Infection prevention in ambulatory settings: A policy statement from the AAP

The American Academy of Pediatrics (AAP) has released a policy statement on infection prevention and control in pediatric ambulatory settings, as published in Pediatrics.

The guideline, which was developed by the Committee on Infectious Diseases, is the AAP’s first update on the topic since 2007. Major changes include the endorsement of mandatory influenza immunization for healthcare personnel, the inclusion of a section on patients with cystic fibrosis, guidance during outbreaks of infectious diseases, communication with other healthcare facilities, considerations for short-term residential facilities, and an update on the immunization of healthcare personnel.

The updated recommendations are as follows:

1. Written policies and procedures concerning infection prevention and control should be developed and incorporated into the ambulatory practice safety program, as well as available at all times to office staff every 2 years.
2. Educational programs for staff should be implemented, reinforced, and evaluated on a regular basis.
3. Annual influenza immunization should be mandatory for staff as well as immunization or documentation of immunity against other vaccine-preventable infections, including pertussis, measles, mumps, rubella, varicella, and hepatitis B.
4. All healthcare personnel should practice hand hygiene using an alcohol-based hand rub or hand washing with soap and water before and after patient contact.
5. Standard Precautions (see original article, Table 1) should be used in every interaction with a patient.
6. In waiting rooms of ambulatory care facilities, healthcare personnel should practice cough etiquette, especially around those with suspected respiratory infection.
7. Patients with potentially contagious diseases and immunocompromised children should be promptly triaged, with a focus on minimizing contact between contagious and uninfected children. All healthcare facilities should have policies to deal with children who present with highly contagious infections such as varicella, measles, pertussis, influenza, mumps, and tuberculosis. 
8. Alcohol is preferred for skin antisepsis before immunization and routine venipuncture. Skin preparation for any incision requires either 2% chlorhexidine gluconate in 70% isopropyl alcohol–based solutions (for children older than 2 months) or iodine (1% or 2% tincture of iodine, 2% povidone-iodine).
9. Clinicians should be aware of requirements agencies such as OSHA, as they operate ambulatory facilities.  
10. Safe needle-disposal units that are impermeable and puncture-proof should be available next to the areas used for injection or venipuncture. Containers should be used only until filled to three quarters of capacity and should be kept out of reach of young children.
11. A blood-borne pathogens exposure control plan should be developed and readily available to all staff. The plan should include written policies for the management of contaminated sharp object injuries.
12. Standard guidelines for sterilization, disinfection, and antisepsis should be followed.
13. Policies and procedures should be developed for communication with local and state health authorities regarding disease outbreaks.
14. A policy for communicating with other health care facilities when referring potentially contagious patients should be established.
15. Policies should be established for communicating with patients and families in case of infectious disease outbreaks, emergencies, and seasonal increases of infections such as influenza or respiratory syncytial virus.
16. Antimicrobial agents should be used appropriately, and Standard Precautions should be observed to limit the emergence and spread of antimicrobial-resistant bacteria.

Reference

Ratjore MH, Jackson MA, American Academy of Pediatrics Committee on Infectious Diseases. Infection prevention and control in pediatric ambulatory settings. Pediatrics. Oct 2017. DOI: 10.1542/peds.2017-2857