title: Open intensive care units: a global challenge for patients, relatives, and critical care teams.
abstract: OBJECTIVE
  The aims of this study were to describe the current status of intensive care unit (ICU) visiting hours policies internationally and to explore the influence of ICUs' open visiting policies on patients', visitors', and staff perceptions, as well as on patients' outcomes.
  
  
  METHODS
  A review of the literature was done through MEDLINE, EMBASE, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. The following keywords were searched: "visiting," "hours," "ICU," "policy," and "intensive care unit." Inclusion criteria for the review were original research paper, adult ICU, articles published in the last 10 years, English or Italian language, and available abstract.
  
  
  RESULTS
  Twenty-nine original articles, mainly descriptive studies, were selected and retrieved. In international literature, there is a wide variability about open visiting policies in ICUs. The highest percentage of open ICUs is reported in Sweden (70%), whereas in Italy there is the lowest rate (1%). Visiting hours policies and number of allowed relatives are variable, from limits of short precise segments to 24 hours and usually 2 visitors. Open ICUs policy/guidelines acknowledge concerns with visitor hand washing to prevent the risk of infection transmission to patients. Patients, visitors, and staff seem to be inclined to support open ICU programs, although physicians are more inclined to the enhancement of visiting hours than nurses.
  
  
  CONCLUSIONS
  The percentages of open ICUs are very different among countries. It can be due to local factors, cultural differences, and lack of legislation or hospital policy. There is a need for more studies about the impact of open ICUs programs on patients' mortality, length of stay, infections' risk, and the mental health of patients and their relatives.
authors.affiliation: Elena Cappellini, RN, is a staff nurse at the Emergency Department, Ospedale Nuovo San Giovanni di Dio, Florence, Italy. Stefano Bambi, MSN, RN, is a PhD student in nursing science at the University of Florence; Emergency Intensive Care Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy. He is a staff nurse in the Emergency and Trauma Intensive Care Unit, with a 24 hours a day open visiting policy. He was formerly a lecturer in emergency and critical care nursing at University of Florence (Italy). Alberto Lucchini, RN, is nurse coordinator at the General Intensive Care Unit, Ospedale San Gerardo, Monza, Italy. He is a lecturer in critical care nursing at University of Bicocca, Milan (Italy). Erika Milanesio, MSN, RN, is a lecturer of bachelor science in nursing at the University of Turin, Turin, Italy. She was formerly a staff nurse in Intensive Care Unit.
authors.forename: Elena
authors.initials: E
authors.lastname: Cappellini
authors.forename: Stefano
authors.initials: S
authors.lastname: Bambi
authors.forename: Alberto
authors.initials: A
authors.lastname: Lucchini
authors.forename: Erika
authors.initials: E
authors.lastname: Milanesio
mesh_terms: D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D038622:Internationality; D016134:Organizational Policy; D014789:Visitors to Patients