Every day there are thousands of children entering the offices and clinics of community pediatric practices. What occurs in our pediatric practices can affect the entire community. Therefore, the ambulatory setting is the first line of defense to control the spread of infections in children.
During the COVID-19 global pandemic, many pediatric practices adjusted their operations to reduce the spread of the SARS- CoV-2 virus. However, standard infection prevention and control precautions are essential every day with every patient, not only during an outbreak.
For offices that are not associated with a tertiary center or hospital, the available resources for infection prevention and control (IPC) may be limited. This page provides information to improve infection prevention and control in the ambulatory setting by highlighting the infection risks, educating on transmission, and equipping practices with specific strategies to prevent the spread of infection.
Importance of Infection Prevention and Control
- Healthcare-associated infections result in over 1.7 million infections each year.
- Poor use of Standard Precautions (ie, hand hygiene and injection safety) has resulted in outbreaks of skin and soft tissue infections following immunization.1
- Children with a recent well-child visit have up to a 20% increased risk of developing a respiratory infection compared to those without a recent visit.
- Bacterial and viral contamination of seats, tables, and other objects is common in both well-child and sick-child waiting areas. Shared toys have an especially high risk of contamination with substantial levels of intestinal bacteria detected on 20% of soft toys.
- Up to 90% of the non-immune people who come into close contact with a measles or varicella case will become infected.
- While “respiratory hygiene”—covering a cough, disposing of used tissues, and cleaning hands—is integral to standard precautions to prevent respiratory illnesses, it should not be relied upon as the sole measure.
- Since a medical facility is a public place, infection prevention and control practices are essential to maintain the health of all
- Pediatric offices need to have infection prevention and control policies that align with local and state regulatory requirements, are evidence -based practice, and are well understood by all staff.
Pediatric Specific Challenges
- Vulnerable newborns have frequent visits to the office.
- Multiple members of a family often accompany the patient when visiting the outpatient medical office.
- Difficulty sorting “well” and “sick” patients; children coming for a “well” visit who are symptomatic, and children coming for a “sick” visit could have a non-contagious illness.
- Bodily secretions are easily spread through handling of diapers, drool, and spit up unless IPC strategies implemented and adhered to.
- Children may be unable to control secretions due to age or medical condition.
- Developmentally normal behaviors and typical social interactions mean children will play with each other and share play objects (toys, books, crayons) in the waiting area, which can contribute to transmission.
- Communication between medical professionals and school or daycare about symptoms or exposures is often limited.
Clinical Syndromes and Modes of Transmission
|
Body Site Reservoir |
Clinical Syndrome |
Examples |
Mode of Transmission |
Pathways |
|
Gastrointestinal |
Nausea, vomiting diarrhea |
Norovirus, Camplylobacter spp. |
Contact |
Touch |
|
Respiratory |
Cough |
RSV, Influenza, Adenovirus, COVID-19 |
Droplets Contact |
Inhalation, Touch |
|
Respiratory |
Coryza, cough |
Pertussis |
Droplets |
Inhalation |
|
Respiratory |
Coryza, fever, and rash |
Measles, Varicella |
Airborne Contact |
Inhalation, Touch |
|
Skin |
Wound infection |
Staphyloccous aureus, Group A Streptococcus |
Contact |
Touch |
|
Blood |
Frequently asymptomatic |
HIV, Hepatitis B |
Contact with body fluids |
Bypassing the body's defenses |
Personal Protective Equipment (PPE)
| Standard Precautions | PPE |
| Blood or body fluids | Gloves |
| Handling draining wound | Gloves, gown |
| Irrigating a wound | Gloves, gown, mask, eye protection |
| Transmission-based Precautions | PPE |
| Contact | Gloves, gown |
| Droplet | Surgical mask, eye protection |
| Airborne | Fitted NIOSH approved N95 or respirator, eye protection |
Infection Prevention and Control Strategies
There are 2 forms of recommended precautions to prevent the spread of infections in healthcare settings: Standard Precautions and Transmission-Based Precautions.
|
Standard Precautions: Routine actions taken with all patients |
Transmission Based Precautions: Additional strategies to use based on symptoms or exposure |
|
| Before the visit | ||
|
Triage at time of scheduling |
|
|
| During the visit | ||
|
Arrival |
|
|
|
Waiting Room |
|
|
|
Examination |
|
|
| After the visit | ||
|
Environmental Cleaning |
|
|
Additional Infection Prevention and Control Strategies
| STAFF | FAMILIES | COMMUNITY |
|
PPE
|
|
Health department
|
|
Sick policies
|
Provide instructions to families about when to return to school and/or daycare. Some states have regulatory or guidance practices. |
Schools
|
|
Vaccination of staff
|
Keep family up-to-date with vaccinations |
Support public vaccination campaigns |
Additional Resources
Project Firstline offers shareable infection prevention and control resources for healthcare facilities and providers. Use the posters, infographics, lock screens, and more to help keep everyone at your facility feeling confident about their infection prevention and control decisions.
AAP Policy Statement: Infection Prevention and Control in Pediatric Ambulatory Settings (AAP)
Reference
1. Blau ER, Flinchum A, Gaub KL, et al. Mycobacterium porcinum Skin and Soft Tissue Infections After Vaccinations – Indiana, Kentucky, and Ohio, September 2018-February 2019. MMWR Morb Mortal Wkly Rep. 2021 Oct 22;70(2):1472-1477. DOI: http://dx.doi.org/10.15585/mmwr.mm7042a3
