His first tip? “Consider [movement outside the room] only for patients who are contact precautions and not the patients on other types of isolation precautions, like airborne and droplet. You might consider limiting it only to patients who are colonized with organisms that you’re interested in having precautions [for] and not with patients who have active infections,” said Dr, Sandora. He shared that at Boston’s Children Hospital, they have a few organisms, such as “selective multidrug-resistant organisms” with “lower stakes,” like methicillin-resistant Staphylococcus aureus
(MRSA) and vancomycin-resistant Enterococci (VRE), for which they’ll “create a way for patients to be outside of the room.”
“If you’re going to do this,” he suggested, “I would encourage you to develop a set of factors that you might consider in deciding for each individual patient concerning whether or not you’ll allow them to have some time outside of their room.” The factors to consider include: age of patient, continence, behavioral issues, and family willingness to follow instructions. He warned that at Boston’s Children Hospital, they typically do not allow children to be outside of the room if they have: active respiratory syncytial virus (RSV), viral gastroenteritis, or Clostridium difficile
“The next tip I would give you is to create a plan of how that time outside of the room is going to happen. Think about the destinations to which you’ll allow the patient and family to go, the route to get there, and the timing of when those visits could happen, how long you’ll let them be outside the room, and whether or not you want staff to accompany them,” Dr. Sandora continued. He suggested to allow these patients to take advantage of outdoor locations, (for example: the Boston Children Hospital’s garden), or places that have less patients, which means less potential for contact with other patients who are not on precautions. For this reason, Dr. Sandora said that mindfulness of scheduling room exits at times when other patients will be less likely to be around is also a good strategy.
For patients and families who you feel may be less compliant with instructions, you may want to think about using staff members to accompany them during the time outside of the room. Staff may also arrange private playtime, which entails working “with your child life [specialists] to have them bring play materials inside the patient’s room, so that they can be sort of distracted and having fun in the room and not have that urge to exit,” Dr. Sandora said. He also suggested closing off the activity room for a period of time for private playtime under supervision and then thoroughly cleaning it before re-opening it to other patients.