New Guidance on Pediatric Infection Prevention and Control in Ambulatory Settings Issued by AAP

By on 9:14 AM

The American Academy of Pediatrics (AAP) has issued new guidance providing recommendations for infection prevention and control in pediatric ambulatory settings.

The new policy statement, published in Pediatrics, is AAP's first update on these issues since 2007.

AAP makes the following recommendations:
  • Written policies and procedures concerning infection prevention and control should be developed, incorporated into the ambulatory practice safety program, available at all times to office staff and reviewed at least every two years.
  • Educational programs for staff concerning infection prevention and control should be implemented, reinforced and evaluated on a regular basis. All staff should be required to review the policies at the time of employment.
  • 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) that can be transmitted in an ambulatory care setting.
  • All healthcare personnel should perform hand hygiene using an alcohol-based hand rub or hand washing with soap and water before and after patient contact or contact with the patient’s immediate environment.
  • Standard Precautions should be used in every interaction with a patient.
  • In waiting rooms of ambulatory care facilities, the use of respiratory hygiene and cough etiquette should be encouraged for patients and accompanying people, especially those with suspected respiratory infection,
  • Patients with potentially contagious diseases and immunocompromised children should be promptly triaged. Contact between contagious children and uninfected children should be minimized. Policies to deal with children who present with highly contagious infections (such as varicella, measles, pertussis, influenza, mumps and TB) should be devised and implemented; travel, immunization and exposure history is key to identify patients who may be at increased risk for such infections.
  • Alcohol is preferred for skin antisepsis before immunization and routine venipuncture. Skin preparation for incision, suture and collection of blood for culture requires either 2% CHG in 70% isopropyl alcohol–based solutions (for children older than 2 months) or iodine (1% or 2% tincture of iodine, 2% povidone-iodine). Most skin preparation agents must be allowed to dry before surface bacteria are killed.
  • Physicians should be aware of requirements of government agencies, such as OSHA, as they relate to the operation of ambulatory facilities.
  • Needles and sharps should be handled with great care. Safer needle-disposal units that are impermeable and puncture-proof should be available next to the areas used for injection or venipuncture. The containers should be used only until filled to three quarters of capacity and should be kept out of reach of young children. Procedures should be established for the removal and incineration or sterilization of contents. Needle devices with safety features should be evaluated periodically with input from staff members who use needles, and the use of devices that are likely to improve safety should be implemented.
  • A written bloodborne pathogens exposure control plan that includes written policies for the management of contaminated sharp object injuries should be developed, readily available to all staff and reviewed annually.
  • Standard guidelines for sterilization, disinfection and antisepsis should be followed.
  • Policies and procedures should be developed for communication with local and state health authorities regarding reportable diseases and suspected outbreaks.
  • A policy for communicating with other  healthcare facilities when referring potentially contagious patients should be established.
  • 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).
  • Antimicrobial agents should be used appropriately, and Standard Precautions should be observed to limit the emergence and spread of antimicrobial-resistant bacteria.

The policy statement was developed by AAP's Committee on Infectious Diseases. Access it here.

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Phenelle Segal, RN, CIC, FAPIC

Phenelle Segal, RN, CIC, FAPIC, is the founder and president of Infection Control Consulting Services LLC (ICCS). Phenelle has more than 30 years' experience providing customized comprehensive infection control and prevention services to healthcare facilities nationwide. Her services focus on assisting hospitals, ambulatory surgery centers, dental office and oral surgery practices, doctor's offices, nursing homes and other organizations with implementing and maintaining an infection control program that: complies with The Joint Commission, AAAHC, Centers for Medicaid and Medicare Services (CMS) and other regulatory agencies; respond to situations of noncompliance; and improve the processes for reducing risk.