Is a spit guard or hood a restraint?

Any examples are for illustrative purposes only.

The Joint Commission and CMS do not call out specific products or devices as a restraint but rather defers to the manufacturer's instructions for use (MIFUs) to determine whether the product meets the definition of a physical restraint:  'Any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely.'

Generally, if a patient can easily remove a device, the device would not be considered a restraint.  In this context, "easily remove" means that the manual method, device, material, or equipment can be removed intentionally by the patient in the same manner as it was applied by the staff (e.g., side rails are put down, not climbed over; buckles are intentionally unbuckled; ties or knots are intentionally untied; etc.) considering the patient's physical condition and ability to accomplish objective (e.g., transfer to a chair, get to the bathroom in time).

An organization must make their own assessment of any product or device and be prepared to provide evidence on whether a specific device or product meets the definition of restraint.

Because this definition of physical restraint does not name each device and situation that can be used to immobilize or reduce the ability of the patient to move his or her arms, legs, body or head freely, it promotes looking at each patient's situation on a case-by-case basis.

It would be up to the organization to determine the appropriate use of spit guards or hoods in accordance with MIFU, organizational policy, and any applicable law or regulation.

In addition, if the patient is at risk of self-harm, any potential risk imposed by the use of these devices should be considered to determine what, if any, additional clinical mitigation should be implemented to protect the safety of the patient.