will often determine what are essentially arbitrary rules.

Isolation

The concern is, of course, preventing infection of a newborn whose immune response is more limited, whose passive antibody protection is not yet strong and is a poor candidate for antivirals medications.  The CDC has most recently (11-10-09) recommended that the provider "consider temporarily separating the infected mother from the newborn within her room (in an isolette) or in separate rooms until the risk of infectious transmission is reduced, defined as having met ALL of the following criteria:

  • The mother has received antiviral medications for at least 48 hours and;
  • The mother is without fever for 24 hours without antipyretics and
  • The mother can control cough and respiratory secretions.

Others have taken a more "common sense" approach to isolation taking into consideration the degree of illness in the the mother and her ability to care for herself and her infant (see a well done CDC webinar with Dr Laura Riley representing ACOG).  Several Health Departments including San Francisco have taken a similar tact.  Certainly, extensive hand washing, gowns and masks are the minimum.

Visitor Policies

The focus is on ill children and adults potentially infecting hospitalized patients.  Obviously, once the new family goes home, there can be exposure to all sorts of family and friends.  However, the hospital is an environment where others (staff and other patients) are put at risk besides the mother to whom the visitors are attending.  Many hospitals have chosen a staged limitation based on the level of H1N1 activity in the community.  Most restrict any person with respiratory symptoms from visiting. Currently many have chosen to restrict all children under 16 from patient areas (though some hospitals allow a mother to come down to the lobby or cafeteria and visit their other children).  It is important to announce that this is a temporary change in policy for the duration of this pandemic so as not to negate years of cultivating a family friendly unit.