Why Some Hospitals Are Banning Flowers and Balloons

Why Some Hospitals Are Banning Flowers and Balloons (Credit MSN.com)

Flowers, balloons and other traditional get-well gifts are no longer welcome in many hospitals that are increasingly focused on reducing the risk of infection and allergic reactions.
The next time you plan to bring a gift to a friend in the hospital, check the visitor policy first.

Some health-care facilities are tightening restrictions on where flowers, plants, balloons and other cheery items are allowed, citing concerns about the potential for infection, among other risks.

Most intensive-care units have been no-flower zones for decades. Many hospitals now have banned latex balloons out of concern for latex allergies. Now, some are extending limitations to ICU step-down units, cardiac-care units, pediatrics, labor and delivery units.

“Every place has its quirks. It varies with each hospital, each unit, sometimes each patient,” says Jeff Gaster, owner of CitiFloral, which has delivered flowers and other items to the cluster of hospitals along “bedpan alley” on Manhattan’s Upper East Side for 30 years.

Yet evidence linking flowers and plants to outbreaks of infection or illness in individual patients is minimal, infectious-disease experts say.

“This is one of the issues where there’s a paucity of evidence, and when that happens in infection control, one of our goals is always to keep the patient safe,” says Susan Dolan, president of the Association for Professionals in Infection Control and Epidemiology, which represents more than 15,000 clinicians working to fight healthcare-associated infections. “It’s not cut-and-dried, if you’ll pardon the pun, which is why you see a spectrum of what hospitals will and won’t allow.”

New York University Langone Medical Center bans all balloons. New York Presbyterian Hospital bars not only latex but also Mylar balloons as well as fresh, dried and artificial flowers from nurseries, labor and delivery areas and rooms for transplant and cancer patients. A spokeswoman says the policy is based on the Centers for Disease Control and Prevention recommendations for protecting immunosuppressive patients.

Yet across the street at Memorial Sloan Kettering Cancer Center, volunteers with the Fresh Flower Program place seasonal blooms at the bedsides of all new in-patients and throughout the hospital, and the program offers interested patients weekly flower-arranging classes. A spokeswoman says flowers are banned in the hospital’s ICUs, operating rooms and transplant units.

Hospitals have been working intently to reduce their rates of healthcare-associated infections, which can affect a hospital’s quality ratings and Medicare reimbursements. On any given day, about one in 25 hospital patients has at least one such infection, according to the CDC.

Ms. Dolan says hospitals do their own risk assessments and develop policies based on their patient populations. Major medical centers that perform transplants may be more wary of flowers than small community hospitals, she notes. Some psychiatric facilities see glass vases and balloon strings as tools patients could use to harm themselves.

“Even if the patient isn’t allergic, the pollen could get on a health-care worker’s clothes and be carried into the next room, where the next patient might have allergies,” says Ms. Dolan, who is also the hospital epidemiologist at Children’s Hospital Colorado, in Aurora. Flowers and plants can get in the way when patients need treatment suddenly, she says; water spills can damage equipment and create a slip-and-fall hazard.

Still, those risks are mostly circumstantial. According to the CDC’s 2003 Guidelines for Infection Control in Healthcare Facilities, clinicians in a 1974 case suspected that a plant pathogen called Erwinia, identified in a newborn who died from septicemia, had come from plants in the delivery room, but no direct link was established. Later studies found a high concentration of potentially harmful bacteria in vase water in hospitals, although in no greater amounts than found in flower vases in some homes.

The CDC suggests that fresh and dried flowers and ornamental plants be kept away from patients with compromised immune systems, because they can be a reservoir for a form of mold called Aspergillus. And while it says flowers and plants pose little danger to healthier patients, it recommends they be maintained by hospital staffers who aren’t directly involved with patient care.

One randomized clinical trial found that flowers can be useful in healthcare settings: After abdominal surgery, patients assigned to rooms with flowering plants on average used less pain medication, had lower blood pressure and expressed higher satisfaction than patients in rooms without plants, according to a 2008 study of 90 patients in HortTechnology, one of the journals of the American Society for Horticultural Science.

Many health concerns about balloons, including the risk of children choking, are exaggerated, according to the Balloon Council, a U.S. trade group formed in 1990

Latex balloons aren’t to blame for the sharp rise in latex allergies in recent years, the Balloon Council says. Allergic reactions, ranging from skin irritations to life-threatening anaphylaxis, are about twice as common in surgical patients and health-care workers as in the general population, the CDC says. Experts blame prolonged contact with latex-coated equipment, not brief encounters with balloons.

Even so, the Balloon Council and many retailers say they support hospitals’ bans on latex products and instead offer balloons made of Mylar, a synthetic material that comes in different colors.

Maxine Simon, chief regulatory officer, NYU Langone Medical Center, says balloons aren’t allowed in patient care areas “because the strings can get tangled in equipment, such as IV poles, or create a barrier between the patient and the clinical team.” She says administrators will re-evaluate the policy when the hospital’s new building, with all private rooms, opens.

Food can be a problem, too, if patients (or roommates) have food allergies or dietary restrictions. Children’s hospitals, in particular, often don’t allow food gifts without prior approval by a nursing supervisor. Stuffed animals can be treacherous if they have eyes, noses, buttons or beads that very young patients could pull off and swallow.

“Cards are nice. Books are nice—but remember, pretty much any surface could be a source of bacteria,” says Ms. Dolan. “It’s important to check with the nursing staff before you bring anything in, and remember to wash your hands when you go in and go out of the room.”

Hospital policies on visitors’ cellphone use are equally varied. With fears about electromagnetic waves interfering with medical equipment proven largely unfounded, many hospitals have lifted blanket bans on cellphone use. Some still post signs telling visitors not to bring them into ICUs and other high-tech areas.

The nonprofit ECRI Institute, which studies healthcare technology (and used to be called the Emergency Care Research Institute), says that while the risk that cellphones will endanger medical equipment is “extremely low,” it recommends that they be kept at least 3 feet away from patient monitors.

Many hospitals are more concerned about cellphones and electronic devices as sources of unnecessary noise in an already-noisy environment, as a tripping hazard when recharging, a drain on WiFi systems, a distraction for medical staff and yet another vector for infection. A 2012 study from the University of Arizona found cellphones can carry 10 times as much bacteria as most toilet seats.

Still, enforcing cellphone restrictions is difficult, says Paul Anderson, director of risk-management publications at ECRI. “I think hospitals have come to terms with the fact that they’re not going to stop visitors and patients from bringing these devices into the building, short of frisking them. You have to pick your battles.”

Write to Melinda Beck at HealthJournal@wsj.com