AAP Updates Guidance on Infection Control in Pediatric Clinics

Troy Brown, RN

October 23, 2017

An updated policy statement from the American Academy of Pediatrics (AAP) on infection prevention and control (IPC) in pediatric ambulatory settings could change the way clinics approach toys and triage patients. AAP continues to recommend mandatory immunizations for all staff.

"Cross contamination could occur from toys, books, and computers, among other fomites in the waiting room or in the clinic examination rooms. It is therefore recommended that practices have policies in place addressing the method and frequency of cleaning toys," the authors write. "Furry and plush toys such as stuffed animals are difficult to clean and can harbor germs and should generally be avoided in clinic waiting areas and game rooms. Parents can also be encouraged to bring their child's own toy for the office visit."

Mobeen H. Rathore, MD, from the University of Florida Center for HIV/AIDS Research, Education and Service and Infectious Diseases and Immunology, Wolfson Children's Hospital, Jacksonville, Florida, and Mary Anne Jackson, MD, from the Division of Infectious Diseases, Department of Pediatrics, University of Missouri–Kansas City School of Medicine and Children's Mercy Kansas City, Missouri, present the policy statement in the November issue of Pediatrics on behalf of the AAP's Committee on Infectious Diseases. The committee opinion replaces the policy statement published in 2007.

"Major changes include the endorsement of mandatory influenza immunization for [healthcare providers] HCP, the inclusion of a section on patients with cystic fibrosis, guidance during outbreaks of infectious diseases, communication with other health care facilities, considerations for short-term residential facilities, and an update on the immunization of HCP," the authors explain.

The policy statement also provides detailed information about standard precautions, hand hygiene, respiratory hygiene and cough etiquette, management of potential occupational exposure to bloodborne pathogens, and work restriction policies for employees, as well details on sterilization, disinfection, and antisepsis.

"Because most patient encounters are in ambulatory settings, prevention of the transmission of infection in ambulatory settings is important," the authors write. "In addition to the risk of health care–associated infection during medical evaluation and treatment, the reception and waiting areas of ambulatory facilities present opportunities for the transmission of infectious agents among patients, accompanying people, and staff."

Ambulatory care facilities should have written policies and procedures on IPC available to staff at all times, and employees should review them at least every 2 years. Staff should receive educational programs on IPC regularly and should review IPC policies at the time of employment.

"Most disease outbreaks reported in ambulatory medical facilities were associated with nonadherence to recommended IPC procedures," the authors add.

Yearly influenza vaccination should be required for staff; staff should receive immunization or provide documentation of immunity against other vaccine-preventable infections with the potential for transmission in an ambulatory care setting.

Healthcare providers should perform hand hygiene before and after contact with patients or their immediate environment and use standard precautions in every patient interaction to prevent the spread of infections and "to limit the emergence and spread of antimicrobial-resistant bacteria," the authors write. Contaminated hands are the most common mode of transmission of infectious agents, they note.

Patients and accompanying people should use respiratory hygiene and cough etiquette. This is especially true for those with suspected respiratory infection. Triage immunocompromised children and those with potentially contagious diseases promptly. Minimize contact between contagious children and uninfected children.

The document includes guidelines for skin antisepsis before immunization and routine venipuncture, as well as handling of needles and sharps.

Ambulatory care offices should have policies and procedures for communication with local and state health officials about reportable diseases and suspected outbreaks and for communication with other healthcare facilities when referring patients who could be contagious.

The authors have disclosed no relevant financial relationships.

Pediatrics. 2017;140:e20172857. Full text

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