Efficacy and safety of unrestricted visiting policy for critically ill patients: a meta-analysis

Abstract

Aim To compare the safety and effects of unrestricted visiting policies (UVPs) and restricted visiting policies (RVPs) in intensive care units (ICUs) with respect to outcomes related to delirium, infection, and mortality. Methods MEDLINE, Cochrane Library, Embase, Web of Science, CINAHL, CBMdisc, CNKI, Wanfang, and VIP database records generated from their inception to 22 January 2022 were searched. Randomized controlled trials and quasi-experimental studies were included. The main outcomes investigated were delirium, ICU-acquired infection, ICU mortality, and length of ICU stay. Two reviewers independently screened studies, extracted data, and assessed risks of bias. Random‑effects and fixed-effects meta‑analyses were conducted to obtain pooled estimates, due to heterogeneity. Meta-analyses were performed using RevMan 5.3 software. The results were analyzed using odds ratios (ORs), 95% confidence intervals (CIs), and standardized mean differences (SMDs). Results Eleven studies including a total of 3741 patients that compared UVPs and RVPs in ICUs were included in the analyses. Random effects modeling indicated that UVPs were associated with a reduced incidence of delirium (OR = 0.4, 95% CI 0.25–0.63, I2 = 71%, p = 0.0005). Fixed-effects modeling indicated that UVPs did not increase the incidences of ICU-acquired infections, including ventilator-associated pneumonia (OR = 0.96, 95% CI 0.71–1.30, I2 = 0%, p = 0.49), catheter-associated urinary tract infection (OR 0.97, 95% CI 0.52–1.80, I2 = 0%, p = 0.55), and catheter-related blood stream infection (OR = 1.15, 95% CI 0.72–1.84, I2 = 0%, p = 0.66), or ICU mortality (OR = 1.03, 95% CI 0.83–1.28, I2 = 49%, p = 0.12). Forest plotting indicated that UVPs could reduce the lengths of ICU stays (SMD = − 0.97, 95% CI − 1.61 to 0.32, p = 0.003). Conclusion The current meta-analysis indicates that adopting a UVP may significantly reduce the incidence of delirium in ICU patients, without increasing the risks of ICU-acquired infection or mortality. Further large-scale, multicenter studies are needed to confirm these indications.

Clinician perceptions of the impact of ICU family visiting restrictions during the COVID-19 pandemic: an international investigation

“…The importance of family input into the provision of ICU care is not new (20,21). Prior to the pandemic, research focused on the type of visitation arrangements ( exible vs xed) and demonstrated the impact on rates of delirium and ICU acquired infections (22). The present ndings extend this previous knowledge by delineating the impact that family visitation has on the entire ICU system, including care delivery and staff wellbeing.…”

Clinician perceptions of the impact of ICU family visiting restrictions during the COVID-19 pandemic: an international investigation

“…The importance of family input into the provision of ICU care is not new [ 21 , 22 ]. Prior to the pandemic, research focused on the type of visitation arrangements ( flexible vs fixed ) and demonstrated the impact on rates of delirium and ICU acquired infections [ 23 ]. The present findings extend this previous knowledge by delineating the impact that family visitation has on the entire ICU system, including care delivery and clinician well-being.…”

Delirium prevention and management in hospitalized older adults

“…Family, friends, and hospital volunteers can provide assistance with certain activities, such as reorientation, range-of-motion exercises, and oral fl uid encouragement; the feasibility and effectiveness of using volunteers for such a role has been well established. 20,24,25 During the COVID-19 pandemic, hospital visitation policies became increasingly restrictive, even to the point where loved ones were prevented from visiting patients who were actively dying. As we transition from a "pandemic approach" to a more "endemic approach" to COVID-19, hospitals are faced with liberalizing restrictive hospital visitation policies.…”

“…Th e NP must ensure that physical restraints are ordered according to institutional policy. Since physical restraints do not [18][19][20]24,25,31 • Identify patients at high risk for delirium (that is, those with multiple predisposing factors), and implement prevention strategies early. *3,34 Haloperidol (Haldol)…”

“…Nurses and unlicensed assistive personnel are hard-pressed to find lengthy blocks of time during their shifts to dedicate to these activities, despite their importance. Family, friends, and hospital volunteers can provide assistance with certain activities, such as reorientation, range-of-motion exercises, and oral fluid encouragement; the feasibility and effectiveness of using volunteers for such a role has been well established 20,24,25…”