AFL 20-38.5 From the California Department of Public Health
October 23, 2020
TO: All Facilities
SUBJECT: Visitor Limitations Guidance (This AFL supersedes AFL 20-38.4)
All Facilities Letter (AFL) Summary
- AFL 20-38.5 updates the California Department of Public Health’s (CDPH’s) visitation guidance, permitting facilities with medium or low Coronavirus Disease 2019 (COVID-19) county positivity rate to allow one visitor per patient at a time.
- This AFL also provides visitor guidelines for certain individuals, regardless of the COVID-19 county positivity rate:
- Pediatric patients
- Patients in labor and delivery
- Neonatal intensive care unit (NICU) patients
- Pediatric intensive care unit (PICU) patients
- Patients at end-of-life
- Patients with physical, intellectual, and/or developmental disabilities and patients with cognitive impairments
- Students obtaining clinical experience
- Long-term care (LTC) facilities should refer to AFL 20-22.5 for updated LTC visitation guidance.
Due to the community spread of COVID-19, considerations must be made for the safety of health facility staff and patients, resulting in many health care facilities suspending visitation, except when medically necessary or essential to the care of the patient. CDPH recognizes the importance that visitors play in the mental well-being of patients. For purposes of this AFL, the terms “visitor” and “support person” are used interchangeably, as are “patient” and “resident.”
Visitors play an important role in supporting the well-being and recovery of patients; however, this must be balanced with a goal of preventing transmission of COVID-19 in the hospital setting, and hospitals must be prepared to adjust their visitor guidelines, as appropriate, for infection control. Health facilities located in counties with substantial or lower risk levels of community transmission (as per CDPH’s Blueprint for a Safer Economy website, any county not in the purple tier), should permit any patient to have one visitor present at a time.
The visitor does not have to be a single person designated in advance by the patient; however, each visitor is subject to screening for fever and COVID-19 symptoms and must wear a face covering upon entry and at all times within the facility, and other personal protective equipment (PPE) as appropriate while in the patient’s room. Facilities should also limit visitor movement in the facility. For example, visitors should not walk around in hallways of the facility and must go directly to and from the patient’s room.
In addition, CDPH has developed visitor guidelines for specific patient groups to ensure support for their mental health and well-being, while striving to limit the spread of the virus. The following visitation guidelines continue to be recommended by CDPH for specific populations regardless of the county positivity rate.
- Visitors are essential for the mental health of pediatric patients. CDPH recommends that pediatric patients be allowed one support person.
- In the case of prolonged hospitalization, the facility should permit two designated support persons for pediatric patients, provided that only one visitor is present at a time.
- For NICU and PICU patients, the facility should permit two designated support persons that may visit at the same time.
Labor and Delivery Patients
- The presence of a partner or support person is essential to the mental health of patients who are in labor and delivery. CDPH recommends that one support person be allowed to be present with the patient. In addition to the support person, CDPH recommends that a doula, if desired by the patient, be permitted to be present if prior arrangements have been made with the hospital and the doula complies with hospital PPE and infection control guidelines.
Patients at End-of-Life
- Visitors are essential to the mental health of patients who are at end-of-life. For their continued mental health, and well-being, CDPH recommends that one visitor be allowed to be present with the patient; a single visitor does not need to be designated, provided that only one visitor is present at a time.
Patients with Physical, Intellectual, and/or Developmental Disabilities and Patients with Cognitive Impairments
- The presence of a support person is essential to patients with physical, intellectual, and/or developmental disabilities and patients with cognitive impairments. CDPH recommends that one support person be allowed to be present with the patient.
- For patients, especially with prolonged hospitalization, the patient or family/patient representative may designate two support people, but only one support person may be present at a time.
Students Obtaining Clinical Experience
- CDPH supports efforts to ensure that new nurses and other professionals coming into the healthcare workforce are able to obtain necessary clinical experience. CDPH encourages students obtaining their clinical experience be permitted to enter the facility if they meet the CDC guidelines for healthcare workers to maintain the workforce needed during this pandemic.
All visitors and support persons must stay in the patient’s room. Visitors and support persons should be screened by the facility upon entry for fever and COVID-19 symptoms, and be asymptomatic for COVID-19 and not be a suspected or recently confirmed case. Visitors and support persons must wear a face covering upon entry and at all times within the facility, and must comply with any health facility instructions on PPE while in the patient’s room.
Additionally, CDPH strongly encourages facilities, including but not limited to skilled nursing facilities, to create ways for residents and patients to have frequent video and phone call visits. If shared devices are used for video calls facilities should ensure appropriate infection control measures are in place. For additional visitation guidance applicable to skilled nursing facilities, please see AFL 20-22.5.
If you have any questions about this AFL, please contact your local district office.
Original signed by Heidi W. Steinecker
Heidi W. Steinecker